In 2019, the term “burnout” was added to the World Health Organization’s International Classification of Diseases (ICD).
According to the ICD, burnout is a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” It is characterized by three dimensions: energy depletion or exhaustion, increased mental distance or feelings of cynicism related to one's job, and a sense of ineffectiveness and lack of accomplishment.
Around the same time burnout was being added to the ICD, studies showed that approximately a third of all nurses in the United States were suffering from some form of this newly defined disease.
And this was before they had to battle a global pandemic.
Today, the number of U.S. nurses reporting symptoms related to burnout has risen to 62 percent, according to a recent national survey conducted by the American Nurses Association.
While the causes of burnout are multi-factorial, we do have an understanding of some of the major, overarching trends that have led to this rise in stress among our health care workers.
Advances in medicine and patient care have allowed people to live longer lives, resulting in an aging population and a greater demand on the health care system and its workers.
Advances in technology have introduced efficiencies and tremendous progress in patient care, but also significant changes in health care workers’ day-to-day roles.
Throughout all of this change, health care workers have looked to ground ourselves in the consistency of common elements such as chain of command, well known policies, and patient workflows. These elements add structure to what we do, balance the unpredictability and provide some shelter from the symptoms experienced with burnout.
Over the past seven months however, these grounding forces have been wiped away, replaced by a new wave of constant inconsistencies. Things we typically take for granted – like following a familiar process when moving patients from one unit to another, or allowing family members to gather to say their goodbyes – became brand new sources of stress.
We don’t know when these new sources of stress will go away, in large part because we still know so little about this virus. Many experts have pointed out that if immunity lasts less than a year – as is typical with other coronaviruses – we could experience annual surges in COVID-19 infections over the next several years.
Even more concerning, is the theory that this pandemic is not a “once in a century” event, but rather, the beginning of a new normal where continued social and environmental changes contribute to a higher frequency of pandemics over the next several decades.
While the scientific community is focused on preventing this outcome by breaking down barriers and building more bridges between scientific research and the public health sectors, the medical community must be focused on preparing for it.
For years, hospitals have been exploring new – and enhancing existing – ways to support the physical, mental and emotional wellbeing of health care workers. Now, this effort has become a central focus among our leaders at the local, national and international levels.
At the local level, individual hospitals and health systems are investing more time and effort in increased communication to ensure transparency in operations and encourage open dialogue between staff and leaders. Many of us have increased the cadence of town halls and video calls to provide additional opportunities to share experiences, work through challenges or vent about a particularly difficult day.
Many have also established a “Code Lavender” in which colleagues are empowered to look out for one another and deploy a dedicated team to remove a team member from a situation that might become overwhelming. We are adding to already established suites of spiritual and emotional care services, building quiet areas throughout our facilities in which staff can decompress and offering internal mental health training for staff.
At the national level, we are working with groups like the American Hospital Association and the American Organization for Nursing Leadership to deploy online training designed to help nurse leaders cope, stay centered, build resilience and lead with integrity. We are learning how to better listen to our staff, understand their needs and respond accordingly.
Increasingly, hospitals are implementing policies and programs to address the mental and emotional wellbeing of our staff, just as we do the physical and financial. But it’s not enough to put these programs into place. We must invest the same time and energy into promoting our commitment to them, as well.
According to The American Nurses Association, there will be more registered nurse jobs available through 2022 than any other profession in the United States, and the U.S. Bureau of Labor Statistics projects 11 million additional nurses are needed to avoid a further shortage.
Like this pandemic, it’s becoming increasingly clear that burnout among our health care workers is not a one-time phenomenon, but rather, a new normal that if gone unchecked will have significant impacts on our current population of health care workers, as well as our ability to attract the next generation. The hospital field is taking this issue very seriously and has already made significant strides in addressing it – it’s time we start sharing that with others.
Anne Schmidt is chief nursing officer at Novant Health UVA Health System Prince William Medical Center and Novant Health UVA Health System Haymarket Medical Center.