By Melinda Young

Natural disasters, pandemics, and other crises can lead to more hospital staff experiencing post-traumatic stress disorder (PTSD) symptoms. Case management directors and other leaders need to screen employees for signs of PTSD and create a prevention plan.

“I think it’s critical that hospitals implement screening programs to assess levels of anxiety, depression, and PTSD so they can identify providers who are experiencing issues and get them support and help,” says Bernadette Melnyk, PhD, APRN-CNP, vice president for health promotion, chief wellness officer, and dean of the College of Nursing at The Ohio State University.

“We know when providers are depressed or burned out, more medical errors are made. That’s a major issue because medical errors are the third-leading cause of death in this country,” Melnyk says. “We should shift our paradigm from crisis intervention to prevention.”

Hospital leaders need to help their staff grieve, says Alexander Wolf, DNP, RN, APRN, nurse practitioner at TriHealth in Cincinnati.

Understand Ethical Dilemmas

In hospitals where personal protective equipment (PPE) is scarce or where providers must decide how to use limited resources, such as experimental treatments and ventilators, nurses and other staff might experience ethical concerns and regret. These issues have been on everyone’s minds during the COVID-19 pandemic.

“We have to help them understand the nuanced ethical issues that play into this pandemic,” Wolf says. “There are whole different ethical concepts that go into those decisions, and it requires a conversation.”

Hospital employees will give everything they have to helping their patients, leaving little time or emotional energy for themselves. One example Wolf witnessed involved an intensive care unit (ICU) physician who had spent 30 hours in the ICU. “He was dog-tired, but he went out of his way to do a daily meeting with us, over the phone,” Wolf says. “We took time to remind him of what he’s doing and to make sure, in the course of being tired and completely overwhelmed, that he needs to remember that he is fulfilling his mission and is making an impact.”

Highlight All the Short-Term Wins

One way to help staff during a difficult period is to acknowledge short-term wins.

“Short-term wins are not necessarily predictable and they may look different from day to day,” says Michelle Sanchez, MSN, RN, Beacon Program manager with the American Association of Critical-Care Nurses (AACN). “A win might be completing a shift without any additional admissions, discharging a patient with COVID-19 to a lower level of care, or implementing an innovative change to typical care processes in the face of challenges presented by COVID-19. It’s important for leaders to celebrate these wins, whether through recognition at the shift huddle, a note of appreciation or encouragement, or a simple cup of coffee.”

Leaders can teach themselves and their staff how to develop a positive outlook, which is an important shield against depression and PTSD.

“A positive outlook can apply to any circumstance. No matter how bad something gets, there’s always something good that comes out from it,” says Garrett P. Salmon, DNP, RN, APN, CRNA, assistant professor at Middle Tennessee State University School of Nursing.

Case managers and other healthcare staff should ask themselves what they did well that day, as well as what they could have done better, Salmon says.

“Look at what you did wrong and how you can get better, and look for positives that come out of that situation,” he adds.

Another tactic is to teach staff to focus on what they can control in their lives and let go of the things they cannot control, such as the amount of PPE or understaffed shifts. “Control your own behavior and how you react,” Salmon says.

Organizations should have wellness support in place, Melnyk says.

“Our work has shown that if clinicians believe they are getting wellness support, their outcomes are better,” she says.