It’s a safe assumption that most people who go into healthcare enter the field to help people. They know the profession is difficult, high pressure, hard on the body, and that there are occupational risks. However, the average healthcare worker probably doesn’t start their career thinking they’ll end up overwhelmed and overworked, and often feeling unsupported. And yet, unfortunately, that’s where a great many medical professionals have arrived.
The result: Burnout.
Recently, United States Surgeon General Dr. Vivek Murthy issued a surgeon general’s advisory highlighting the urgent need to address the health-worker burnout crisis across the country. Health workers—including physicians, nurses, community and public-health workers, nursing aides, etc.— have long faced systemic challenges, such as burnout, in the healthcare system. The COVID-19 pandemic further exacerbated burnout, with many workers risking and sacrificing their own lives in the service of others while responding to the public health crisis.
The surgeon general’s advisory addressing health-worker burnout lays out recommendations to address the factors underpinning the crisis, improve health-worker well-being, and strengthen the nation’s public health infrastructure.
“At the height of the COVID-19 pandemic, and time and time again since, we’ve turned to our health workers to keep us safe, to comfort us, and to help us heal,” said U.S. Secretary of Health and Human Services Xavier Becerra. “We owe all health workers—from doctors to hospital custodial staff—an enormous debt. And as we can clearly see and hear throughout this surgeon general’s advisory, they’re telling us what our gratitude needs to look like: real support and systemic change that allows them to continue serving to the best of their abilities.”
The nation’s health depends on the well-being of our health workforce, said Surgeon General Murthy in his advisory. “Confronting the long-standing drivers of burnout among our health workers must be a top national priority. COVID- 19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point. Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk. This surgeon general’s advisory outlines how we can all help heal those who have sacrificed so much to help us heal.”
Even before the COVID-19 pandemic, health workers were experiencing alarming levels of burnout, broadly defined as a state of emotional exhaustion, depersonalization, and low sense of personal accomplishment at work. Burnout can also be associated with mental-health challenges such as anxiety and depression.
In 2019, the National Academy of Medicine (NAM) reported that burnout had reached “crisis” levels, with up to 54% of nurses and physicians, and up to 60% of medical students and residents, suffering from burnout. The pandemic has since affected the mental health of health workers nationwide, with more than 50% of public health workers reporting symptoms of at least one mental-health condition, such as anxiety and depression, and increased levels of post-traumatic stress disorder (PTSD).
Health-worker burnout not only harms individual workers, but also threatens the nation’s public health infrastructure. Already, Americans are feeling the impact of staffing shortages across the health system in hospitals, primary care clinics, and public health departments. With more than half a million registered nurses anticipated to retire by the end of 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses across the U.S. Further, within the next five years, the country faces a projected national shortage of more than 3 million low-wage health workers.
The Association of American Medical Colleges (AAMC) projects that physician demand will continue to grow faster than supply, with the most alarming gaps occurring in primary care. Health-worker burnout affects the public’s ability to get routine preventive and emergency care, and our country’s ability to respond to public health emergencies.
Consider the following from a U.S. Department of Health and Human Services webpage: “The realities of our healthcare system are driving many health workers to burnout. They are at an increased risk for mental-health challenges and choosing to leave the health workforce early. They work in distressing environments that strain their physical, emotional, and psychological well-being. This will make it harder for patients to get care when they need it.”
HHS wrote, “Workplace systems cause burnout among health workers. There are a range of societal, cultural, structural, and organizational factors that contribute to burnout among health workers. Some examples include: excessive workloads, administrative burdens, limited say in scheduling, and lack of organizational support.”
According to Dr. Murthy, we should all be on the lookout for detecting burnout in our colleagues and the medical professionals we know in our personal lives. “Check in with the health workers you know,” Dr. Murthy advised in a Q&A on the HHS website. “Help them stay connected. Ask them how they are doing and how you can help them. Pay attention to warning signs that indicate that they may need professional support from a mental health provider. Common behaviors to watch out for are: increased irritability, withdrawal from friends and family, impaired judgment, excessive alcohol or substance use, reduced ability to manage emotions and impulses, and decreased personal hygiene.”
To help address burnout on a wide scale, topline recommen- dations from the surgeon general’s advisory include:
- Transform workplace culture to empower health workers and be responsive to their voices and needs. We can begin by listening to health workers and seeking their involvement to improve processes, workflows and organizational culture.
- Eliminate punitive policies for seeking mental-health and substance-use-disorder care.
- Ensure that on-demand counseling and after-work care are more accessible to health workers to promote and preserve their well-being.
- Protect the health, safety and well-being of all health workers.Provide living wages, paid sick and family leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies (including childcare and care for older adults) for all health workers.
- Ensure adequate staffing—including surge capacity for public health emergencies—that is representative of the communities they serve. This is critical to protect and sustain health workers and communities.
- Organizations, communities and policies must prioritize protecting health workers from workplace violence and ensure that they have sufficient personal protective equipment. In a national survey among health workers in mid-2021, eight out of 10 experienced at least one type of workplace violence during the pandemic, with two-thirds having been verbally threatened, and one-third of nurses reporting an increase in violence compared to the previous year.
- Reduce administrative burdens to help health workers have productive time with patients, communities and colleagues. One study showed that on average, for every hour of direct patient care, a primary care provider will spend two hours a day on administrative tasks. That is time that could be spent with patients, in the community, and building relationships with colleagues, which is essential to strengthening the health and well-being of both health workers and
- Prioritize social connection and community as a core value of the healthcare system. This enhances job fulfillment, protects against loneliness and isolation, and ultimately improves the quality of patient care. Include peer and team-based models of care to strengthen collaboration and create opportunities for social support and community.
- Invest in public health and our public health
- Diversify and expand the public health workforce and improve disease surveillance systems to help address social determinants of health and health inequities, counter health misinformation, and strengthen partnerships across clinical and community settings.
Until we address at least some of the above problems, we can expect healthcare worker burnout to increase and patient satisfaction to move in the opposite direction.
Most of the above article is part of a recent surgeon general’s advisory. These advisories are public statements that call the American people’s attention to a public health issue and provide recommendations for how it should be addressed. Advisories are reserved for significant public-health challenges that need immediate attention. To view the advisory in full, visit https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html
