{"id":8887,"date":"2024-03-05T09:38:30","date_gmt":"2024-03-05T14:38:30","guid":{"rendered":"https:\/\/jordanbarab.com\/confinedspace\/?p=8887"},"modified":"2024-03-04T17:11:35","modified_gmt":"2024-03-04T22:11:35","slug":"protecting-healthcare-workers-caring-for-the-caregivers","status":"publish","type":"post","link":"https:\/\/jordanbarab.com\/confinedspace\/2024\/03\/05\/protecting-healthcare-workers-caring-for-the-caregivers\/","title":{"rendered":"Protecting Healthcare Workers: Caring for the Caregivers"},"content":{"rendered":"

W<\/span>orking in health care has always had its risks and challenges: exposure to infectious diseases, long hours, shift work, back injuries, violent physical assaults and the emotional toll of witnessing human suffering. These demanding working conditions exact a toll of those providing direct patient care (physicians, nurses, therapists, technicians), but also affect emergency responders, long-term care staff, public health workers, and others who provide support services in our nation\u2019s health care organizations.\u00a0 [Just now recalling my college summer job in housekeeping at a local hospital, where I saw pain, sadness, and worry in patients\u2019 rooms on a daily basis.]<\/p>\n

The statistics bear that out. OSHA reports<\/a> that more workers are injured in the healthcare and social assistance industry sector than any other. This industry has one of the highest rates of work related injuries and illnesses and it continues to rise.<\/p>\n

But even though healthcare has always been a high-risk occupation, it wasn\u2019t until the early 1990\u2019s during the AIDS epidemic, that OSHA finally issued its bloodborne pathogens standard. Aside from the short-lived COVID-19 emergency temporary standard, issued in 2021, the agency has so far done little else to address hazards in healthcare, although OSHA is progressing on standards to protect healthcare workers from infectious diseases and workplace violence.<\/p>\n

The COVID pandemic has only exacerbated health and safety challenges faced by healthcare workers. Studies and surveys have found high levels of stress, anxiety, exhaustion, and burnout in health care workers during the pandemic (for example, see here,<\/a> here,<\/a> here<\/a>, here<\/a>). These impacts have enormous costs. One study<\/a> estimated the societal costs of health care worker burnout in the U.S. to be $4.6 billion!\u00a0 Our providers are worn out. \u00a0And worn out, stressed out exhausted healthcare workers cannot be good for patients.<\/p>\n

Adding to the burnout were the thousands of healthcare workers who died from COVID-19, many because of the shortage of adequate personal protective equipment, especially N-95 respirators, and the CDC\u2019s errant recommendation that surgical masks would adequately protect healthcare workers.<\/p>\n

Adding to that tragedy is the fact that we no accurate count<\/a> of the number of healthcare workers who died from exposure to COVID-19 in the workplace.<\/p>\n

A \u00a0national survey<\/a> of clinical and non-clinical staff conducted in the early days of the pandemic found the following:<\/p>\n

Proportion of Respondents Reporting Burnout, Intent to Leave, and Work Overload by Role Type*<\/strong><\/p>\n\n\n\n\n\n\n\n
<\/td>\nBurnout<\/td>\nIntent to Leave<\/td>\nWork Overload<\/td>\n<\/tr>\n
Physician<\/td>\n47.3%<\/td>\n24.3%<\/td>\n37.1%<\/td>\n<\/tr>\n
Nurse<\/td>\n56.0%<\/td>\n41.0%<\/td>\n46.9%<\/td>\n<\/tr>\n
Clinical Staff<\/td>\n54.1%<\/td>\n32.1%<\/td>\n47.4%<\/td>\n<\/tr>\n
Non-clinical Staff**<\/td>\n45.6%<\/td>\n32.6%<\/td>\n44.5%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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*Table 2 from Rotenstein LS, Brown R, Sinsky C, and Linzer. M. The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19. Gen Intern Med 38(8): 120-127, 2023<\/strong>
\n**Non-clinical staff included housekeeping, administration, receptionists, schedulers, lab or X-ray technicians, finance, food service, IT support, and researchers without a clinical role.<\/strong><\/font><\/span><\/p>\n

The public health workforce has also experienced significant losses. Data from a nationally representative survey<\/a> of state and local government public health agency workers in 2021 revealed that approximately 40% intended to leave their jobs within the next five years. Of those, 76% began thinking about leaving since the start of the COVID-19 pandemic.
\nClearly, the COVID pandemic further strained and exhausted our healthcare and public health workers, and it has taken yet another toll on their mental health (see here<\/a>, here<\/a>). The tragic death of Dr. Lorna Breen, medical director of the emergency department at New York-Presbyterian Allen\u00a0Hospital, was a window into the immense pressure and demands faced by our health care providers in the onslaught of the pandemic.<\/p>\n

Dr. Breen died by suicide on April 26, 2020 (read more about it here<\/a>, here<\/a>, here). <\/a>After contracting and recovering from COVID herself, Dr. Breen returned to her ER and hospital overwhelmed with incredibly sick patients, limited personal protection, insufficient supplies (including oxygen), and not enough help. Though depressed and despondent over the situation, she did not seek help for fear that it would impact her career It was a wake-up call that led to the creation of the Dr Lorna Breen Health Care Provider Protection Act (more here<\/a>, here<\/a>). Signed into law in 2022, the Act has funded $103 million across\u00a044 organizations<\/a>\u00a0to implement evidence-informed strategies that reduce and prevent suicide, burnout, mental health conditions, and substance use disorders. \u00a0Read more about what the grantees are doing here<\/a>.<\/p>\n

The American Journal of Public Health has just published a supplemental issue entitled Health Worker Mental Health: From the Current Crisis to a Sustainable Future<\/em><\/a>.\u00a0 The special issues was conceived and sponsored by NIOSH and the CDC, with support from the American Rescue Plan Act which included funding for research, interventions, training, and education in response to the mental health crisis unfolding due to the COVID-19 pandemic.<\/p>\n

The issue includes articles that explore trends in mental health and well-being, evidence-based interventions and call for additional research, leadership and change at the organization, state, and national levels.<\/p>\n

Work: A Social Determinant of Health<\/h2>\n

Employment provides both benefits and risks to working people. As such, work is recognized as an important determinant of health (see here<\/a>, here<\/a>, here<\/a>).\u00a0 Exhaustion and emotional burnout in our nation\u2019s health care workers certainly takes a toll on their health and wellbeing. It also can impact patient care (e.g., increased risk for medical errors, lower-quality care) and be costly for the organizations that employ them (e.g., absenteeism, turnover; increased insurance costs).<\/p>\n

It doesn\u2019t have to be this way. There\u2019s no mystery around the psychosocial work factors that can impact workers\u2019 mental health and well-being; they include excessive job demands, low control over work, harmful supervisory and managerial practices, ineffective or lack of communication, bullying, and incivility (See here<\/a>, here<\/a>, here<\/a>). \u00a0And there\u2019s plenty of information on how to create a healthy work environments (here<\/a>, here<\/a>, here<\/a>).\u00a0 In 2021, NIOSH created a Health Worker Mental Health Initiative<\/a> to safeguard and promote the mental health of health workers. It includes a 5-part plan to raise awareness of the issue and urge employers to take action, with a focus on primary prevention. NIOSH Director Dr. John Howard and CDC official Debra Houry write about it here<\/a>.<\/p>\n

Empowering Workers: The Union Solution<\/strong><\/h2>\n

Forming a union is one sure-fire way to enhance worker health and wellbeing \u2013 and improve patient care. They give workers more control over their pay, benefits, and working conditions. Unions collective workers\u2019 concerns and demands and counter the enormous power of employers.\u00a0 The Economic Policy Institute reports<\/a> that:<\/p>\n