The situation is dire but not hopeless: More must be done to protect our health-care workers

COVID-19 has created an endemic of unprecedented burnout levels amongst front-line workers, exponentially exacerbating an already complex issue.

Within Canada, critical burnout levels doubled within the span of one year, from spring 2020 to spring 2021, and there are no indications that this trend will plateau anytime soon. In fact, based on trends observed from the 2003 SARS outbreak, post-pandemic burnout is expected to continue well after the height of COVID-19.

The World Health Organization defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed,” consisting of extreme exhaustion, negative feelings toward work and reduced professional and personal accomplishment. Burnout is a complicated occupational hazard that can be affected by multiple factors, including increased workload, patient acuity, work-induced moral or ethical distress, employee-management relationships and leadership support.

Burnout also has a significant economic cost due to increased turnover, absenteeism, lower productivity and early retirement. A 2014 study estimated that physician burnout costs the health-care system $213 million per year. Health-care burnout also leads to decreased patient outcomes due to reduced physician availability and increased medical errors.

However, no one is more gravely impacted than our health-care workers. The negative outcomes of burnout are not contained to one’s work environment, with an overall reduction in mental health leading to depression and anxiety, substance use and suicide.

Concern for rising levels of burnout among health-care workers and the need for mitigation strategies was expressed early in the pandemic. Increased workload and pandemic-induced trauma were predicted to have a significant impact. What was not predicted was the cumulative burnout that would arise from a constant wave of misinformation that began in the initial stages of the pandemic and has resulted in increased hostility and violence toward health-care staff.

A lack of governmental proactiveness over the past 20 months has resulted in workforce losses, with significant proportions of health-care workers leaving their jobs and even their professions. The health-care industry has seen a higher “year-over-year increase in job vacancies than all other sectors” with a 39 per cent overall vacancy as of the first quarter of 2021. This has and will continue to further perpetuate the levels of burnout due to mounting patient cases as health-care worker numbers decrease.

About 20 per cent of physicians at acute care centres in Vancouver and Montreal expressed intentions of quitting the profession as a result of COVID-19 related burnout. Similarly, 16 per cent of registered nurses surveyed in Ontario reported plans to leave nursing within the next year, with younger professionals being at highest risk of leaving the profession. However, COVID-19 burnout spans across all health professions, including hospital and community pharmacists who have continued to work tirelessly, taking on increased workloads and often being the only accessible in-person primary care health-care professionals throughout pandemic lockdowns.

The situation is dire but not hopeless. A multifaceted approach is needed, starting at the federal and provincial government levels and extending to all health-care organizational levels of leadership and management.

In March, HealthCareCAN sent out a public call-to-action to the federal government to help protect health-care workers by addressing the causes of escalated burnout levels, enhancing mental health supports and establishing a national health-care workforce plan to help reduce staffing shortages. More recently, on Oct. 6, the Canadian Medical Association (CMA) and the Canadian Nursing Association (CNA) gathered at an “emergency COVID-19 summit” along with “40 national and provincial health organizations” to discuss the urgent need to address COVID-19 crisis mismanagement, associated health-care burnout and the detrimental consequences to our health system and staff.

Recommendations focused on staffing retention and recruitment or redeployment of staff to areas with critically high case numbers, including mobilizing the Red Cross and military health-care personnel to these areas; redeploying health-care workers from COVID-19 controlled zones to provinces in need if provincial licensing restrictions were removed; and creating a national licensing program to meet the needs of the pandemic. Redeployment between regions or clinical practice areas requires adequate training for out-of-scope staff. However, this has not always been prioritized throughout the pandemic, further contributing to increased psychological and professional distress.

Mental health prioritization was discussed as both an acute and long-term solution to maintaining a sustainable health-care workforce. There needs to be a coordinated, significant effort toward quickly scaling our mental health resources while also incorporating more protective strategies.

The negative outcomes of burnout are not contained to one’s work environment.

At an organizational level, there is much that can be done to protect health-care workers. The American Medical Association has created a 17-step guide to strengthening health-care workforce resilience, to help organizations create resilient teams during crisis situations. One of the key steps to establishing resilience is to “assess stress and needs within the workforce.” Thankfully, organizations across Canada have access to resources such as the Guarding Minds at Work survey and Caring for Health-care Workers toolkit that facilitate assessment of workplace psychological health, particularly in the context of COVID-19.

However, results from such assessments need to be quickly transitioned into impactful action plans.

Prioritizing the mental health of our health-care providers requires more than simple signposting. Organizations should invest in easily accessible on-site mental health professionals with expertise in burnout and trauma. Interdepartmental strategies could include creating formal peer support groups that may produce organizational benefits while changing the workplace experience for individual employees. Even informal peer support can have a significant influence on the well-being of employees. Early in the pandemic, staff at the Vancouver General Hospital created a “wobble room” for individuals to come together and support one another.

Leaders play an important role in reducing the levels of burnout their employees experience. It is time for leaders and managers at all levels of the health-care system to become strong advocates for front-line staff. A 2020 study identified several protective measures for psychological distress that can be implemented by managers and leaders during health-care outbreaks, including engaging in open and clear communication with staff; providing appropriate training; recognizing employees’ hard work; encouraging daily breaks; supporting vacation time; and implementing departmental “staff support protocols.”

To ensure ongoing open communication with staff, frequent check-ins between leadership and team members or employees also has been recommended. Above all, leaders should help foster cohesive and supportive teams while maintaining a culture focused on employee wellness and self-efficacy.

Health-care workers have been driving our nation’s survival throughout this pandemic and it is time for us to take action to ensure their recovery from this pandemic-induced burnout crisis.

For more information on mental health resources for health-care workers during COVID-19, please visit the CAMH website.