Burnout among healthcare frontliners

“Burnout happens when you avoid being human for too long”. – Anonymous

An apt description for a syndrome whereby the characteristics include a high degree of emotional exhaustion causing sense of self-doubt and failure. Feeling trapped, helpless and defeated. Detachment, desolate feeling alone in the world.

There is a lack or even loss of motivation and increasingly negative and cynical outlook. The person also feels decreased satisfaction and sense of accomplishment at work.

Covid-19 has called upon the dedication and efforts of physicians, nurses and other hospital staff to the fore, no other than as frontliners. In times of exigency and crisis, healthcare workers continue to give daily care to patients, despite at great risk of their own safety.

The National Institute of Occupational Safety and Health (NIOSH) a division of the Centre for Disease Control and Prevention (CDC) highlighted that these situations exacerbate the risk of burnout owing to excessive workloads, extended working hours, increased work stress and a much higher influx of critically ill patients.

There has been an increase in the prevalence of burnout and it has been made worse during the pandemic which means patient safety and staff wellness are in jeopardy. NIOSH stated that healthcare frontliners experiencing fatigue could risk their own health and safety, which increases their vulnerability to infectious diseases like Covid-19, work related injuries and serious safety occurrences vis-a-vis the patients.

Causes of burnout

Many factors can cause burnout and some of them are of greater intensity in healthcare. Some of the factors causing burnout are the extra hours required and the ratio of nurse-to-patient.

It could also be due to being compelled to learn and use technology including the ubiquitous and exacting Electronic Health Record (EHR) affecting relationships with colleagues and patients. There is a perception that health systems and hospitals are behemoths and megaliths which prioritise the bottom line than quality of care.

Efforts to help reduce the risk of burnout

All areas of healthcare must collaborate to help alleviate the injuries and risks caused by fatigue. Some issues can be solved at the personal level, but others require systemic transformation.

It is worth explaining that these recommendations can only be efficacious and essential during a more halcyon period when the pandemic at it its lowest ebb.

Below are steps that can be taken that have the healthcare industry’s attention.

Staff should not be allowed to do too long an extended shift. Short breaks
should be allocated at reasonable periods say, every two hours, during their shifts with intermittent short naps and longer breaks for meals. During a crisis, give a minimum of 10 hours off in between shifts of every 24 hours and one full day rest for every seven days for sufficient sleep and recovery.

See burnout from a systems viewpoint

Countries generally found that clinician burnout is a serious nationwide problem and according to the US National Academy of Medicine, it needs to be resolved at the institutional level, not personal. It is from the systems aspect involving healthcare regulations, policies, work culture and expectations of society.

Caring and communication

Employee’s health and safety should be important as much as their concern for giving the best possible care to patients. Employees are encouraged and given opportunities to communicate what they need. After operations begin to stabilise as crisis begin to show less intensity, employers will do their best to engage their staff by having counselling, and stress debriefings.

Lighten the burden on technology demands

It is found that the design and exacting aspects of EHR are directly associated with stress and burnout among clinicians. Taking steps to improve matters like excessive data entry, slow systems, unnecessary information, slow navigation and workstation ergonomics may help alleviate stress on the job.

There must be a balance between utilising technology providing care and staff especially physicians using it experiencing stress. Administrators can raise key issues at industry level with regards to the intricacy and complexity faced by staff.

Doing away with doctors’ comparison

There have been calls to do away with doing peer comparisons among doctors, comparing them in their prescriptions and work which causes anxiety and can add to causes of burnout

Burnout is an unfortunate syndrome plaguing healthcare frontliners especially physicians even from the time before the pandemic but made worse since its onset. Despite this, there seems to be a dearth of studies assessing the correlationship between safety attitude and psychological impact.

Furthermore, studies examining the correlation between personal traits and psychological impacts are limited during Covid-19. Worldwide efforts at doing the findings are haphazard and it is a matter of concerted effort to find ways to address the complexity of the problem.

There is an equivalent as in ‘industry alienation’ especially in the aspect of feeling detached from the job.

Doctors have complained that not much has been done to address the problem as the above limited findings would have illustrated the situation. — The Health

Zulkifli Ahmad is the founder of ESG Vision, a think tank advocating ideas and actions on sustainability. He is also a member at KSF Space Foundation USA and a member of ICC’s Chambers Climate Change.