COVER STORY COVID-19 Demands Correspond with

COVID-19 Demands Correspond with Uptick in Burnout Among Healthcare Professionals

Many nurses disillusioned due to overwork and lack of support from administrators

BY BECKY GILLETTE

Burnout among nursing professionals was an issue long before the coronavirus disease 2019 hit the U.S. beginning in March putting nurses on the front lines of the worst pandemic seen in 102 years.

As of early August, Florida had nearly a half million people test positive for COVID-19, and 7,279 deaths. The state is experiencing one of the worst outbreaks in the country.

Even before going to work carried a risk of contracting a highly-contagious and potentially deadly disease – and the risk of bringing the virus home to loved ones at high risk for complications from COVID-19 – nurses were leaving the medical field due to high stress and poor mental health. Many reported becoming disillusioned due to being overworked and lacking support from administrators.

Now with some hospitals overwhelmed by the number of COVID-19 patients, nurses and other healthcare professionals are working longer hours while struggling to balance high-quality patient care with the increasing amount of paperwork required to document COVID-19 cases.

“An uptick in COVID-19 cases corresponds with an uptick in burnout among healthcare professionals at a time when more than ever before we need nurses to pull together during this crisis and step up in partnership with nursing leadership,” said Dr. Renee Thompson, a nursing professional development/bullying and incivility thought leader, and founder of the Healthy Workforce Institute. “We can’t wait until this crisis is over before we take positive action to protect our front-line nurses and healthcare teams from burnout and mental exhaustion.”

The pandemic resulted in many non-urgent surgeries being stopped temporarily, and a trend toward patients avoiding hospitals and clinics out of fear of the virus. With revenues down drastically and losses mounting, some hospitals and clinics have cut staff, resulting in even more work for the remaining employees.

“Many nurses, including my colleagues in Central Florida, have observed that the healthcare environment is getting more and more stressful and that they are being asked to do more and more with less and less, thereby adding to feelings of not being able to keep up with the demands,” Thompson said. “Since the global pandemic hit, healthcare leaders started cutting back on their resources to the point where they have stopped investing in their people – stopped offering the very same programs that could help their teams protect their physical, emotional, and mental energy to ride this additional wave. When things get tough financially, administrators cut back on education and development first. Over a period of time, they realize their mistake and then spend more time, energy, and financial resources to compensate for that mistake. Yet, here they go again making the same mistake.”

After leaders realize it is a huge mistake to stop developing their people, they have to double up and spend even more money to re-develop their people when the crisis is over.

A Kronos Incorporated study in 2017 reported 98 percent of hospital nurses report their work is physically and mentally demanding. More than half – 63 percent – said their work resulted in burnout.

“That was in 2017,” Thompson said. “Fast forward to 2020, the physical and mental demand on nurses is extraordinary. Now they’re battling exhaustion and burnout due to COVID-19. When COVID-19 hit, healthcare teams were called upon to save the world. And they did. They made it through and when cases started to drop, they claimed victory over the virus.

However, they didn’t realize that the battle had just begun. Before they had a chance to recover and recuperate, they’ve been called upon yet again. The world went from praising the healthcare team as heroes to worrying about their physical, mental, and emotional health as this crisis drags on. As COVID-19 cases rise, so do physician and nurse burnout.”

Some nurses are quitting. Thousands have come down with COVID-19 themselves requiring them to take off work for at least a couple of weeks. Kaiser Health News estimated in late July that 898 frontline healthcare workers in the U.S. have died of COVID-19.

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The crisis of today raises concerns for the future.

“During a time when we need more people to enroll in nursing programs, the programs are struggling to properly educate their students by providing them with good clinical experiences,” Thompson said. “Also, more and more people who considered becoming a nurse are now having second thoughts. After all, why would they put their lives and potentially, the lives of their families, at risk? I’m concerned the nursing shortage that we have been fighting to stop will see epic numbers in the future.”

Compounding all that is layoffs because of declining revenues.

“There’s already a fear response occurring among healthcare teams,” Thompson said. “And now they’re watching their colleagues being furloughed, laid off, or quitting. Nurses are worrying that they might be next.

Before the pandemic, there used to be breaks in the schedule that helped with resilience.

“You had good days with stable patients,” she said. “Sometimes the unit was quiet and you could get caught up on education, attend committee meetings, and work on projects. Now, there is NO break. Nurses and physicians have gone from ‘normal’ burnout to consistent, unrelenting burnout and now, exhaustion. Anyone can handle a crisis when it’s short term. Not when the crisis becomes the new norm.”

Thompson advises against waiting until the pandemic subsides to address the issues.

When people are exhausted and burned out, not only do they underperform, but they also spread that stress and burnout to others. Nurse burnout begets more nurse burnout.

“When nurses don’t feel valued, they become disengaged,” she said. “When they disengage, they don’t advance the science of nursing and, may not have the mental and physical capacity to effectively care for patients. Therefore, healthcare executives need to focus just as much on strategies to reduce their healthcare team’s stress and burnout as they do managing their influx of COVID-19 patients.”

During the pandemic, some healthcare teams have pulled together and put aside their differences to meet the unprecedented demand. Some organizations are learning how to live with COVID-19 and not be paralyzed because of it. Other healthcare teams have fallen apart.

“During this time we’ve seen more complaining, nitpicking, arguing, and myopic attitudes – even from some of the ‘nice’ nurses,” Thompson said. “Some of this uptick in disruptive behavior is because of the extreme stress nurses and physicians are under. We can all misbehave when under stress. However, when there is no relief from that stress, we just accept the bad behavior as the new norm. Nurses and physicians are misbehaving. Increased, ongoing, relentless stress is at the root of their behavior. Leaders are even more reluctant to confront them because the leaders understand why they’re behaving this way. When disruptive behaviors go unaddressed, they escalate.”

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Thompson offers following strategies to reduce nurse burnout:

Protect your brain from negative news.

Your brain is the primary source of energy because it controls the release of hormones that play a significant role in where your available energy is spent. The brain is the conductor in an orchestra of chemicals. Just three minutes of negative news in the morning increases your chances of having a bad day by 27 percent.

Tip: Instead of listening to negative news on your way into work and on your way home, listen to inspiring music, an audiobook, or even have a conversation with a great friend who is upbeat and positive. You are influenced by everything your brain is exposed to. Be careful what you put into it.

Laugh as often as you can.

When you laugh, like exercise, you release endorphins that act as powerful stress busters. And here’s the good news: your brain doesn’t know if you’re laughing for real or laughing for fake. When you laugh, even if you just force yourself to laugh, you release magical stress-fighting chemicals.

Tip: Watch a funny cat video (or two), practice laughter yoga, share funny stories at work, or have a break with a colleague who is upbeat and funny. Laughter is one of the most powerful cortisol squashing weapons we have – and it’s free!

Eat real foods.

We spend half of our energy digesting our food, and that’s if we’re eating healthy foods that our bodies recognize. We use more energy digesting processed, high fat, and artificially-laden foods. The food we eat should increase–not decrease–our energy. Choose wisely.

Tip: As Michael Pollan says, eat real food–mostly plants–not a lot. So, put down the donuts and eat a banana instead. Take “baby steps” in changing bits and pieces of your eating habits.

Ask for help.

Many nurses think that by asking for help, they are admitting failure or that they are weak. Smart people ask for help to solve problems. They get advice on handling complex situations and delegating appropriately to others.

Tip: Identify one thing that you struggle with at work (for Thompson, it was chest tubes) and ask for help from a colleague who excels at it. Graciously thank this colleague and tell them what his or her support meant to you. Research has demonstrated that tying the goal (e.g., insert a chest tube) with the result (e.g., better patient care), we are more apt to achieve this goal. Caring for patients is a team sport.

Stay away from “energy vampires.”

Unfortunately, there may be people you work with who suck the life out of you. Imagine how draining it can be if negative people constantly surround you. Over time, you can become negative too. Therefore, the key is to move away from them.

Tip:

If you’re in the break room and a vampire starts complaining, just leave.

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LET’S TALK

Four Women are Redefining What it Means to be a Urologist

These physicians at Orlando Health are unique in their specialty

Everybody has a heart. Everybody has lungs. Everybody has a digestive tract and nervous system.

We have these things regardless of whether we are male or female. Everybody also has a urinary tract, but because that system is interrelated with our reproductive systems, there has traditionally been a divergence in the genders of the physicians in these practice areas: Obstetrics and Gynecology (OB/GYN) for women and Urology for men.

Now, if you accept the proposition that patients generally prefer to be treated by a member of their own gender, especially when it comes to matters relating to their reproductive system or sexuality, it probably makes sense that more than 80 percent of OB/GYN’s are women. After all, obstetrics and gynecology deal with bodily systems that are uniquely female. But if that’s true, why is urology so dominated by male physicians?

According to the latest census by the American Urological Association, only nine percent of urologists are women. And yet, as Jacqueline Hamilton, MD, of Orlando Health Medical Group is quick to point out, “Women and children also have urological issues; anyone who has a urinary tract can have issues.”

So, while that statistic might look like a hurdle for some doctors to overcome, it has become an inspiration and an opportunity for Dr. Hamilton and three other urologists at Orlando Health who are the only women urologists in Orlando.

Dr. Hamilton, who has been in practice for 22 years, the longest in the group, said it’s about time that attention turns to women in this profession, hoping that it will help inspire more women in medical school to consider urology.

Dr. Hamilton was drawn into medicine by her father who was a general surgeon. From the time she was a little girl, she spent hours in his office. By the time she was a pre-med student in in college she was allowed to scrub in to watch her father perform surgical procedures during breaks from school.

She knew she wanted to be a surgeon, but it wasn’t until a woman urologist gave a presentation at Howard University College of Medicine that she knew urology was the field for her. “I pulled her aside after her lecture and asked her about women in urology and what her practice was like. And she allowed me to come in and shadow her, and that was eye-opening. I decided then that urology was the career I wanted to pursue.”

Years later, Dr. Hamilton had the opportunity to reprise her own experience. At a urology conference, she met Esther Han, another urologist sub-specializing in Female Pelvic Medicine and Reconstructive Surgery.

How small the number of women in urology is really obvious at professional conferences, said Dr. Han. “I joke that when you go to a Urology conference, there’s never a line outside the women’s restroom.” So, while the prospect of living in Orlando’s sunny climate was very enticing, the opportunity to work in a health care system with other women urologists really helped seal the deal for Dr. Han.

“Women have issues that urology can specifically treat,” said Dr. Han. “Gynecologists and primary care physicians treat reoccurring urinary tract infections to some degree, but you may need a urologist for voiding issues, incontinence surgeries, kidney stones and the like.”

One of the elements of urology that Dr. Han especially likes is its blend of surgery and “a lot of medicine in the more traditional sense. It’s a good balance of both. There are not a lot of emergency issues,” she said. “But helping patients improve their quality of life can really make a huge difference.”

Making a difference in people’s lives drew Nahomy Calixte, MD, into the practice. She’s part of the PUR group at Orlando Health South Lake Hospital. She had grown up in the Caribbean and was inspired to become a doctor by reading about the medical heroics of Doctors Without Borders, the international organization that sends physicians to trouble spots around the globe. With the support of her male and female mentors the idea of becoming a doctor to help others, which seemed a dream, became a reality.

During her rotations in medical school at Boston University, Dr. Calixte discovered that many urologists were able to overcome the awkwardness of their interactions with patients through gentle humor and that was one of the aspects of the field that she found appealing. And since most of her patients are men, the ability to make light of what might otherwise be embarrassing, helps a great deal.

This area of practice also enables her to indulge in her original passions, traveling the world to provide medical care and helping those who are without the financial or

family support structures. For example, several years ago, she was in Mongolia with International Volunteers in Urology. The fourth woman urologist in the Orlando Health system came to the United States from Albania with her parents when she was a child. Ruth Strakosha, MD, often served as a translator for her family members, including her grandfather when he needed to visit a urologist. That doctor, David Jablonski, MD, would go on to lead the Medical Group in which she is now a urologist, herself.

Dr. Strakosha says this is an exciting time to be a woman in urology. “It’s exciting because I see more and more women in the field. When I started in this field there weren’t many women at all, but now there are more every day.” The lack of role models can be a challenge, she said, but emphasized the support she has gotten from mentors and teachers regardless of their gender.

In fact, that’s a point each of these women took pains to note. The field of urology is the least gender-diverse specialty in modern medicine, but it is also a deeply collaborative and collegial profession where excellence matters more than one’s sex.