EXECUTIVE SUMMARY

The emotional fallout from the COVID-19 crisis could affect surgery center physicians, nurses, and other employees, but there are ways to prevent the common issues of stress, anxiety, and depression.

Healthcare professionals are under a lot of pressure during the pandemic, including stress over contracting the virus.

Encourage staff to acknowledge their anxiety and find a way to leave their work experiences at work.

Leaders can support staff by encouraging them to take breaks and to designate quiet spaces for mindfulness.


Surgery center leaders can help prevent emotional problems among staff if they acknowledge and assess the potential for stress, anxiety, and depression among nurses, physicians, and others on staff.

Studies conducted before the COVID-19 pandemic revealed nurses and other clinicians faced high rates of suicide, post-traumatic stress disorder, depression, and anxiety. The public health crisis has worsened emotional problems considerably, according to mental health professionals.

“There are a lot of psychological issues involved in being a physician or healthcare professional, whether it’s having to be flexible about converting ventilators or prioritizing surgeries, wishing that you could take care of people sooner,” said Susan McDaniel, PhD, professor of families and health in the departments of psychiatry and family medicine at the University of Rochester in New York. McDaniel spoke at a Newswise media web conference on May 21 about surgeons and other health professionals during the pandemic’s post-crisis phase.

“There also are a lot of pressures on healthcare professionals right now. Fears about their own health, as we haven’t had enough PPE. Fears about their becoming positive, or taking the illness to family members,” McDaniel continued. “I know about residents who are sleeping in their basements and not talking to their family members to try to make sure that they don’t pass it on.”

In a survey of 1,257 healthcare workers in Chinese hospitals, 50% reported symptoms of depression, 45% reported anxiety, 34% experienced insomnia, and 71% reported distress.1

Clinician burnout, depression, and suicide likely will spike after the pandemic, says Bernadette Melnyk, PhD, APRN-CNP, vice president for health promotion, university chief wellness officer, and dean of the College of Nursing at The Ohio State University.

“You will see issues like post-traumatic stress disorder, a lot of chronic grief, in response to this. More depression and, I hate to say it, but I do expect suicides,” Melnyk says. “I published a longitudinal analysis of nurses’ suicide in the country, and it shows that nurses are at higher risk of suicide than the general population.2 That was an issue prior to the pandemic, and it will only grow after.”

A number of physicians, nurses, and others who work in a surgery center setting have helped hospitals that were overwhelmed with COVID-19 patients. Those clinicians were firsthand witnesses to the trauma. But the others who witnessed it from a distance also could be affected emotionally, says Maureen Brogan, LPC, ACS, DRCC, statewide program manager of the Traumatic Loss Coalitions for Youth program at Rutgers University Behavioral Health Care.

“We didn’t have time to prepare this workforce for the level of exposure to trauma and the length of the trauma,” Brogan observes. “People knew it would be traumatic, but we didn’t grasp or understand completely what it would entail.”

When people are under stress, they will not exercise or eat well, and they start drinking and self-medicating, says Garrett P. Salmon, DNP, RN, APN, CRNA, assistant professor of nursing at Middle Tennessee State University. People need encouragement to engage in constructive behavior, he adds.

It helps both leaders and staff to reduce stress when they acknowledge their anxiety and concerns, find a way to leave their work experiences at work, prioritize their goals, and execute, Salmon explains.

“Make a list of the biggest problems you’re facing, execute, and get those things done,” he offers. “It doesn’t have to be a perfect plan because a good plan now is better than a perfect plan several days later.”

There are other ways to help staff cope with the pandemic’s emotional fallout:

Attend to the small stuff. “I’m hearing of people who have not had a water break,” Brogan says.

Healthcare workers should avoid overexposure to the media, Brogan advises. “There’s no escaping it because there is a 24/7 newsfeed, and they’re being inundated by it,” she observes. “Everything in print is something to do with the pandemic; turn on the radio, and it’s about the pandemic.”

Everyone needs a break from the bad news, so they should take time for themselves. Engage in distracting activities such as yoga, running, or walking. Watch TV shows that are funny or light. Read and embrace other hobbies.

Accentuate positive events. “Cognitive behavioral therapy is a frontline treatment for depression and anxiety,” Melnyk says.

This helps people learn how to accentuate the positive and bypass negative events. “Teach people that how they think affects how they feel and behave,” Melnyk offers.

Learn to monitor employees for positive moments, and draw their attention to these good things that are happening. Practice mindfulness techniques, including deep abdominal breathing, which can lower blood pressure and reduce stress. “Those are the kinds of things that have really good evidence of success,” Melnyk adds.

Support workers. It is important for staff to know their leaders care about them and will have their back when they give their all to the job, despite challenges, Brogan says.

“Have supports in place: mental health, peer support, and infrastructure,” she says. “This is not a short-term thing; it is the way we do business. We take care of each other.”

Examples of this support include surgery center leaders encouraging staff to take breaks. If feasible, designate space for employees to retreat and practice mindfulness, or just to escape the frenzy, Brogan says. “We should have a culture that is accepting of that, showing people that self-care is not selfish,” she says. “If you’re not good to yourself, you can’t be good to anyone else.”

Supporting staff also includes putting some flexibility into work schedules and asking employees (through surveys, if possible) for their opinions and their needs. “There is something very validating about that,” Brogan adds.

REFERENCES

  1. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.
  2. Melnyk BM. Burnout, depression and suicide in nurses/clinicians and learners: An urgent call for action to enhance professional well-being and healthcare safety. Worldviews Evid Based Nurs 2020;17:2-5.