Maggie Smith, a registered nurse at an inner city safety net hospital, arrives at the Covid-19 unit where she works at 6:30 a.m., checks in, records her temperature, completes a pre-shift screening questionnaire, and changes into her scrubs. By 7:30, she’s gotten her assigned patients for the day and completed her room-side shift report with the outgoing nurse. At 9:00, Mr. Brown in 206 suddenly experiences shortness of breath and his oxygen level plummets, requiring him to be intubated and placed on a ventilator. By 11, she’s reached out to Mr. Brown’s emergency contact, gently providing a somber update and explaining the plan of care, then fielded two incoming calls from the frantic family looking for updates, all while tracking and caring for the three other patients in her care. As she changes PPE before entering each patient room, she notices the flecking and bruising on her face from the tight-fitting N95 mask.
At 1 p.m., she sits alone and eats a sandwich from the cafeteria delivery tray while she tries to catch up on charting.
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At 4 p.m. one of her colleagues spikes a sudden fever and is sent to employee health, leaving Maggie to take on another patient as the workload is divided and there’s no remaining resource pool to backfill absences. At 5:30, Mr. Brown in 206 takes another turn for the worse and Maggie holds an iPad so the patient can share his last moments on a video call with his family, a new type of job she’s now had to take on more times than she wants to count. At 8 p.m., after working overtime to finish up with Mr. Brown and charting, she leaves and heads home, changing in the garage and running straight to the shower before saying good night to her kids. As she sets her alarms for 4:30 a.m. to do it over again tomorrow, she wonders how she can keep doing it.
With frontline medical professionals across the country facing daily routines like that, it’s not hyperbolic to say that declining mental health is one of the most fundamental threats to medicine right now. Healthcare providers pushed to the brink after a year of the Covid-19 pandemic are tired, burned out, and even suffering the effects of Post-Traumatic Stress Disorder. A study from North Carolina State University found that healthcare workers are facing incredible mental health risks and, on average, healthcare professionals reported enough symptoms of depression to be diagnosed with clinical depression.
Unfortunately, this isn’t surprising. In speaking to many healthcare executives across the country since the onset of this pandemic, mental health is a major concern that each of them has for their teams. Covid-19 has pushed healthcare providers to points that they have never been before. Their feelings and concerns are real, and for many of them, self-preservation falls down the priority list in favor of caregiving. Unfortunately, mental health suffers.
It’s not just uncertainty around care and safety, though. Healthcare providers are also being asked to step into de facto family roles, providing the emotional support families can’t due to restricted visitation, resulting in widespread compassion fatigue. Alarmingly, data from the NCSU study and others show that nearly one in four healthcare providers exhibit signs of depression, and one in five show signs of PTSD.
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You may have heard that “healthcare providers are the worst patients.” Their focus is caring for others, with self-care often taking a backseat. This is where healthcare leadership can be instrumental in affecting change. As healthcare executives provide Covid-19 patient care updates routinely with frontline staff, they should also take the opportunity to share valuable physical and mental self-care information and tools with the staff.
Additionally, healthcare executives should be visible, transparent in their communication, and checking in with staff directly and frequently. This can assure that the frontline staff recognizes their leaders are there for them, supporting them, and making sure they have what they need to feel safe and valued – from basic essentials (a bathroom break, a snack, water) to required essentials to maintain safety (PPE, equipment, hand hygiene supplies). Staff wellness check-ins are also a great time to identify healthcare providers who may need a little extra such as a quick PTSD screening or help with scheduling an EAP appointment. Routine rounds or check-ins will establish and nurture a trusting relationship between executives and frontline staff.
Ultimately, it’s imperative that there’s a systemic focus on care for the caregivers. Nurses have reported seeing more deaths due to Covid-19 in one day than in their entire career. Helping healthcare providers navigate these unchartered waters with strong support systems, team interaction and engagement, and providing them the necessary resources and tools are just a few examples of ways to help prevent burnout, compassion fatigue and maintain resiliency. This can also help to promote a culture of transparency and trust to ultimately give the healthcare providers the reassurance that it’s okay to seek the mental health assistance that they need.
These calls to action can absolutely be applied to any setting – and can hopefully make a difference. Everyone is experiencing the effects of Covid-19 in some way – let’s help those desperately in need with mental health and wellness programs that can positively shape our future.
Photo: gpointstudio, Getty Images
Joy Avery, MSN, RN is SVP of Clinical Strategy at CipherHealth. She brings 37 years of expertise in clinical practice, healthcare operations, capacity management, and operationalizing enterprise command centers in dozens of healthcare systems across the US and UK. Prior to moving into the healthcare IT space, Joy had the opportunity to deliver patient care in a wide range of roles at North Mississippi Medical Center in Tupelo, MS, including Chief Flight Nurse, Trauma Program Manager, and Director of Specialized Clinical Services responsible for transfer center, patient throughput, bariatric services, and nursing leadership programs. In her role at CipherHealth, Joy serves as a clinical SME, assisting both her Cipher peers and customer partners in improving the patient, family, and staff experience. Joy is passionate about improving patient outcomes and access across the care continuum.
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