Trauma-Informed Interventions to Address Health Care Worker Burnout, Stress, and Attrition During and After the COVID19 Pandemic
The COVID-19 pandemic has impacted the health and mental well-being of people globally. Health care workers (HCWs) are experiencing unique consequences of the pandemic, based on the nature of their work. As helping professionals, HCWs were already more likely to experience workplace stress and burnout. Now, those effects are compounded by pandemic conditions with very little relief on the horizon. Combined with generalized anxiety about the pandemic, economy, and other social unrest, the trauma of the health care workplace harms the mental health and resilience of HCWs.
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) definition of trauma helps us better understand how the pandemic is affecting individual mental health:
Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.
The COVID-19 pandemic is both individually and collectively traumatizing, especially for HCWs. Early research shows that HCWs in the US and abroad are experiencing Post-Traumatic Stress Disorder / Post-Traumatic Stress Syndrome (PTSD / PTSS), increased severe-state anxiety and distress, and high emotional exhaustion. In addition to being personally distressing, these factors in the workplace contribute directly to burnout and are frequently cited by exiting employees as a reason for leaving their jobs. Several factors contribute to increased stress and burnout in HCWs, including:
High-risk working environments, such as emergency rooms and intensive care units; even generally low-risk health care settings are now high-risk for HCWs, because of the potential for COVID-19 transmission
Long shifts and odd hours, such as repeated overnight shifts; or being reassigned to understaffed units outside of your specialty
Lack of resources such as personal protective equipment (PPE) and reliable treatments for COVID-19 patients
Poor peer and manager relationships due to stress and conflict
Perceived or actual lack of choice, voice, and agency in decisions that affect their work environment, such as choosing shifts, length of shifts, and exposure to COVID 19
Addressing trauma and burnout in HCWs is imperative from a workforce planning perspective. HCWs are highly-skilled employees and replacing those who leave because of stress and burnout is challenging, sometimes impossible in the current economic and labor market conditions. Understaffed teams create even more burnout for those employees left behind, by increasing the workload and lengthening shifts of remaining employees. In order to prevent further burnout and attrition, managers, human resources professionals, and health care administrators must devise compassionate interventions designed to support and retain their valuable employees. Interventions at the team- and system-level are necessary to ensure that HCWs get the support they need to be healthy, and that the workforce is not negatively impacted.
Interventions from a Trauma-Informed Approach
Retaining HCWs during a traumatic time period is a daunting task for health care administrators and human resources (HR) professionals. It requires patience, compassion, organization, and commitment to design structural and interpersonal interventions that ensure that staff are cared for, supported, and appreciated.
One approach to utilize in creating interventions is a trauma-informed approach. The CDC’s Office of Public Health Preparedness and Response (OPHPR) and SAMHSA’s National Center for Trauma-Informed Care developed a framework for their employees to use while responding to public health emergencies (Figure 1). Trauma-informed approaches start from an assumption that people have experienced trauma—in this case, living and working through a deadly global pandemic. This does not mean that HCWs are all traumatized to the same degree, or that they will always experience negative feelings related to trauma. It is simply a perspective to take in order to address all the potential factors contributing to poor mental health in the moment.
Suggestions for Trauma-Informed Interventions by Health Care Administrators, Human Resources Professionals, and Managers
1, Encourage & Facilitate Mental Health Care
Contrary to instinct, many people in helping professions are resistant to asking for help. They may also have difficulty recognizing that they are experiencing a crisis. Healthcare leaders should address the mental health of their employees by openly discussing mental health impacts of the pandemic and the unique challenges of the health care setting, frequently and without judgment. A major barrier to seeking help is finding the time away from work. Organizations should provide employees with paid time to seek psychological help during working hours; and, consider staffing units or floors with an on-call counselor for shorter check-ins, group therapy, or to help with acute moments of stress or crisis.
A major component of burnout is feeling a lack of control or agency over your working environment. In healthcare settings, it can be challenging to exert control with so many human factors; even less in emergency settings. Healthcare leaders can provide employees with agency in other ways, such as the timing of shifts and breaks and assigning working areas.
Another component of burnout is feeling a lack of trust and respect from leadership, and not feeling that your voice or opinion matters. Being transparent can feel risky, but honesty with employees will always build goodwill and trust. When administrators are sharing decisions or changes with frontline staff and managers, emphasize where input or feedback from front-line employees was implemented. This builds trust over time by helping employees feel heard and respected with important information.
As we move towards recovery from the COVID19 pandemic, we must attend to the long-term effects in all areas of our work and personal lives. Using a trauma-informed approach can help administrators, HR professionals, and managers create healthy, sustainable policies in their workplaces that support the wellbeing of their employees, and ultimately the organizational mission.
