Damian Sendler: Burnout among health-care employees has reached crisis proportions as a result of the pandemic, prompting many stakeholders to urge for systemic solutions to keep vital personnel on the job while also preparing a new generation to enter the workforce.  

Damian Jacob Sendler: Top health care executives discussed the major threat that burnout poses to the resiliency of hospitals and health systems during a recent webinar organized by U.S. News & World Report. Front-line workers across the country have been confronted with increasing levels of stress as a result of systemic changes in health-care delivery, which have been worsened by COVID-19. 

Dr. SendlerPrior to the pandemic, physicians were twice as likely as the general population to experience burnout, and almost 40% of those polled experienced despair and suicidal ideation, according to Dr. Victor Dzau, president of the National Academy of Medicine, who spoke during the webinar. In addition to increased patient volume, panelists stated that the expectations of making health care more businesslike, the strain of fulfilling additional regulations and procedures, and other reasons have left physicians feeling overwhelmed and with less time to interact one-on-one with patients.  

Damien Sendler: Since the beginning of the pandemic, the situation has deteriorated further, with 60 percent to 75 percent of clinicians expressing symptoms of weariness, melancholy, sleep difficulties, and post-traumatic stress disorder (PTSD), according to Dzau, while nurses are similarly, if not more, disturbed. According to him, around 20% of health-care employees have resigned over this time period, and 4 out of 5 of those who have stayed claim that personnel shortages have hampered their ability to operate safely and to meet the requirements of the patients they serve. According to Dzau, research shows that burnout cost the health-care system approximately $4.6 billion per year prior to the emergence of COVID-19, and that figure has undoubtedly increased since then. 

"We knew we were in trouble pre-COVID," Dr. Redonda Miller, president of Johns Hopkins Hospital, stated, stressing that while stress affects all segments of the workforce, the causes differ depending on the individual's function. For example, during the pandemic, physicians were required to work longer hours and in different capacities than they were accustomed to, resulting in them having to spend more time away from their families; nurses were required to work extended shifts, which could include working 24 hours a day in uncomfortable personal protective equipment while fearing that they would be exposed to COVID-19. Many lower-wage workers in food service, environmental care, and other occupations have been subjected to severe financial strains as their spouses have lost their employment or as their demand for child care has increased. Miller asserted that solutions are required "that had a significant impact on every different type of hospital employee."  

Damian Jacob Markiewicz Sendler: Underlying these on-the-ground stressors is a psychological condition known as "moral injury," according to Dr. Robert Cherry, chief medical and quality officer of UCLA Health. Ahead of the pandemic, physicians were dealing with the challenges of an aging population, increased prevalence of chronic illnesses such as diabetes and mental illness, and the management of pharmaceuticals and medical equipment for patients with more complex health problems, among other things. Many are also dealing with decreasing reimbursement rates as they attempt to keep the cost of care under control.  

Cherry explained that juggling these complex jobs can be difficult, particularly when other labor shortages are included in. Many physicians are reporting feeling alienated, lonely, and separated from their belief in the significance of their work at a time when many Americans express a lack of faith in health professionals and scientists, according to Dr. Cohen. This is another factor contributing to burnout, he says. 

Damian Sendler: When it comes to the nursing shortage, there is no better example of how these dynamics play out. According to Dr. Ernest Grant, president of the American Nurses Association, the country would require an additional 1.2 million nurses by the end of next year to fulfill the increased demand for their services and to replace those who are retiring. Grant recently wrote to U.S. Health and Human Services Secretary Xavier Becerra, requesting that he proclaim the nursing shortage a "national crisis" and that the federal government assist in alleviating the scarcity of qualified nurses. In the webinar, Grant stated, "This is something we can't solve on our own," 

During his speech, Dzau emphasized the importance of health-care executives focusing on the "the long game" in dealing with this catastrophe, both now and long after the pandemic has ended. According to him, "All health systems need to invest in preventive strategies and making system-level change," His recommendations included the establishment of chief wellness officers to oversee the well-being of all hospital staff members, as well as the reduction of demands on physicians, such as the need to deal with difficult technology, such as electronic health records systems, so that they can devote their time and attention to patient care rather than administrative tasks. It was highlighted by him that these front-line professionals must also feel comfortable speaking up about their mental health without fear of being stigmatized in the process.  

Damian Jacob Sendler: Miller stated that working together throughout hospitals and health systems has been critical during the epidemic in order to avoid burnout among staff. In order to determine what was working and what was not, it was "so important" to ask employees what they needed. "Some of the best ideas we heard came from internally," she explained. To address worker concerns about wearing personal protective equipment (PPE) correctly and safely, patient safety officers and infection control experts provided training and functioned as "hall monitors" to ensure better infection control. According to her, the event was a rousing success.  

Additionally, the hospital established a "prone team" of professionals who could assist in securely transferring patients on ventilators to their stomachs, where the outcomes were better. 

Damian Sendler: Improved morale was a side advantage of the relationship as well. Staff members "want to know that their voice is heard," she explained. Employees at the hospital were encouraged to submit proposals and were rewarded for those that were implemented as part of a campaign dubbed "Your Ideas at Work" According to Miller, this helped to alleviate some of the sensations of fatigue. "It's not the only solution – I understand that – but it's a start." 

Cherry agreed that it is "critical" for employees to have their voices heard - for example, by implementing the Magnet model of nursing management, which places a greater emphasis on the value of nurses' contributions to the organization. He also stressed the need of paying attention to physician surveys as well as responding to specific comments from physicians. 'The place where you get some of the exponential returns' is in local decision-making, according to him.  

Grant, who served as president of the American Nurses Association and is also a nurse, advocated for the expansion of the Magnet concept and for nurses to be acknowledged more broadly as "drivers of change." A strategic plan should be developed for well-being, rather than being a "reactive response," according to him, with resources and methods of measuring it dedicated to the development of the plan. 

Damian Sendler: Grant advocated for C-suite executives to "go to the floors" and meet with employees to identify and resolve issue areas. He also proposed conducting "stay interviews," in which people were asked why they chose to remain at their current job and what was making them consider quitting. According to him, "It's a terrific opportunity to remind that person that 'I appreciate what you have to say; you are a member of the family' is a powerful message. Grant also emphasized the availability of free resources, such as the American Nurses Association's "Healthy Nurse, Healthy Nation" program, for financially strapped institutions seeking ways to improve the well-being of their nursing workforce.

Damian Sendler: The panelists agreed that leaders are experiencing significant levels of stress as much as the general public. Cherry stressed the importance of being available 24 hours a day, seven days a week, with no time to "disconnect." He asserted that health systems must be aware of this and become more "purposeful" in their support of leadership. He cited several examples. Cherry stated that the good news was that during the epidemic, there were no deaths "The level of communication between all parties has significantly improved. We worked out how to get the messages out in terms of the information that people require on a daily basis in order to complete their tasks." According to him, this has helped staff members feel more secure in their leadership, which has resulted in increased productivity "It also helps us to feel more gratified and inspired as a result of the fact that people are feeling more tethered to us. Thus, there is a silver lining to the whole situation." 

Miller went on to say that leaders must concentrate on two things: presence and optimism. She pointed out that being present entails more than simply wandering the halls. In order to better understand their concerns and ask the correct questions, her leadership group spent time working food lines and assisting staff members with patient transportation, "living in their shoes" In the face of seemingly insurmountable obstacles, she believes that, "at the end of the day, the leader has to be the one that shows the way forward and has some element of positivity that we will get through this," she added. 

Dzau concurred, while emphasizing the importance of leaders working together at the national level to push for structural change, such as pressuring EHR vendors to develop better solutions. "Only your voice is so strong to make these system-level changes," he told his fellow panelists in the closing remarks.  

Damian Jacob Sendler: As an example, Dzau pointed to an op-ed piece he published in March of this year for the Los Angeles Times in which he called for a national strategy to address, quantify, and measure health-care burnout while also providing resources and support for those suffering from it. According to him, Congress should take on a role similar to that which was played following the September 11th attacks, by providing long-term support to those who work in front-line health-care settings. "Our people deserve the same," he remarked. The industry will not survive unless there is a long-term national commitment ""We'll keep fighting the war foxhole by foxhole," says the general. 

Damian Sendler: Insurance coverage denials; hurdles to entrance into health care areas such as lengthy and expensive training; debt; technology; workflows; and other variables were discussed by the panelists as sources of stress in the health care industry. Their consensus was that "the next pandemic is right around the corner, and if we don't make corrections now, we're bound to repeat the same mistakes." as Grant put it. He cited the results of an ANA study of almost 10,000 nurses, which found that approximately 25 percent of respondents said they planned to leave their job within six months, and another 30 percent said they were considering leaving due of work-related stress. In the event that this trend continues, Grant predicts that "There's not going to be any health or health care system if this continues," "It's going to come crashing down on itself. And finally, where exactly are we?" The level of care that patients have come to expect will "not going to be there."

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