Written by: Amy Wagner, M.Ed., CPC, ICDCT-CM
and Shannon Theus, MSW, LISW
A critical component of the nationwide battle against COVID-19 is supporting the physical and emotional well-being of the healthcare workers on the frontline of patient care. Ongoing assistance must be made available to healthcare workers who are directly and indirectly involved in patient care for long periods of time, as well as those who must reintegrate back into the workforce following a personal bout of infection with the virus. Assistance should be readily available for those who need it with organizational advocacy for self-identifying the signs of burnout or recognizing a colleague exhibiting symptoms of secondary traumatic stress. Finally, self-care, stress management, and seeking professional help as necessary must be presented by healthcare leadership as fundamental components of the responsibilities of the healthcare worker.
The Challenges to our Healthcare Workers
Healthcare workers put the needs of others above their own; however, the physical and emotional burdens on these workers caused by the COVID-19 public health emergency are unprecedented. Long hours, lack of sleep, lack of nutrition or proper hydration – these all may be viewed as “part of the job” for the average healthcare worker. COVID-19 adds to those challenges due to the physical strain of the protective equipment that must be used, the mental strain that hypervigilance to infection control procedures requires, and the psychological and emotional toll of supporting patients who are isolated from family and friends. Add to these challenges the fear of contracting the virus and the risk of bringing the infection home to one’s own family, and the potential for burnout is high.
SAMSHA, the Substance Abuse and Mental Health Services Administration, defines two stages of compassion fatigue: burnout and secondary traumatic stress. Healthcare workers should know and acknowledge the signs of burnout before they progress to the more serious phase of secondary traumatic stress. While not every worker will experience every sign of burnout, when the following start to dominate the thought process of the workers in their day-to-day duties, care must be taken:
- Feeling hopeless, like nothing you do will help
- Feeling cynical or frustrated
- Feeling like you’re not doing your job well or feeling like a failure
- Lacking feeling or indifference
- Needing or desiring alcohol or other substances to cope
Physical signs of stress may include:
- Lack of appetite
- Gastrointestinal distress
- Racing heart, muscle spasms, eyelid twitching
Mental signs of stress may include:
- Having difficulty remembering things
- Lack of concentration
- Difficulty making decisions
Strategies to Prevent Burnout
First, the basics…good nutrition, adequate sleep, proper hydration and active relaxation. Try to avoid excessive use of caffeine or alcohol. Take time for personal hygiene: shower, brush your teeth, wash your face, or change into fresh clothes midway through a long shift. Take adequate breaks. Avoid always rushing to eat. Minimize rushed or distracted calls to family and friends, as these calls may be less satisfying or more frustrating than not having contact with the outside world at all.
Some strategies, however, are specific to the healthcare worker, especially during the COVID-19 pandemic. Teams should make an effort to practice the following strategies together:
- Work in partnerships or small groups to accomplish a spirit of patience, tolerance and hope.
- Focus efforts on what can be directly controlled or actively managed.
- Seek out accurate information and guidance from leadership in decision-making.
- Communicate with colleagues constructively, share problem-solving techniques, and compliment each other.
- Celebrate successes and mourn sorrows as a group.
What to Avoid
Healthcare workers should check their own thought processes, and gently and constructively redirect others in the following circumstances:
- Working too long without a break
- Subscribing to the following thoughts, “It’s selfish to take a break.” “The patients need me more than I need a break.” “Everyone else is working around the clock so I have to.”
- Excessive worry that something will happen to you, your colleagues, your family, etc.
- Feeling like you can’t stop replaying the trauma you see and hear in your head when on a break.
After a long period of caring for COVID-19 patients, it is important to recognize that steps can be taken to “return to normal”. Seek out and share social support, listen to the stories of other healthcare workers while carving out time with family and friends that is purely personal. You may also need to schedule time to be alone, time to meditate or reflect on your experience but in a positive way. Avoid excessive media exposure. Be prepared to have a fundamentally different view of the pandemic than your family and friends outside of the healthcare field.
Mental health professionals are trained to see the signs of burnout and post-traumatic stress and to provide coping strategies to relieve the symptoms if you are experiencing them. Don’t feel like your burnout will “just go away”. It’s okay to ask for help and to practice self-care by seeking out and setting aside time for that help. If the stress and anxiety caused by compassion fatigue are affecting the quality time you have with your family and friends and preventing you from relaxing when away from the frontlines, get help!