After 18 months on the front lines of the fight against COVID-19, hospital workers have become exhausted and cynical. They show their frustration by stopping in large numbers. This is especially true for nurses. An obvious burnout crisis is upon us. But there are ways to alleviate this crisis. Here’s how to win back healthcare workers:
The COVID-19 pandemic has laid bare that we have an inadequate plan to respond to medical disasters at the federal, state, departmental, municipal and hospital levels. The federal government has rushed in vain to increase supplies of life-saving masks and ventilators. Individual states have faced varying degrees of health worker shortages: doctors and nurses were in short supply in some areas, but in others they remained inactive.
The response to crises at all levels of government must be clearly defined. What’s the plan for another respiratory disease crisis? What other medical crises are possible and what plans are in place to deal with them? These comprehensive preparations should be described annually to all hospital staff to send a clear message to frontline workers that we are ready and supporting them.
Healthcare workers have been significantly affected by the extreme racial and economic inequalities experienced by patients who contracted, suffered and died from COVID-19. We like to think that everyone should have similar access to the resources and basic care necessary to sustain life. But the pandemic has exposed the gross inequality that exists in the United States.
Black Americans were almost four times more likely than whites to die from COVID-19. Black and Hispanic Americans were more likely than whites to contract and be hospitalized for the disease. This sharp disparity in health outcomes is nothing new, but I hope the lessons of the pandemic inspire us to improve equality in health insurance, health outcomes and access to health care. , especially at the primary care level. This will have to be done at the federal level with the cooperation of the states, with the government vested with the power and the money to effect the appropriate changes.
A shortage of nurses had lasted for a decade, but its magnitude was accentuated by the pandemic. In the latest wave of the virus to spread, hospitals facing a shortage of nurses have started shedding beds and refusing surgeries. There are 6,000 nursing vacancies in Louisiana today, and there are 2,000 fewer nurses in Mississippi today than in early 2021.
A 2019 opinion poll by the Association of American Medical Colleges found that 35% of people had difficulty finding a doctor, up 10 percentage points from 2015.
Doctors are also often tied to a single state due to licensing, hampering their ability to see telemedicine patients and respond to a crisis. We need to make a plan to use telemedicine more effectively. We must also end state-level restrictions on medical practice during pandemics. Perhaps more importantly, we need to train more nurses and we need to value them more.
The rapid virulence of COVID-19 has also made it clear that we need to better understand the limits of medicine and what the human body can and must endure. In a 1957 declaration, Pope Pius XII made a very important distinction between ordinary and extraordinary measures. Common measures include dressing a cut or taking an antibiotic for pneumonia. Extraordinary measures include being placed on a ventilator or undergoing experimental chemotherapy. These extraordinary interventions place an enormous burden on the patient, often with only vague assurances of success.
In his speech, Pope Pius XII declared that there is no spiritual obligation to undergo extraordinary measures if they are unsuccessful. Understanding this distinction and having each patient define in a living will a comfort level with extraordinary measures would go a long way in relieving a patient’s end-of-life burdens, often placed on caregivers and hospital staff. Discussions about end-of-life care, while difficult, should take place with family or close friends – and with your family doctor at least once a year.
This last recommendation is the least concrete, but perhaps the most important. Recently, there appears to be a general decline in civility in hospitals. We need to focus on kindness and hope when interacting with caregivers in the hospital. Medicine is an imperfect science, practiced by people we know to be imperfect. There are too many stories today of doctors – and nurses – facing abuse. Doctors often hear “You treat my relative like a guinea pig” or “You ignore my mother and do not care for her”. For nurses, physical violence is common.
Understand that healthcare workers have dedicated their lives to a generous profession. Your fight is our fight. When we return home at the end of the day, we judge ourselves by the healing we have been able to achieve. Think of the hospital for what it is: a place where healing needs to happen in a collaborative and organized way.
Michael J. Stephen is Associate Professor of Medicine at Thomas Jefferson University and Director of the Adult Cystic Fibrosis Center. He is also the author of the recently published book “Breath Taking: The Power, Fragility and Future of Our Extraordinary Lungs”.