Healthcare providers on the brink
Thursday, June 06, 2019
No one in their right mind would argue that healthcare careers aren’t stressful. Burnout, depression, stress-based illness, and even suicide are common in certain populations of healthcare workers.
If our nation and the world depend upon nurses, doctors, pharmacists, and other professionals to provide care that millions of patients require, why are we ignoring the stressors that cause healthcare providers to develop debilitating symptoms, abandon their careers, or even take their own lives?
Nurses at the Edge
The reality of nurse burnout is well-documented. Bullying and incivility (also known as lateral or horizontal violence) among nurses has also been thoroughly researched. New and seasoned nurses alike leave the profession in droves each and every year due to their inability to work under such conditions.
High nurse-patient ratios and other staffing issues are cited by nurses as a source of stress and untenable work environments. Being unable to practice safely is not a recipe that bodes well for a happy and satisfied nurse workforce.
Nurse managers understand the deleterious impact of nurse attrition on staff morale, workloads, institutional budgets, patient satisfaction, health outcomes, infection rates, and other factors.
With nurses constituting the largest segment of the healthcare workforce, high rates of attrition are problematic at best, and disastrous at worst. As the backbone of the healthcare machine, we simply cannot deliver the patient care we’re committed to providing when nurses drop like flies and turnover rates skyrocket.
Nurses are not infallible; they are, in fact, as prone to stress, depression, or anxiety as workers in other industries, all while managing care under significant duress.
Physician Suicide: A Disturbing Reality
According to Medscape, American doctors face the highest suicide rate of any profession. Statistics state that one physician per day takes his or her life, with 28 to 40 per 100,000 suicides being double the average for the general population. Untreated or undertreated depression is a factor, as is massive debt, legal liability, overwork, and a pervasive culture of martyrdom.
Medical students also suffer, and although maximum awake hours during medical training have been decreased, anecdotal evidence points to continued mental health issues among both medical students and residents. The culture of working to the bone is persistent throughout the medical profession, and the results are alarming.
The aforementioned Medscape article also notes that, with the knowledge and means to make lethal plans, physicians are more apt to complete suicide attempts; this is dangerous knowledge indeed.
Healing Hearts and Minds
Healthcare personnel face multiple challenges, whether in the hospital, community, or other environments. We must offer healing to the hearts and minds of those who provide care; otherwise we’re utilizing woefully compromised staff in our attempts to treat patients.
Solutions are difficult to come by in a system with ingrained cultures and practices, no matter how negative those dynamics may be. Change — even positive change — often meets resistance, and money is often cited as one reason to maintain the status quo.
If we think supporting staff is expensive, how much more expensive are doctor suicide, nurse attrition, and decreased patient satisfaction scores and Medicare reimbursements? Eschewing meaningful staff assistance is penny-wise and pound-foolish, not to mention ethically and morally irresponsible.
When we’re losing one doctor per day to suicide and scores of nurses consider leaving the profession— including new nurses who are sorely needed to fill the leadership pipeline during a nursing shortage fueled by older nurses retiring — something must change. Some ideas for instigating change include, but are not limited to:
- Increased effectiveness and availability of Employee Assistance Programs (EAP) for healthcare personnel
- Mentoring programs that support new nurses and physicians as they launch their careers
- Effective, non-stigmatizing treatment for substance abuse, depression, and other mental health issues
- Holistic career counseling
- Stress reduction initiatives
- A further decrease in the hours medical residents remain awake and working
- More robust loan forgiveness programs for medical professionals
- Courses on resilience, mental health, emotional intelligence, and suicide prevention for healthcare professionals
- Ongoing challenges of the status quo
Moral Leadership Needed
There is no panacea or silver bullet that will fix this problem overnight, but there is plenty of research, data, and evidence-based interventions that can move us in the right direction.
We need moral leadership within the healthcare sphere that overcomes the objections of the bean counters who say we can’t afford to help these overworked personnel who staff our medical institutions.
We are in utter need of a paradigm shift that allows for a change in a pervasive culture that values martyrdom, self-sacrifice, and suffering. This, of course, must ultimately come from within each individual, yet employers, managers, professors, and mentors can walking the talk by demonstrating how a balanced and healthy life is indeed possible.
Until we take individual and collective action, nurses will continue to develop stress-based illnesses and leave the profession in droves, medical students will experience mental health issues and addiction, and 400 or more physicians will complete a suicide each year.
These crises can be averted, yet decisive action and inspired leadership must pave the way in order for this deadly and unhealthy zeitgeist to change.
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