Health care workers suffering from burnout and burnout
Australia’s healthcare system is held in high esteem internationally, performing well in terms of access, equity and outcomes. While no system is perfect, until now it was generally assumed that if you needed care in Australia, especially emergency care, you would get it. It is therefore shocking to read that intensive care beds are full, that it is difficult to recruit the highly qualified doctors and nurses needed to work in intensive care units, Covid-19 medical wards and emergency wards. emergency, and paramedics are at breaking point. How did it come to this?
The pressures on the health care system over the past 12 months have been immense. As Mark Putland, director of emergency medicine at Royal Melbourne Hospital, says: “It has been a great trip. It all started with a real fear of dying when coming to work. Then there was the exhaustion of ever-changing guidelines and procedures. We built what we thought was a ready-to-respond model of care. But then we found that the workforce was being decimated by time off, and we had to rearrange everything on the fly and make do. “
For most of us, the daily grind of Covid-19 is evident in the news reports, as we listen to ‘the numbers’ and adjust our emotions accordingly. The Restrictions Roadmap provides factual information on the expected increase in cases and deaths. Expressed as numbers, these reports cannot capture the feelings of mental distress in healthcare workers who are exhausted and emotionally exhausted. Associate Professor Putland says healthcare workers have mixed emotions: “On the one hand, they now feel like they can see the other side of it, at a time when they can socialize with their families again. and their friends; on the other hand, the anticipation of the overwhelming volume of work that is about to occur is horrific.
Australia’s healthcare system has depended on the flexibility of its workforce – shiftwork, occasional banking, with many healthcare workers choosing to work part-time or working in multiple settings. This has changed drastically in the last year. Strategies to minimize the spread of the virus mean staff can no longer work at multiple sites. The Covid-19 testing and vaccination centers have required a massive investment of staff who are no longer available to work in their usual environments, such as hospitals. Private sector staff redeployed to the public setting and some public patients sent to private facilities add to the restrictions on the availability of elective procedures.
As outbreaks occur, exposed or potentially exposed personnel should be placed on leave – removed from work for 14 days, isolated and tested until there is a negative result. Those who contract the virus are absent from work for long periods of time.
The Covid-19 is constantly disrupting the availability of labor. One of the authors of this article, Dr Natasha Smallwood, is a frontline worker. She describes an ordinary week:
“On Monday evening my daughter developed a cough, sore throat and other flu-like symptoms – early in the morning on Tuesday morning my husband took her for a Covid-19 test. My husband and I are both senior primary care physicians. While we waited for the test results, neither of us could risk going to work. If we went to the hospitals we work in and our daughter tested positive, we didn’t want to risk inadvertently exposing colleagues and patients to Covid-19.
“So the consultations were rescheduled in telehealth. Fine for patients who did not need a physical examination; not good for those who need to be seen in person. This is how easy it is to eliminate two senior clinicians for two days, in an overworked and overworked workforce that increases for the expected wave of Covid-19. “
Simply put, the flexibility of the workforce that supported the healthcare system is no longer there.
Stories about the pressures on staff in the healthcare system are now emerging day by day. They echo the findings of the research we conducted on the psychosocial impacts of Covid-19 on frontline healthcare workers during the second wave of the pandemic. At that time, we found that 70.9% of our sample of 7,846 health workers reported emotional exhaustion and 40% had moderate to severe symptoms of post-traumatic stress disorder. Anecdotally, in their free-text responses, many healthcare workers wrote about leaving the workforce – young people early in their careers rethinking their choices; older specialists or senior managers were considering early retirement. Others wanted to stay in health care, but not on the front lines.
Additional staff trained to work with Covid-19 patients during the second wave of the pandemic are no longer willing to do this work – such is the exhaustion and trauma of working in a crisis that is not an event punctual but a long and hard work. As Putland says, “There are people among us who suffer from some kind of PTSD. Some find it difficult to work, especially those who have caught Covid, so they say, “I can’t do this anymore.” “
Besides emotional exhaustion and burnout, the reasons why healthcare workers want to leave the profession are varied. Many feel in danger and fear transmitting the virus to their loved ones. Others think that the work they do is not valued.
There are concerns about the rationing of care and difficult choices. This leads to moral distress – the obligation to act in a way that goes against core values. For some healthcare workers, moral distress is felt when considering working in a healthcare system where services will be rationed, as is concern about the availability of intensive care beds. For others, it is about providing safe or high-quality care – for example, the proposition that intensive care nurses should treat double the number of patients they normally treat.
The plight of health workers was evident in our investigation, as health workers described holding iPads so families could say goodbye to loved ones who were dying alone, or being the only person in the room comforting frightened patients. . While many health workers were grateful for the technology that made it possible to say goodbye via iPads or cellphones, they were also shocked by the lonely deaths they witnessed.
Health workers have written extensively on what it is like to treat patients with Covid-19 and there are common themes everywhere. Some have used graphic descriptions to emphasize the importance of getting the vaccine – describing suffering from Covid-19 as feeling like “you can’t get enough oxygen” or “like you’re drowning”. They are shocked at what they witness. The most dramatic is the rapid deterioration of the patients.
This year’s patients are much younger and unvaccinated. They are afraid to show up to hospital for any reason, including Covid-19, and therefore are sicker when admitted. Alarmingly, entire families, including children, can be infected with the virus.
Recent calls by frontline healthcare workers, especially nurses, for a ‘risk premium’, or what the Victorian branch of the Australian Federation of Nurses and Midwives calls a PPE allowance, have been controversial. Critics argue that healthcare workers “do what they sign up for.” But did they subscribe to this level of risk? for working conditions where they are in hot and uncomfortable personal protective equipment for a whole shift, unable to drink water or go to the toilet for several hours; where they feel like they’re letting their co-workers down if they can’t work extra shifts?
These healthcare workers want to be recognized and valued for the work they do on the front lines. Valuing staff increases the likelihood of retaining them and bringing back those who have left the workforce.
Like all of us, people in frontline health care put their lives on hold during the pandemic. Putland says, “In normal life, with all of its challenges, during a short seizure you can put it all on hold; but in long-term crises like this all of this still happens and needs to be dealt with in the background. Last year we pretended that all events in life can wait, but they can’t. We knew it wasn’t a sprint, but we expected there to be a finish line. We had to change our expectations, try a more sustainable approach, accept that it was enough to put one foot in front of the other.
Even when we reach 80% of the population fully immunized, the world of health care will have changed. We need to examine what this means for a healthcare system that was already stretched before the pandemic. The road to ‘normal Covid’ healthcare will require vision from healthcare leaders, especially with a depleted workforce, where patients have delayed seeking care and are therefore sicker and more. more complex to deal with, and where waiting lists are longer for procedures that have been delayed due to the pandemic.
If Australia’s healthcare system is to remain one of the best in the world, this road will begin with supporting and empowering frontline staff.
This article first appeared in the print edition of The Saturday Paper on September 25, 2021 under the title “Care trauma”.
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