Front-line health care workers’ jobs are stressful in the best of times. But during the pandemic, these professionals are experiencing stress, anxiety and burnout at exponentially higher levels.
As COVID-19 cases and hospitalizations rise, health care institutions such as UCHealth, Centura Health and Peak Vista Community Health Centers are working overtime to provide their employees with resources to help them cope.
Their efforts include counseling, distribution of information and on-the-job initiatives such as peer groups and “battle buddies.”
Health care leaders say that businesses in other industries could replicate some of these programs to help relieve employee stress and increase productivity.
UCHealth participated in a national survey by the American Medical Association that looked at how health care workers are coping with COVID and has also performed internal surveys.
“Everybody across the board — nonclinical staff, EMTs, nurses, physicians — has a pretty high degree of concern around exposing themselves or their families to COVID,” said Dr. Elizabeth Harry, senior director of clinical affairs at UCHealth University of Colorado Hospital in Aurora. “That is a stressor that is different and new. We also know that we’re seeing very high rates of burnout, ranging from 30-70 percent, depending on the department that you look at.”
Burnout existed before COVID, but it’s worse now.
“Emotional exhaustion is the biggest manifestation,” she said. “It’s the inability to hold so much pain and suffering.” Another indicator is depersonalization — “a coping mechanism to keep people from overidentifying with those that are suffering because they’re so exhausted.”
Anxiety and depression, rates of sleep disturbance and thoughts of suicide are up as well, along with feelings of isolation.
UCHealth drew upon the data to develop a well-being framework for employees.
A virtual behavioral health center is available 24 hours a day, and employees have access to a new faculty and staff mental health clinic, a COVID support hotline and a psychologist who works with support groups.
FRUSTRATION AND SADNESS
Part of the challenge for health care professionals is that, although treatments have improved and there has been a decrease in mortality since the pandemic took hold, “we still don’t have great treatments for patients,” said Dr. Robert Lam, a practicing emergency physician and director of physician wellness for the southern Colorado region of UCHealth. “The lethality of the disease has been a burden. There’s also the added stress of potentially bringing the virus back home to our own families.”
Communication with team members and patients is more difficult and frustrating with personal protective equipment as a barrier, he said.
Lam said he hasn’t seen much absenteeism but thinks that is because “we have this sense of calling and we try to push through to get things done.”
But that can add to the stress and sadness that health care professionals feel and push them to the breaking point. Lam notes that about 330 U.S. physicians a year die by suicide.
“The culture in medicine, I think, is that sometimes asking for help is looked at as a sign of weakness,” he said.
To call attention to the “silent epidemic” of physician suicide, Lam organized a team run in September in Monument Valley Park. The team’s goal was to log at least one mile for every physician lost annually to suicide; it logged more than 1,000 miles.
A relay race also was part of the suicide awareness campaign.
“We did that because we wanted to reinforce the concept that you have to have a battle buddy … who understands the challenges that you have in your work environments and can help bring you back from the edge,” he said.
Lam checks in frequently with his battle buddy; “that’s an incredible resource for me,” he said.
BEHAVIORAL HEALTH SUPPORT
Centura Health provides behavioral health support for both associates and their family members, and the providers who work for Centura, said Dr. Calvin Paries, Employee Assistance Program/Health and Wellness manager.
Centura strives to provide that support as quickly as possible before stress, anxiety or depression progress to more serious issues.
“When there’s a pandemic, there’s three big behavioral issues that we deal with as a society — suicide, substance abuse and domestic violence,” he said. “We’ve rolled out programs in which we train our folks in HR, our managers and our spiritual care team and occupational health team on what to do when they have an associate who has thoughts of harming themselves. We also have a specific training we’ve rolled out for domestic violence. We can help individuals out getting them to a safe location” and with any other needed assistance.
Managers and leaders also are trained to recognize signs of drug abuse, which can have consequences ranging from loss of licensure to loss of life.
Centura maintains an operations center in Colorado Springs with an 800 number associates can call to schedule an appointment with a licensed counselor. Associates and their family members get eight free visits to deal with issues ranging from stress to marital problems.
“We’ve been getting a lot of adolescents who are having trouble with all the changes going on,” Paries said. “Within the last month and a half, we’ve really seen an uptick of both high school and college students accessing our services.”
Centura also provides online support groups and weekly webinars for associates and their families, as well as peer support groups for physicians and other professionals.
TRAINING AND COUNSELING
Peak Vista Community Health Centers opened the Enrichment and Counseling Center in July at its North Academy Boulevard location to provide mental health services for both patients and employees. In addition, Peak Vista’s employee assistance program offers counseling and training.
“If you join our staff, on your very first day, we begin talking to employees about ensuring that they have some strategy for mitigating stress,” said Randy Hylton, director of training and development. “We go around the room and ask people specifically what their strategy is, and often that reveals that people may not have a strategy.”
Peak Vista also developed a new training for all employees this year — a 20-minute, small-group session on how to deal with heightened emotions such as fear and anger.
Hylton said participants learned three evidence-based coping mechanisms: practicing gratitude; maintaining supportive relationships rather than isolating; and serving others.
“We are really trying to educate our employees on the signs and symptoms associated with being stressed,” said Dr. Sherri Sharp, vice president of behavioral health. “We don’t want our folks to get to the point of burnout before they start tending to their own needs.
“We also help support each other through peer-to-peer checks — ‘Hey, Randy, are you doing OK today? How are things going?’ It could be really informal in that way, or it could be more formal — our internal website where we’re providing education, or some of our social media posts, where we’re not only educating our staff but also the community on systems and resources.”
Peak Vista’s executive team encourages employees to take time off when they need to take a break to tend to themselves or their families and shares factual information about the virus with employees to dispel misinformation.
Coping with the pandemic as individuals and as an organization has been a learning process.
“We are figuring it out as we go along, as many employers are,” Sharp said.
TAKEAWAYS FOR BUSINESSES
Flexibility and communication are important to help employees in any industry work successfully during this crisis, Sharp said.
She urges employers to “really stay in touch with your employees and check in about how they’re doing. ‘What do you need from us? How can we help you?’ And then be willing to follow through on that. Another thought is letting your employees know they’re valued, because they need to know that the work they’re doing matters.”
“Reach out and care for the people that you walk by in the hallway,” Hylton said. “Even the smallest acts of kindness to one another within an organization, right down to just saying good morning, have a good night — those small things mean so much to people.”
Business leaders need to model self-care for their employees, Paries said.
He suggests training peer coaches and managers to look for changes in behavior that can signal stress and burnout.
“It might be a very quiet individual that all of a sudden becomes active and aggressive,” he said, or the opposite.
Another signal is a “flat affect — you just finished talking to them about an issue and there’s no expression there,” Paries said.
Anger, irritability, mistakes, accidents, inability to pay attention and lack of focus, taking long breaks or more sick days, and defensiveness when confronted about issues also are signs that an employee is having difficulty.
Peer support is an underrated resource, Lam said.
“A trusted peer can do a lot to speak about a difficult work environment,” he said.
Business owners should acknowledge that employees face a degree of risk just by showing up.
“Being able to fulfill the needs of people in crisis is a great, tangible way to show you really care about your employees,” Lam said. “UCHealth has done a good job about helping with the needs of child care and people’s physical needs. If you have means to do that, it can be very powerful.”
Employers can find more resources on UCHealth’s website, uchealth.org, on the employer solutions page.
RESPECTING HEALTH WORKERS
Health care professionals wish that patients and community members would remember a few things to help them do their jobs better.
First and foremost, they wish everyone would follow public health guidelines about wearing masks and practicing social distancing.
“It makes me crazy how often I see people hanging out with a group of people with no masks,” Sharp said. “It’s making our job harder.”
Paries would like to see patients be more patient.
“Patients and families are quick to get angry toward health care workers,” he said.
“I tell clients, ‘Look at every person as if that person is your mother,’ and see how that changes how you treat them. In general, we need to treat people with more kindness and respect.”