The coronavirus (COVID-19) pandemic has taken a toll on its health care workers. According to the Centers for Disease Control and Prevention (CDC), over 340,000 cases of COVID-19 among health care personnel have been reported, and it is estimated that these numbers are grossly underreported. It is estimated that more than 1,700 health care providers have died from COVID-19 since the pandemic began, with more than 200 being nurses. With COVID-19 vaccines beginning to be administered to health care workers, and the general public soon, we are hopeful that this is the beginning of the end. We must recognize the impact this pandemic has had on our health care workers and health care system and work forward to healing our health care workers and health care system.
Healing the health care worker
The first thing we need to address, and perhaps the most important, is how to help our health care provider’s well-being after the last traumatic, stress-filled year. We have already seen and heard the emotional and physical toll it has taken. Between the isolation from family, fear of contracting the illness and bringing the virus home to their families, long work hours, and the loss of family and friends, our health care providers are stressed. The emotional and physical manifestations are real – loss of sleep, grief, anxiety, burnout, depression, and unfortunately, the rising number of suicides. A recent survey reported that eight out of ten nurses stated that their mental health has been affected by the pandemic. In a study by the Society of Critical Care Medicine involving almost 9,500 critical care health care providers, the median self-reported stress score increased from 3 to 8. The top three stressors identified were lack of personal protective equipment (PPE), fear of contracting COVID-19, and the fear of spreading to their families. As a result, many are now leaving the profession.
With the increasing number of COVID-19 cases increasing exponentially, hospitals have been filled, and resources are being strained. Shortages of hospital beds and ventilators, in addition to the shortage of health care professionals, including physicians, nurses, and respiratory therapists, have been a constant challenge. Physicians and other care providers have been faced with the ethical dilemma of rationing care. Rather than prioritizing the well-being of each patient, physicians have been forced to make decisions that maximize the amount of good for the greatest number of patients. Physicians and health care providers have been faced with deciding who gets the available scarce resources.
In addition to the pandemic itself, health care providers have been battling against the endless spread of COVID-19 misinformation and disinformation. With many people in public denying the existence of the virus, downplaying the severity of the illness and pandemic, and continuing to ignore the advice of public health experts, health care providers have been faced with the increased number of cases and surges resulting from group gatherings and community spread of the virus.
Health care administrators must use their influence and resources to assist in caring for stressed-out employees. The first thing that can be initiated is to acknowledge the burden that has been placed on our workers. This will provide the acceptance and understanding that there has been a large emotional price that the pandemic put on our employees.
Staff should also have the opportunity for someone to talk to during their shift. Human resource departments can reach out to staff regarding the organization’s mental health benefits and employee assistance programs. Many staff do not know what services might be included in their health care plans. Services such as yoga, quiet rooms, pack-and-go meals, respite, dog visit options might be available to the staff. Human resources should also encourage the use of paid time off as the census and acuity allow. Enlisting in a chaplain’s services can provide an opportunity to search for spiritual strength, a safe person to talk with, and someone who can inspire. Lastly, if staff is exhibiting signs and symptoms of depression and overwhelming anxiety or lack of coping, a trusted person should have a conversation with the employee and recommend mental health services.
Investing in our staff at this difficult moment will help with the continued fight against COVID-19. At this point, no one knows when we might return to “normal.” We have to continue to keep our patients’ mental and physical welfare and our staff at the forefront. As the pandemic continues its rampage throughout our society, we have health care workers who are tired, frustrated, and emotionally exhausted. We have to have a loss prevention plan in place as health care workers are leaving the profession. Our responsibility is to keep our health care workers safe and minimize the emotional toll as much as we can.
Healing the health care system:
This pandemic has exposed numerous flaws and cracks within the health care system. COVID-19 has brought to light the disparities within the health care system, including access to health care and structural racism among the health care system. COVID-19 has disproportionately affected the Latino and Black communities, low-income populations, and those incarcerated. Tackling the underlying structural racism and improving access to health care are crucial in resolving many of these issues. Many are afraid of seeking help as they fear deportation.
The cost of medical care and the lack of affordable health insurance has forced people to put off physician visits. Many people have lost their health insurance this past year due to layoffs, furloughs, and long-term unemployment. This, in turn, leads to sicker people entering the emergency department.
Health care administrators, providers, and communities must recognize the disparities in the health care system, including access to care and structural racism. They must engage in these difficult conversations and topics and work with the community to develop culturally-sensitive responses.
Regaining the trust of the people and battling misinformation and disinformation
During the past year, people have seen first-hand the evolving process of science. Compounded with the news which has often discredited the virus as a hoax and advertising bogus remedies, it is no doubt that evidence and facts are increasingly viewed with skepticism. As a result, individuals are losing trust in the Institutions, experts, and science itself. To tackle this problem of misinformation and disinformation and rebuild the community’s trust, we must work together as a medical community – of physicians, nurses, scientists, and educators – to disseminate factual proven science, clarify misconceptions, and distinguish facts from conspiracy theories. We must make sure scientific information is reliable and readily accessible to the public, not just within academia. Peer-review processes must also be improved upon, to ensure accurate and reliable information is being disseminated. Physicians, nurses, health care organizations, and public health agencies must all promote basic health understanding. Social media and news media outlets can often reach a large population and, therefore, help clarify common misconceptions and provide direct rebuttals.
Christine Lau is a physician. Collette Williams is a nurse educator.
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