FEATURE
Up In Flames
While wildfires devour parched landscapes this summer, frontline Oregon health care workers are feeling another kind of burn By K.M. Collins
C
onjure a memory of Central Oregon deep summer triple-digit heat thick with hazy smoke and humidity. Now imagine you’re working a 12-hour shift in the designated outdoor COVID tent where you aren’t allowed to keep a water bottle with you and full Personal Protective Equipment is required at all times— aka sticky plastic full-body garb. This was the mid-pandemic recurring Groundhog-Day nightmare that Alison Fountain, a Central Oregon-based urgent care nurse, found herself in off and on over the last 18 months. Now imagine amplifying the incubi. Cue the PPE shortage. “It caused a whole other level of burnout,” Fountain laments. “Being told to reuse masks that have already been worn for over 12 hours, trying to re-sanitize a single-use mask and give it to other caregivers, and being given protective gowns that on the box says, ‘not to be used for isolation against viruses’ was a complete joke.” It’s no wonder Fountain (and so many other health care professionals) are feeling burned out. Fountain says burnout feels like, “A dread of going to work. Waking up in the morning before a shift and throwing a fit before heading out the door. Being tired most of the time (both physically and mentally). Hiding a negative-trending attitude really well. My internal dialogue is one of a negative nature these days—which is not who I usually am.” When Jen Rainey, an Oregon-based oncology physician’s assistant, was confronted with the reality of working during a shortage of adequate PPE, she and her health care co-workers felt like single-use masks themselves: disposable. 12
“If you don’t feel protected or safe where you work, even though you know you’re a valuable resource, it’s not a good feeling. People felt like they were busting their butts for patients, but extra efforts were lost in the distraction of COVID,” Rainey said. To boot, Rainey’s particularly vulnerable oncology patients need both reassurance and close monitoring in the face of COVID. In the current setting of widespread staff shortages throughout the health care system, providers are not necessarily set up for increased patient volume. Rainey says transitioning to telemedicine early in the pandemic was particularly challenging. “At the start of COVID I always wondered, did I miss something on that call, or would I have gotten something different if it was an in-person meeting? Though telemedicine has been necessary, it has contributed to provider burnout. A lot of us hadn’t done much telemedicine before COVID and we had to figure out how to give good care and keep patients at home.” On top of this she has seen a huge spike in daily phone calls—which she must return, in addition to her regular responsibilities. These are not Rainey’s preferred methods of meeting with patients and not what she was expecting or anticipating when she got into medicine. Rainey says burnout looks like, “Feeling overwhelmed to the point you can’t solve easily fixable problems anymore. Compassion fatigue. Losing trust in the leadership of the organization you work for. Entire team apathy, as opposed to just a provider occurrence. It’s an entire health care team thing. It’s easy enough to rally around an individual experiencing burnout and help them out. But when the team
WWW.BENDSOURCE.COM / AUGUST 19, 2021 / BEND’S INDEPENDENT VOICE
Courtesy Jen Rainey
Jen Rainey, PA-C, MPH.
as a whole is burnt out, that is hard to recover from.” For Christina McKeown, a hospital nurse who formerly lived in Central Oregon, COVID burnout looks like extreme fatigue, lack of enthusiasm for work that she would have typically loved and feelings of hopelessness. To sum it up, McKeown says, “Heaven knows those of us in medicine have been through the wringer.” Ileana Bourland, licensed acupuncturist, herbalist and owner of Heal Grow Thrive Medicine, had to shut down her practice in March 2020 when national COVID restrictions were first put into play. “I was very concerned about my patients who use acupuncture and massage for pain management. Many would otherwise take opiates or other medication and still have to go to the ED [emergency department] or urgent care for help with their pain. My stress was very high as I learned how to navigate Governor Kate Brown’s and the Oregon Health Authority’s rapidly changing guidelines regarding COVID safety. In mid-April 2020, we were able to reopen for emergency, physician-referred patients only. I was
thrilled to be able to open our doors, but I was plagued with the stress of trying to get it right.” Emergency, physician-referred patients are typically disadvantaged financially and otherwise, and/or veterans. Defining Burnout The National Center for Biotechnology Information published a paper in 2020, “Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies,” defining it as such: “Burnout is a work-related stress syndrome resulting from chronic exposure to job stress. The term was introduced in the early 1970s by psychoanalyst Herbert Freudenberger and has subsequently been defined by Christina Maslach, et al, as consisting of three qualitative dimensions which are emotional exhaustion, cynicism and depersonalization, reduced professional efficacy and personal accomplishment.” Clearly not outliers, many of the experiences Fountain, Rainey, McKeown and Bourland express are defined in this paper, and bolstered by a recent poll from Kaiser Family Foundation and The Washington Post, which found that six out of 10 health care workers are currently struggling with mental health issues as a result of the pandemic. More than half say they are burned out as a response to chronic stress at work. Dr. Angelina Montoya, who’s practiced psychiatry in Bend since 2005 and is a member of the Deschutes County Medical Society, has counseled a number of health care providers in various positions including nursing, physician assistant and physician. From these visits she has gleaned, “I would characterize their concern not so much as burnout but more as feeling overwhelmed with
