The Mental Health Impacts of Healthcare Burnout

The Mental Health Impacts of Healthcare Burnout

April 9, 2021

THE MENTAL HEALTH IMPACTS OF HEALTHCARE BURNOUT

Healthcare professionals are in the midst of one of the most challenging and traumatic periods in the history of healthcare in America. Dealing with the COVID-19 pandemic has taken its toll, exacerbating burnout and mental health issues to extreme levels. Healthcare professionals are often treating the influx of COVID-19 patients under extraordinary pressure and are faced with the reality that they can transmit the disease to loved ones and one another due to greater levels of exposure. AMN Healthcare survey data shows that the pandemic is extending this issue beyond burnout, but is leading to increased alcohol use, drug use and suicide rates amongst caregivers. The severity of the impact cannot be understated on current and future generations of healthcare providers.

Burnout is defined by the Agency for Healthcare and Research Quality as a long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of sense of personal accomplishment. Recognizing the seriousness of the issue is only one step. What can healthcare organizations do to help their healthcare professionals? This report will examine the severity of burnout, mental health and physical well-being issues in healthcare and the impact of mindfulness as an effective intervention for healthcare organizations to provide more support for employees.

COVID-19 AND MENTAL HEALTH

The fallout surrounding unemployment increases, social isolation, and financial instability have created a perfect storm for depression among all age groups, with some groups reporting a tripling in rates of anxiety and other symptoms of declining mental health.

A recent study from Boston University found that those with lower income were twice as likely to have depression. Some reported depression levels exceed those seen after major events such as September 11 and Hurricane Katrina.

The cascading effects of growing depression on many demographics of the population is creating a domino effect on clinicians who care for these patients. When you add the pre-pandemic reasons that were contributing to clinician burnout-i.e., increasing patient loads, high cognitive burdens, and the complexities of reimbursement models-to COVID-19 related problems, it creates a level of distress in the healthcare workforce that must be addressed.

THE HISTORY OF HEALTHCARE BURNOUT AND THE WORKFORCE DILEMMA

Prior to the pandemic, the Association of American Medical Colleges (AAMC) reported that the U.S. would face a shortage of 139,000 physicians by 20333, but these numbers pale in comparison to the total number of shortages the country may experience in years to come.

A recent study from Boston University found that those with lower income were twice as likely to have depression. Some reported depression levels exceed those seen after major events such as September 11 and Hurricane Katrina.

The cascading effects of growing depression on many demographics of the population is creating a domino effect on clinicians who care for these patients. When you add the pre-pandemic reasons that were contributing to clinician burnout-i.e., increasing patient loads, high cognitive burdens, and the complexities of reimbursement models-to COVID-19 related problems, it creates a level of distress in the healthcare workforce that must be addressed.

THE HISTORY OF HEALTHCARE BURNOUT AND THE WORKFORCE DILEMMA

Prior to the pandemic, the Association of American Medical Colleges (AAMC) reported that the U.S. would face a shortage of 139,000 physicians by 20333, but these numbers pale in comparison to the total number of shortages the country may experience in years to come.

In fact, the U.S. Bureau of Labor Statistics reports that 1.1 million additional nurses will be needed over the coming years to address an aging population, especially given increases in life expectancy and the comorbidities that accompany the aging process. With over 1,000,000 nurses currently over the age of 50, the need is further exacerbated with retirements increasing for this critical member of the healthcare community.

In pre-pandemic 2019, the rate of physician burnout was already hitting new highs-with 77.8% reporting some level of professional burnout-a rate nearly twice as high as those experienced by workers in other fields. As a result, healthcare facilities are also feeling the effects of physician burnout, with the cost of replacing a physician staff member who leaves their facility reaching between $500,000 and $1,000,000.5 Organizations will also feel the impact on the nursing side, as a 2019 AMN survey of RNs indicates that each percent change in nursing turnover costs the average hospital $328,400.

Burnout amongst healthcare professionals is not a new phenomenon. With long hours, high pressure and critical stakes, healthcare professionals face high levels of stress in the best of times. AMN Healthcare data going back to 2012 highlights this issue, citing factors such as stress, staffing shortages and work/life balance as impactful factors.

Healthcare organizations are learning that burnout is a problem that is both widespread and affects more than just staff satisfaction and retention. Research also shows that staff disengagement and its symptoms across teams influence quality of care, patient safety, teamwork and patient satisfaction.

When you add the expeditious effects of COVID-19 and growing staffing shortages into the burnout equation, it becomes obvious that the phenomenon must be addressed sooner than later. In fact, the World Health Organization now officially characterizes clinician burnout as a medical disease.

According to Merritt Hawkins' 2020 Physicians Foundations Survey, the ramifications of the pandemic have contributed to increased levels of alcohol abuse, drug use and even suicide rates among physicians and other clinicians.

BY THE NUMBERS: COVID-19s GROWING EFFECT ON HEALTHCARE PROFESSIONALS

Early in the COVID-19 worldwide crisis, all efforts were focused on dealing with the immediate, daunting issues facing healthcare providers: bed capacity, adequate personal protective equipment (PPE), drug and vaccine research … and managing a very uncertain healthcare environment. But while the spotlight was shining brightly on these critical issues, the growing, serious problem of mental health has been lurking in the shadows.

In the face of this unprecedented challenge, the strain on healthcare professionals has been pushed to new heights, leading to extremely serious mental health issues and physical wellbeing issues amongst caregivers.

These rising numbers coincide with what today's healthcare leaders are saying in a recent AMN survey of more than 550 healthcare executives. They cite caregiver burnout and shortage as the most disruptive forces within the healthcare industry over the next three years, with more than 36% of the group referring to it as a very disruptive factor.

The severity of this impact cannot be overstated, leading healthcare organizations to devise solutions to help clinicians not only recognize their own symptoms, but also get them the help they need.

THE ROLE OF HEALTHCARE ORGANIZATIONS IN BURNOUT

As healthcare organizations and facilities come to terms with the continuing fallout of the COVID-19 pandemic and its effect on clinicians, they are looking for ways to address this growing concern. According to the 2020 Merritt Hawkins survey, nearly half (49%) of U.S. physicians believe COVID-19 won't be under control until after June 1, 2021, hence the need to address clinician burnout sooner than later is extremely important.

'Clinicians are living through a historical shift in the way they practice and deliver care to patients. Not only is the delivery of care changing, but those delivering the care are under more pressure than ever, ' said Dr. Cole Edmonson, DNP, RN Chief Experience and Clinical Officer, AMN Healthcare. 'Across the healthcare industry, we need to acknowledge these wellbeing issues, destigmatize seeking mental health support and make sure that we are providing the right resources to help clinicians face these challenges.'

Adding physicians, nurses and other healthcare staff to the corporate conversation is an integral part of addressing burnout and its effects across the healthcare spectrum.

The natural assumption for healthcare organizations is to expect that these serious mental health and physical wellbeing issues will recede over 12-24 months as vaccine rollouts improve and the current strain on the healthcare industry lessens.

The reality is that pandemics or disasters often have a hidden 'fourth wave,' which plays out over years. When a crisis comes to an end, this wave hits, where people have to come to grips with what they experienced, often taking a significant mental toll. Healthcare professionals are likely to be the most impacted by this fourth wave, and healthcare organizations need to continue to focus on mental wellbeing issues through and beyond the pandemic.

A NEW PERSPECTIVE

Many healthcare organizations are faced with a dire situation as it comes to their workforce, with the impacts of COVID-19 intensifying mental health, physical wellbeing and burnout issues. Combatting this challenge is daunting. So, what can be done?

Right now, healthcare professionals are not taking advantage of mental health resources or being given resources to help deal with these issues. A recent AMN Healthcare survey of nurses indicated slightly over half of nurses do not routinely access mental health or wellness resources.

The first step for organizations is to recognize that mental health of employees is critical and that leadership can commit to take steps to help within their organizations. Here are three steps healthcare organizations can take to improve mental health.

COMPASSIONATE LEADERSHIP

While this pandemic has greatly challenged the healthcare industry, one doesn't need to search long to find true stories of inspiration and compassion within healthcare organizations. Throughout this crisis, healthcare professionals have risen to the occasion time and time again and this is often inspired by those at the top. Caring and authentic leaders that lift up individuals and teams during difficult times create compassion at all levels within the organization and can greatly impact the health of the organization as a whole.

'Compassion has always been central to caring. As we all face unprecedented challenges today and our mental health suffers as a result, it's important leaders learn to respond and support employees with care and compassion. This is the true meaning of authentic leadership and is what great teams and communities are built upon,' said Headspace's Chief Strategy and Science Officer Dr. Megan Jones Bell.

Here are some ways leaders can build a compassionate culture at their organization:

• Create honest, open relationships with their team
• Listen to input and value contributions from all levels of the organization
• Acknowledge and normalize stress and anxiety in the workplace
• Display flexibility as a leader to ensure an opportunity for change

ADDRESS BURNOUT FROM ALL ANGLES

As previously acknowledged, burnout in healthcare professionals is the result of increasing stress and anxiety in the workplace. However, the solution is much more complex than simply reducing workload as many may assume. Employee burnout needs to be addressed holistically in order to fully support mental health. Leaders should consider the documented six dimensions that contribute most to stress, anxiety, and burnout at work.

• Control: perceived ability to influence decisions relating to their work and to exercise autonomy
• Reward: includes monetary, social, and intrinsic rewards
• Community: social interaction at work, including social support and working with a team
• Fairness: the extent to which people perceive organizational decisions as equitable
• Values: the alignment of personal and professional beliefs and motivations
• Workload: overall job demands

It's important to note that a shortfall in one area does not necessarily lead to burnout as it is hard for an individual to feel fulfilled in all of these areas all of the time. Proactive leaders can help individuals who have an imbalance in some of these dimensions by ensuring the other areas are being met.

INVEST IN MENTAL HEALTH AT THE ORGANIZATIONAL LEVEL

Dedication and commitment to supporting employees' health should be visible at all levels within the organization, but especially at the leadership level. Organizations can take steps towards this commitment with structure and policies that show investment in forward steps. Examples of these organization steps could be:

• Providing opportunity for mental health breaks from work, separate from other time off
• Offering additional services such as family support, financial health, coaching, etc.
• Offering in-person as well as digital resources and tools to support mental health
• Investing in mindfulness solutions that reduce stress and build resiliency

'Leaders have a unique opportunity to support employees' mental health in a variety of ways. It's important to offer multiple options for employees, from training to digital tools and beyond, to ensure unique needs and preferences can be met. Equally important is to have the commitment to mental health represented at every level of the organization so support is modeled and felt by everyone,' said Headspace's Senior Director Behavioral Science, Dr. Clare Purvis.

THE IMPACTS OF MINDFULNESS

Research shows that mindfulness meditation can significantly impact employees in the workplace by reducing stress and burnout and increasing resilience. Meditation works by helping people regulate emotions, changing the brain to be more resilient to stress, and improving stress biomarkers. Workers in many high-stress occupations, such as healthcare professionals, call-center employees, and bankers, have experienced health benefits such as decreased stress after mindfulness training.

One study found that after eight weeks of mindfulness training, nurses had significantly decreased stress levels and improvement in general health. The same improvements were sustained four months after the training. Another example looked at employees of a call center working for a financial institution. These people experienced decreased stress after listening to two short meditation sessions daily for five weeks. Going a step further, the clients of these employees actually had increased satisfaction levels over time.

While there are many factors contributing to healthcare burnout and the serious mental issues outlined above, meditation and mindfulness is one tool that healthcare organizations can further explore to alleviate some of these issues.

In fact, the research they've conducted has been published in 26 peer-reviewed journals, with 65 professional partnerships helping to pave the way for new data and solutions.

MOVING FORWARD

Burnout and mental health issues will have a long tail, and upcoming healthcare workforce issues will only intensify the problem. Healthcare organizations face a daunting task as vaccine rollout is already placing further stress on already burnt out healthcare professionals. We encourage healthcare providers to closely monitor issues of burnout, focus on ensuring they are correctly staffing their facilities and to embrace new and creative ways to support employees through avenues like digital mindfulness.

For more information about how your organization can address burnout issues, go to www.headspace.com/work or www.amnhealthcare.com.

ABOUT AMN HEALTHCARE

AMN Healthcare is the leader and innovator in total talent solutions for healthcare organizations across the nation. The Company provides access to the most comprehensive network of quality healthcare professionals through its innovative recruitment strategies and breadth of career opportunities. With insights and expertise, AMN Healthcare helps providers optimize their workforce to successfully reduce complexity, increase efficiency and improve patient outcomes. AMN total talent solutions include managed services programs, clinical and interim healthcare leaders, temporary staffing, executive search solutions, vendor management systems, recruitment process outsourcing, predictive modeling, language interpretation services, revenue cycle solutions, credentialing and other services. Clients include acute-care hospitals, community health centers and clinics, physician practice groups, retail and urgent care centers, home health facilities, schools and many other healthcare settings. AMN Healthcare is committed to fostering and maintaining a diverse team that reflects the communities we serve. Our commitment to the inclusion of many different backgrounds, experiences and perspectives enables our innovation and leadership in the healthcare services industry. For more information about AMN Healthcare, visit www.amnhealthcare.com.

ABOUT HEADSPACE

Headspace was created with one mission in mind: to improve the health and happiness of the world. Reaching 70 million users in 190 countries, Headspace was one of the first meditation apps in the world and remains a leader in mindfulness and mental training. Headspace is committed to advancing the field of mindfulness through clinically validated research, with one of the largest research pipelines of any digital health and wellness company. Headspace operates a B2B business (Headspace for Work) to offer its mindfulness products and services to more than 1,800 companies, such as Starbucks, Adobe, Hyatt and Unilever, to help them build healthier, more productive cultures and higher performing organizations. Headspace supports government entities like New York State and the UK's National Health Service (NHS) to offer digital mental health tools. Headspace partners with many of the world's most-recognizable brands, including Apple and Amazon, as well as with Nike, NBA and the U.S. Women's National Soccer Team to offer sport and movement content. Headspace Health is Headspace's digital health subsidiary pioneering new ways to incorporate the Headspace mindfulness experience into digital medicine. Headspace has been recognized by Fast Company as one of the World's Most Innovative Companies, Apple's Best of 2018, Samsung's Best of 2019 and one of CB Insights' top digital health companies, along with being selected for five Webby Awards in health and fitness between 2018 and 2019. For more information please visit us at www.headspace.com, or follow us on Facebook, Twitter and Instagram.

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