Weathering the storm: Mental, emotional well-being of health care workers during COVID-19 pandemic

Along with its catastrophic effects on human health, the ongoing COVID-19 pandemic is also taking a massive toll on the mental and emotional well-being of front-line health care workers around the world. Longer shifts, work-life balance disruptions and fears about bringing the disease home to family members have led to an increase in stress and anxiety, physical and mental fatigue and burnout for this group of individuals. The pandemic has yielded a wave of support from medical leadership, all levels of government and the general public. However, the question remains: how can hospitals, governments and industry improve pandemic response and lessen the burden on medical professionals?

Bita Kash, PhD, MBA, FACHE, professor in the Health Policy and Management department at the Texas A&M School of Public Health, along with Farzan Sasangohar, PhD, assistant professor in the Industrial and Systems Engineering department, and researchers at the Houston Methodist Research Institute and the Houston Methodist Hospital system, published a new paper in the journal Anesthesia & Analgesia about medical provider fatigue and burnout during the COVID-19 pandemic.  The paper shares insights gathered by medical leaders and collaborating scientists at Houston Methodist Hospital regarding health care professional fatigue and burnout in the intensive care setting, including factors that may contribute to the emotional burden medical workers face, and proposes guidelines and recommendations to prepare for future pandemics and other disasters.

The first factor the researchers identified were the occupational hazards health care workers face when responding to the pandemic. The rapid growth of COVID-19 nationally has exposed a lack of preparedness, limited supplies of personal protective equipment (PPE) and training on how to properly use it. Additionally, hospitals had difficulty testing a sufficient number of patients early in the disease outbreak, hampering efforts to slow disease spread and effectively treat patients. This lack of preparedness, increased risk for health care workers and possible poor patient outcomes increases the psychological toll on medical providers.

Another factor is the scale of the national-level response to the pandemic. States have requested PPE and ventilators from the U.S. Strategic National Stockpile, but most have received only a fraction of what they requested one month into the pandemic, adding to stress and anxiety. This underwhelming response is compounded by the procedures for requesting access to the stockpile, which have been perceived as slow and cumbersome. This has led to further uncertainty on whether more PPE and ventilators will become available, and if so, when. As a result of these uncertainties, health care workers have been advised to use and reuse PPE beyond their originally recommended guidelines, which may reduce effectiveness and lead to additional stress.

Inefficiencies in processes such as ordering equipment and protocols for caring for patients are another source of frustration the researchers identified. A lack of established policies for emergency management can make everyday tasks more time-consuming and increase provider workloads. Attempts to address shortfalls in protocols have shown mixed success, with training videos on PPE use not being updated to address the alternative types of equipment being used. The researchers also note a mix of patient care and PPE guidelines coming from the various subspecialty professional societies and a lack of initiative at higher levels to unify guidelines.

The last factor identified is one that many outside of the medical field are also facing: financial instability. Efforts to slow the spread of COVID-19 through social distancing have led to slowdowns of businesses, including medical visits, elective procedures and surgeries. This has caused a significant economic downturn and loss of income among the healthcare workforce through furloughs and layoffs. Uncertainties about future employment and income have long been known to be associated with anxiety and stress.

With these factors identified, the authors of the paper go on to propose ways to improve readiness and resilience in the face of pandemics and other large-scale emergencies. Having plans in place for disaster management that can be quickly adopted to respond to changes on the ground are crucial, as are procedures to quickly procure adequate PPE, medical equipment and other necessary items such as cleaning supplies and disinfectants. Better communication of topics like testing and PPE availability could also help reduce health care worker anxiety and stress. Regular structured training on disaster management and response is another key strategy the researchers identified as important. They also noted a need for a reserve group of medical providers at the regional, state and national level that can be routinely trained and activated in case of an emergency. Lastly, methods for assessing worker fatigue and burnout such as mobile health tools and wearable sensors to monitor fatigue would be helpful for proactively managing workplace readiness.

“The response to the COVID-19 pandemic at all levels points to a need to create, test and implement disaster management plans that bring together the strengths of individuals, industry and all levels of government,” Kash said. “Additionally, since large-scale disasters can overload responses at the national level, a local-level focus on resilience would be beneficial. Pandemics and other disasters can provide opportunities to learn, but without proper leadership, planning and resource allocation, such lessons can be lost.”

However, with the recommendations listed in this study, medical leadership and government officials have additional insight into ways to improve preparedness and maintain health care workforce readiness.