Addressing Caregiver Burnout

April 2023 – The Journal of Healthcare Contracting

The last few years have not been kind to the health and well-being of healthcare workers in the U.S. Indeed, the COVID-19 pandemic has put extreme stress on the healthcare workforce in the U.S., leading to workforce shortages as well as increased healthcare worker burnout, exhaustion and trauma, according to an issue brief from the Assistant Secretary for Planning and Evaluation (ASPE) Office of Health Policy, part of the Department of Health and Human Services. “These pandemic-related challenges have taken place in a context of significant pre-existing workforce shortages and maldistribution, as well as in a workforce where burnout, stress, and mental health problems (including an ongoing risk of post-traumatic stress disorder) were already significant problems.”

Some points the ASPE made in its brief:

Many healthcare workers who were not directly caring for COVID-19 patients faced being furloughed or having their hours reduced, particularly early in the pandemic. In May 2020, approximately 15% of hospital workers reported being unable to work at some time in the past 4 weeks because their employer closed or lost business due to the pandemic, compared to 23% of non-hospital healthcare workers. These numbers declined to 1-2% by the end of 2020.

Total employment in the healthcare industry declined during the early months of the pandemic but has gradually recovered since summer 2020. The relative decline in employment was substantially larger for ambulatory care employees compared to hospital employees.

Many hospitals have reported critical staffing shortages over the course of the pandemic, particularly when case numbers were high. During the Omicron surge in January and February 2022, the 7-day average of hospitals reporting critical staffing shortages peaked at 22% during mid-January 2022.

“Even after the pandemic, many of the effects the pandemic has had on the healthcare workforce will likely persist,” the ASPE said. “Addressing these impacts as well as the underlying challenges that predated the pandemic can help build a stronger and more resilient healthcare system for the future.”

A need for support

A recent Pulse on the Nation’s Nurses Survey, conducted by the American Nurses Foundation, examined the impact of the pandemic on the nation’s nurses. Some of the findings:

Nurses reported high levels of feeling stressed (71%), frustrated (69%), exhausted (65%), burned out (49%) and overwhelmed (58%).

Millennial and Generation Z nurses (age 34 and under) conveyed these feelings more than their older counterparts: stressed (81%), frustrated (76%), exhausted (77%), burned out (69%) and overwhelmed (69%).

Nurses of color echoed these feelings. They report feeling stressed (73%) and burned out (55%).

Additionally, an American Nurses Foundation survey in August 2021 found that 34% of nurses do not feel emotionally healthy and 42% report experiencing trauma because of the COVID-19 pandemic. Fifty percent of nurse respondents said they are considering leaving the profession.

Efforts are underway throughout the industry to address the burnout. For instance, in December 2022, the United Health Foundation, the philanthropic foundation of UnitedHealth Group, announced a three-year, $3.1 million grant partnership with the American Nurses Foundation to fight nurse burnout with the Stress & Burnout Prevention Pilot program.

The program is designed to transform organizational culture, remove the stigma associated with seeking mental health support and offer nurses a new burnout prevention model to help them use mental health resources earlier and more effectively, with a particular focus on Millennial and Generation Z nurses, as well as nurses of color, “to ensure their unique experiences are recognized and addressed,” the organization said in a release.

“Given the complexity, intensity and intimacy of what nurses do every day, nurses’ need for mental health support has always existed. This has been exacerbated tenfold by the COVID-19 pandemic,” said Kate Judge, executive director of the American Nurses Foundation. “Burnout cannot just be addressed one nurse at a time. This new partnership addresses burnout at the systems level, especially for those most impacted including younger nurses and nurses of color.”

The American Nurses Foundation will pilot the program, implemented as a train-the-trainer model, in four health care organizations representing over 15,000 nurses in rural and urban locations in acute, primary and long-term care settings. Participating health systems include:

BayCare Health in Tampa Bay, Fla.
Indiana University Health in locations throughout Indiana
University of South Alabama Health Hospital in Mobile, Ala.
Wayne Health Care in Newark, N.Y.

Learnings from these pilot sites will be used to iterate and evolve into a national awareness campaign reaching over 50,000 nurses nationwide.

The pilot program is based on a framework originally developed for the military and since deployed in other demanding professions. It is designed to identify and reduce stress reactions before they develop into lasting issues. It goes beyond identification of burnout to intervention by helping nurses speak about their stress/burnout using a common language, normalize talking about it, and provide support to their peers. Program learnings will also be incorporated into a national awareness and education campaign, providing free anti-burnout resources for frontline nurses and nurse leaders.

The role clinical design plays

Kurt Forsthoefel, director of marketing, Midmark Medical, believes better clinical design can play a key role in building a stronger healthcare system and healthier workplace for our nation’s caregivers. In a blog post on the subject, Forsthoefel wrote that it’s important to not overlook the role clinical design can play in helping non-acute facilities reduce burnout and retain healthcare professionals. “Especially how equipment design, workflows and technologies used in this environment can help create a more positive point of care experience for caregivers.”

Forsthoefel listed several examples:

Exam rooms configured and designed to improve standardization, enhance patient-caregiver interaction and accommodate needed equipment and supplies at the point of care. The exam room should also provide adequate space for caregivers to easily move about or remain seated to minimize unnecessary straining and increase comfort.

Exam chairs that are fully adjustable to prevent caregivers from having to overreach, twist or bend their back or torso too much during exams, and can lower to a height that allows patients to transfer onto and off of the chair without being lifted by a caregiver.

Vital signs acquisition devices bring automation to the vital signs workflow to help ensure a higher level of standardization and minimize human variables, while also auto-connecting with a computer using zero clicks to import data directly into the EMR and eliminate manual transcription errors.

Cabinetry that is designed for average-height healthcare workers, enabling caregivers to easily reach frequently accessed supplies without unnecessary bending, stretching or constant overreaching.

Mobile workstations that can support the needs of nearly all users in the clinical space, allowing them to work from an ergonomically correct position whether seated or standing as to not cause unnecessary strain on the caregiver›s back, shoulder and neck.

Wearable locator badges equipped with a call button that helps improve worker safety by enabling healthcare workers to request immediate help and providing security officials with the worker’s name and location so they can respond in a timely manner.

“As these examples illustrate, clinical design has become a strategic component at the point of care, helping healthcare organizations place staff well-being and satisfaction at the same level of importance as clinical outcomes, patient satisfaction, efficiency and profitability,” he said. “Whether it’s equipment that feature ergonomic principles, technology that offers safety and less clicks or room configurations that deliver standardization and increased efficiency, the end result is a better care experience for caregivers.”