THIE From the Field: Health Care Worker Burnout and Moral Injury Amidst the Pandemic
Written By: Angie Merrell, RN Vice President, Risk Management, Texas Hospital Insurance Exchange &
Cecil Conner, Risk Management Advisor, Texas Hospital Insurance Exchange
Since day one of the COVID-19 pandemic, there have been constant challenges that have exceeded and overwhelmed the capacity of our hospitals. Our health care workers have also faced countless additional stressors and anxiety. The long shifts combined with unprecedented regulatory restrictions, including personal isolation and other factors have affected their ability to cope with the job and, in many instances, life. But what impact has this had on our workers and what can health care leaders do to help?
We know that health care workers can be at heightened risk for anxiety, depression, burnout, insomnia, moral distress, and post-traumatic stress disorder. Under the usual working conditions, severe burnout syndrome affects as many as 33% of critical care nurses and up to 45% of critical care physicians. The pandemic has heightened risk factors, which include increased workloads, demands and little control over the work environment, as well as the trauma of caring for patients who are critically ill. These risk factors also represent important exacerbating factors for poor mental health among health care workers.
There is a distinction between burnout and moral injury. Burnout suggests the problem resides within the individual, who is in some way deficient and unable to cope. Moral injury describes the challenge of simultaneously knowing what patients need but are unable to provide it due to constraints that are beyond control. Moral injury is the consequence of the ever-present double binds in health care: do we take care of our patient, the hospital, the insurer, the EMR, the health care system, or our productivity metrics first? Moral injury locates the source of distress in a troubled system, not within a troubled individual, and allows us to direct solutions at the causes of distress. In the end, addressing the drivers of moral injury on a large scale may be the most effective preventive treatment for its cumulative effects among health care providers.
To adequately support health care workers, we must understand their challenges and needs. Burnout and other forms of work-related psychological stress are unavoidable occupational health issues. By acknowledging the stress related to the effects on hospital staff during this difficult time, we can appropriately attend to the mental health needs of all health care workers affected by the pandemic.
As leaders in the health care industry, we must recognize and understand why so many caregivers feel frustrated and unfulfilled in their work as they face barriers to providing the highest quality care to their patients. Leadership and all levels of management have a vital role in leading and guiding their teams to address all aspects of the problem within their span of control and create the conditions for individuals to find fulfillment in their professions to care for patients.
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