• US Surgeon General Sounds Call on the Crisis of Healthcare Provider Burnout

    Burnout is a crisis injuring healthcare providers, other medical workers, patients, and the US healthcare system, and confronting it must be made a top national priority, according to US Surgeon General Vivek Murthy, MD, MBA.

    On May 23, Murthy’s office published “Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce.”  Among other things, the advisory outlines challenges healthcare workers faced prior to the COVID-19 pandemic, and how the pandemic exacerbated already taxed and troubled providers.

    His 76-page call to action is dedicated to the memory of those healthcare workers who perished in the COVID crisis caring for their patients.  “During the COVID-19 pandemic, thousands of health workers lost their lives.  They put their own health and safety at risk so they could heal and comfort others.”

    In the advisory, Murthy suggests practices and policies that health care organizations, insurers, technology companies, lawmakers, academics, and communities can take to tackle the problem “so that health workers can thrive and better answer their call as healers.”

    ‘Long-standing drivers of burnout’

    “The nation’s health depends on the well-being of our health workforce,” Murthy stated in a news release about the advisory.  “Confronting the long-standing drivers of burnout among our health workers must be a top national priority,”

    “COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point,” his advisory continued.  “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.  This Surgeon General’s Advisory outlines how we can all help heal those who have sacrificed so much to help us heal.”

    The document cites the finding of the National Academy of Medicine (NAM) that, even pre-pandemic, burnout had reached “crisis levels” among the US health workforce, with 35% to 54% of nurses and physicians and 45% to 60% of medical students and residents reporting symptoms of burnout.

    It’s collective, not individual

    Burnout is defined in the advisory as “an occupational syndrome characterized by a high degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low sense of personal accomplishment at work.”

    But the document is quick to assign the problem and potential answers to it to the systems in which healthcare professionals struggle.

    “Burnout is associated with risk of mental health challenges, such as anxiety and depression—however, burnout is not an individual mental health diagnosis,” it reads.  “While addressing burnout may include individual-level support, burnout is a distinct workplace phenomenon that primarily calls for a prioritization of systems-oriented, organizational-level solutions.”

    Beyond moral distress is moral injury

    The NAM has also previously called for action on moral distress which takes place when an individual knows the ethically correct action to take but feels powerless to take that action.  The advisory report cautions that repeated and sustained incidents of moral distress can lead to moral injury, then cites its linkage to “feelings of profound guilt, shame, anger, and other psychological impacts.”

    And while education, training, and career experience have all been shown to help prepare health workers to cope with morally distressing situations, many may still experience moral injury if additional systems reforms are not implemented.

    Similarly to the Surgeon General’s call to action, the NAM has advocated for additional dialogue, empirical research, effective interventions, as well as interventions to:

    1) identify factors that mitigate the impacts of moral distress or impair moral strength, and

    2) identify and implement organizational and systems changes to prevent moral distress and foster moral strength among health workers.

    6 action imperatives for addressing burnout

    Murthy proposes 6 specific topline recommendations to address health care worker burnout:

    Transform workplace culture to empower health workers and be responsive to their voices and needs.

    “We can begin by listening to health workers and seek their involvement to improve processes, workflows, and organizational culture,” Murthy stated in the press release.

    Eliminate punitive policies for seeking mental health and substance use disorder care.

    The advisory calls for healthcare leaders to ensure on-demand counseling and after work hours care so as to be more accessible to health workers to promote and preserve their well-being.

    Protect the health, safety, and well-being of all health workers.

    Health care organizations should provide workers with living wages, paid sick and family leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies including childcare and care for older adults, the document states.  These organizations must ensure adequate staffing, including surge capacity for public health emergencies, that is representative of the communities they serve.  “This is critical to protect and sustain health workers and communities,” Murthy said.

    Reduce administrative burdens to help health workers have productive time with patients, communities, and colleagues.

    The advisory cites 1 study which showed that on average, for every hour of direct patient care, a primary care provider will spend 2 hours a day on administrative tasks.  “That is time that could be spent with patients, in the community, and building relationships with colleagues, which is essential to strengthening the health and well-being of both health workers and patients,” the press release said.

    Prioritize social connection and community as a core value of the healthcare system.

    This includes peer and team-based models of care to strengthen collaboration and create opportunities for social support and community, the document specifies.

    Invest in public health and our public health workforce.

    A thread throughout the document is a clarion call that remedies must span levels of public and private authority:  “Federal, state, local, and tribal governments should diversify and expand the public health workforce and improve disease surveillance systems to help address social determinants of health and health inequities, counter health misinformation, and strengthen partnerships across clinical and community settings.”

    Tip of the burnout iceberg?

    The problem has potential to get even worse due to current and projected shortages of physicians and other medical workers, Murthy said, citing the US Bureau of Labor Statistics and the Association of American Medical Colleges that shows that the country will need 1.1 million nurses to replace those retiring at the end of 2022.  Further, he cautions, within 5 years, there is a projected shortage of more than 3 million low-wage health workers, and by 2033, there is a projected shortage of up to 139,000 physicians.

    Hitting home

    Just last month, the AANA Journal published a pivotal article on burnout, job satisfaction, and turnover experienced by CRNAs during COVID-19.  The article cites that close to 40% of CRNAs reported high levels of occupational burnout during the pandemic, and that ~80% reported high levels of disengagement including exhaustion.  Don’t miss the full article here.

    AANA offers a rich collection of resources to its members who may be experiencing burnout and compassion fatigue, including tips, videos, research articles, and more.  Finally, if you are a CRNA or SRNA struggling with drugs or alcohol, you can reach out for confidential peer support 24 hours a day to the AANA Helpline at 800-654-5167.

    Drug or Alcohol Concerns?

    Call the AANA Peer Assistance Helpline