What if I asked you to work in an unfamiliar environment under extreme pressure? No doubt you would be highly stressed and uncomfortable. Well, this is exactly what many healthcare workers (HCWs) experienced when they encountered the onslaught of severely ill Covid-19 patients during the height of the pandemic.
Although the staff may have been “seasoned” emergency room practitioners or highly trained in intensive care medicine, this was a disease they were not familiar with and standard protocol wasn’t always effective. This was also an extremely contagious disease that could not only affect other patients but could cause them to become sick and possibly die.
In my experience as a young nurse in the late 1970s working in an ICU in a large New York City teaching hospital, we were taught to be “tough” and “stoic”. We were not encouraged to seek emotional support. I admit the stress I experienced was not the level experienced by the HCWs in the pandemic, but unfortunately, as it was then, staff today are not always supported emotionally. Thankfully, today in some facilities, healthcare leaders and administrators are more empathetic and realize the need to support the emotional status of HCWs.
A review of the pandemic in the past weeks has shown that (HCWs) have been under extreme levels of stress and anxiety associated with the Covid-19 pandemic. A person cannot pick up a newspaper or magazine article today without seeing a nurse, doctor, or healthcare worker who was not wearing full personal protective equipment (PPE) and looking stressed and exhausted. Many articles focused on the stressors, which included lack of personal protective equipment, fear of getting infected, lack of supplies, staff reductions due to illness and furloughs, and fear of bringing this illness home to their families. Many HCWs also talked about feeling isolated from family and friends and feeling totally overwhelmed.
Experts and psychologists have shared that chronic stress can debilitate us and cause many mental and physical health issues. The hormones and biochemicals that are released during major threats to us cause inflammation, disease, and mental health conditions.
Stress and what it can do to the body is well documented. Many staff reported physical symptoms that included the inability to sleep or eat, exhaustion, headaches, rapid heart rate, and dehydration.
During the pandemic, the staff was not only dealing with their own stress but with the stress felt by the patients and their families. Because the family could not be at the bedside with their loved ones, it was the staff member who was calling, texting, or Face Timing with anxious family members about the patient’s status and care plan.
Healthcare worker stress and burnout is not a new phenomenon, but the levels seen during the Covid-19 pandemic have been unprecedented. It is because of this crisis of high stress with our healthcare staff that healthcare leaders and institutions are being asked to respond to the psychosocial toll that Covid-19 has taken on their employees.
The Joint Commission issues guidance on Mental Health Support
This week The Joint Commission (TJC) issued guidance on how healthcare organizations can address employee well-being amid the coronavirus pandemic. In their publication of June 3rd, Quick Safety 54: Promoting the Psychosocial well-being of Healthcare Staff During Crisis, TJC acknowledged the stressors experienced by HCWs during the pandemic and reinforced that they are real and do not indicate “weakness or incompetence” on the part of the healthcare worker.
In this publication, TJC is stressing that institutions and key healthcare employers should have systems in place to support “institutional and individual” resilience. Historically and unfortunately in the past, a healthcare worker seeking mental health services and care was not always supported. In most cases, healthcare workers who sought out mental health services were seen as “weak” and the request could adversely affect their careers.
Removing the barriers for staff to seek mental health care
One of the recommendations TJC is implementing with this guidance is that facilities are to remove any questions about an employee’s previous history of mental illness or treatment of mental illness. This would remove the stigma associated with mental illness and encourage them to step forward for care. The document sites, “TJC does not require organizations to ask about a clinician’s history of mental health conditions or treatment and supports the recommendations of the Federation of State Medical Boards and the American Medical Association to limit inquiries to conditions that currently impair the clinicians’ ability to perform their job.”
Although doctors and nurses, the front- line workers clearly need the mental health services, TJC has also made it clear that these services should extend to those who support healthcare workers who may be overlooked. This can include respiratory therapists, chaplains, environmental services, and pharmacists to name additional groups.
Managers and Leaders: Ways to Support Your Staff
According to the document from TJC, the following strategies can be taken by healthcare leaders and facilities to support their staff:
Communicate regularly with staff- debriefings and huddles to discuss patients, staffing, and needs.
Model behaviors that promote self-monitoring- leaders to model these behaviors.
Encourage the sharing of concern.
Demonstrate the value of staff.
Orient staff to psychosocial resources- train staff on “psychosocial first aid”.
Proactively monitor staff and provide active outreach.
Encourage peer support.
Share positive feedback.
Alter staffing where possible.
Overall letting staff know they are cared for, listened to, supported, and providing resources when needed, is key. The healing of HCWs who were traumatized during the pandemic will take time, support, and treatment. The guidance from TJC is a huge step in making mental health care a priority and available without employer repercussions or labeling. Hopefully, because of this, more staff members will readily come forward to get the mental health support they need. For additional information on this Joint Commission Safety directive click on the Read More button.