A Workforce Under Stress: Care for our Caregivers

PNW RNs are not OK. Is there any solution for burnout?

As it enters a third surge in the United States, the COVID-19 pandemic may be breaking healthcare workers. As if this writing, more than 11 million Americans have contracted the virus; reported new cases are up 77 percent, to 172,391; new deaths have risen 52 percent, to 1,923. The country recently crossed the quarter-million mark of fatalities. In North Dakota a few days ago, coronavirus infection rates were the highest in the world. To serve their patients and employers, the country’s nursing workforce is working harder, and for more hours, than ever before. Much like the virus itself, burnout remains unchecked.

Before the pandemic, nurses were already performing under significant stress. A recent article in the Journal of Radiology Nursing found that burnout reported among RNs pre-COVID ranged between 35–45 percent. And multiple studies have corroborated that nurses are more likely to experience high stress levels in addition to other health-related symptoms.

As COVID continues to impact communities across the state, employers are sharing how they are supporting their nurses while monitoring stress and burnout. Unsurprisingly, the prolonged stress and anxiety created by the pandemic is taking a toll on RNs region-wide.

Jennifer Henderson, an employee assistant program consultant for Kaiser Permanente Northwest, reports from her colleagues that the stressors Pacific Northwest nurses are experiencing are similar to those felt by their colleagues elsewhere in the country. These include the fear of infecting loved ones; the need for childcare and home-schooling; relationship issues; increased anxiety and/or depression; and the stress of navigating constantly changing recommendations from the CDC.

Organizations are working to proactively reach out and connect with staff. Anne Hansen, Asante Health’s nursing professional development director, explains that these include care team meetings, unit debriefings, and proactively engaging staff to discuss a variety of health and wellness topics.

Still, it may not be enough. Henderson adds that Kaiser utilizes regular team briefings that allow for touch-points with staff. “Additionally, we have drop-in support groups and 24/7 direct access to counselors through our employee assistance program,” she says.

As cold and flu season approaches and COVID infections spike, healthcare organizations are already concerned that an increase in patient numbers may overwhelm the system. Continued demands for care could also engulf an exhausted nursing staff.

“The biggest and most basic worries are about staff’s level of fatigue and their ability to stay well with the chronic and unending path of COVID,” Henderson says.

The Journal of Radiology Nursing article lays out a valuable list of starting places for nurses experiencing burnout, suggesting focus on the following tactics:

  • Cognitive restructuring and reframing
  • Stress management and relaxation skills
  • Yoga, tai chi, or mindfulness meditation
  • Grief counseling
  • Brainstorming around ways to change workplace and workload
  • Writing workshops
  • Music and art therapy
  • Learning communication skills
  • Building workload and organizational management skills

While not COVID-specific, these suggestions are likely to be of value during the current crisis.

Is there a silver lining to such high levels of burnout? Courtnay Caufield, chief nursing executive at Kaiser Sunnyside, suggests that even if it’s short-lived, the added stress may have some benefits. “Hard as it is, I have never seen so much resiliency and teamwork as well as innovation and adaptability,” she says.

To be certain, as the world grows more COVID-informed, the plight of nurses nationwide becomes better known. Jodi Dering, an ER nurse in South Dakota, made news headlines (and a CNN interview) recently after reporting honestly and at length on Twitter about her experience with conditions and patient attitudes in her ward. Nurses in the Pacific Northwest may not have her caseload—not for now, anyway—but they can certainly sympathize with her plight.

Things are likely to get worse before they get better. Zach Fogg, who directs operations for long-term care facilities at multiple Marquis Companies, believes that front-line healthcare workers will continue to see a great amount of stress, and that staff must find ways to temper it. “It is important for them to find new outlets,” he says.

The Journal of Radiology Nursing article notes that because of the emotional connection they have with their patients, nurses are more often affected by compassion fatigue. Patient loss, medical error, or other unanticipated events can lead to additional traumatic stress. Everything adds up. “Left unmanaged,” its authors report, “these work-related conditions can lead to depression—which, as opposed to burnout, affects all areas of a nurse’s life.”

As the pandemic rages and nurses are called upon to maintain an ever-increasing workload, the system that supports them is reaching a breaking point. A recent feature in The Atlantic reminds readers that RNs and other front-line healthcare workers can only do so much; the rest is up to the patients and their friends and families.

“The best strategy remains the obvious one: Keep people from getting infected at all,” the article explains. “Once again, the fate of the U.S. healthcare system depends on the collective action of its citizens…. People can reduce their risk by wearing masks and avoiding indoor spaces…. Thanksgiving and Christmas gatherings, for which several generations will travel around the country for days of close indoor contact and constant conversation, will be risky too.”

For the PNW’s RNs, pulling up the energy to face a holiday COVID spike and whatever comes afterwards will likely increase already precarious levels of burnout.

Stress Resources for Health Care Professionals: