Surgeon General Vivek Murthy on Monday released a new advisory about the growing crisis of health care worker burnout—offering several recommendations for organizations to better support and retain health care workers going forward.
Even before the pandemic, burnout among health care workers had increased to "crisis levels." According to data from the National Academy of Medicine, 35% to 54% of nurses and physicians and 45% to 60% of medical students and residents reported feelings of burnout before 2020.
The pandemic has also significantly increased health care workers' feelings of stress, exhaustion, and anxiety. For example, a survey of 1,100 health care workers from June to September 2020 found that 93% reported being stressed, 86% reported anxiety, and 76% reported burnout and exhaustion.
"Today, when I visit a hospital, clinic or health department and ask staff how they're doing, many tell me they feel exhausted, helpless and heartbroken," Murthy wrote in the report. "They also confess they don't see how the health workforce can continue like this."
Amid this increased stress, many health care workers are leaving or are considering leaving their jobs. In a survey by the American Association of Critical-Care Nurses, 92% of respondents said the pandemic "depleted nurses at their hospitals and cut career short." In addition, 66% of nurses in the survey said they considered resigning because of their Covid-19 experiences.
According to the Bureau of Labor Statistics, there will likely be a shortage of 1 million RNs by the end of the year. Similarly, a report by Mercer Health Care Market Analysis estimates that there will be 3 million fewer low-wage health workers in the next five years, and the Association of American Medical Colleges predicts there will be up to 139,000 fewer physicians by 2033.
If these labor shortages in the health care industry continue to grow, patients are likely to experience negative consequences, including delayed or limited access to care, particularly in marginalized communities. In addition, shortages will make it more difficult for health systems to prepare for future Covid-19 surges or other public health emergencies, Murthy wrote.
In the report, Murthy made several recommendations for health systems, insurers, community members, and others to help retain health care workers and support their mental health.
According to Murthy, health systems should foster an environment that values their workers' well-being by offering a living wage, paid sick and family leave, and adequate rest breaks.
Health systems should also encourage collaboration and social support in the workplace to reduce workers' loneliness. In particular, establishing a chief wellness/well-being officer role could help organizations track workers' well-being and make changes as needed.
To help workers with their mental health needs, Murthy recommends that organizations offer confidential mental health services, such as hotlines and employee assistance programs. Other ways health systems can support their workers include initiatives to prevent workplace violence, reduce the spread of misinformation, and provide sufficient personal protective equipment.
Insurers should improve mental health coverage for health workers, Murthy wrote, including by expanding telehealth coverage for behavioral health care and making sure there are enough mental health and substance use providers participating in their networks.
In addition, insurers can improve the quality of health care by supporting workers who spend more time with patients, instead of making them feel penalized in fee-for-service reimbursement systems. "When health care is constrained to be delivered in 15-minute intervals, trust and communication between patient and provider can suffer," Murthy wrote.
Insurers can also reduce the administrative burden health care workers face with prior authorization and other documentation or reporting requirements. According to the report, implementing a fully electronic prior authorization system could save $417 million annually and reduce the time health care workers on such transactions by up to 12 minutes.
For community members, Murthy recommends reaching out to the health care workers, checking in on them and paying attention to potential warning signs of distress, including increased irritability, social withdrawal, and excessive alcohol or substance use.
Community members can also do their part to reduce the burden on the health care system and on health care workers by staying healthy and keeping up to date with vaccinations and preventive care. People should also follow all local public health guidelines to reduce the spread of disease, such as Covid-19.
"Confronting the long-standing drivers of burnout among our health workers must be a top national priority," Murthy wrote. "COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point. Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk." (Gonzalez, Becker's Hospital Review, 5/23; Berryman, Modern Healthcare, 5/23; AHA News, 5/23; U.S. Surgeon General's advisory, 5/23)
In the wake of Covid-19, health care organizations must commit to providing targeted baseline emotional support for the three types of emotionally charged scenarios that health care employees are likely to encounter in their careers: trauma and grief, moral distress, and compassion fatigue.
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