Surgeon General Calls for Support of HCWs
‘The stakes are high’
Battered by a two-year pandemic during which they often had to work under unsafe conditions without adequate personal protective equipment, healthcare workers are on the brink of a “burnout and mental health crisis” that will only worsen if sweeping actions are not taken, warned U.S. Surgeon General Vivek Murthy, MD, MBA.
COVID-19 has been a “fully and uniquely traumatic experience” for healthcare workers and their families, Murthy wrote in an introduction to a recently issued “urgent” advisory on the situation.1
“Fear, loneliness, and uncertainty were pervasive,” Murthy wrote. “The threat of targeted harassment and violence underscored many interactions. Some health workers were forced to wall themselves off from their loved ones. Too many served as the final comfort for patients walled off from [their loved ones].”
Widely hailed as heroes as they faced the first waves of SARS-CoV-2, “this sense of acknowledgment and gratitude has faded — one more victim of the fatigue and frustration wrought by a prolonged pandemic,” Murthy said. “Today, when I visit a hospital, clinic, or health department and ask staff how they’re doing, many tell me they feel exhausted, helpless, and heartbroken. They still draw strength from their colleagues and inspiration from their patients, but in quiet whispers they also confess they don’t see how the health workforce can continue like this.”
The clear message in the 76-page report is that it cannot. Yet, the very necessity of many critical actions should add some momentum to the recovery of a damaged system and its fractured workforce.
“The stakes are high,” Murthy said. “If we fail to act, we will place our nation’s health at increasing risk. … Equally as important, we will send a message to millions of health workers and trainees that their suffering does not matter.”
Americans already are seeing the effects of staffing shortages. If the system continues to unravel, preventive care, emergency care, and medical procedures could be compromised.
“It will make it harder for our nation to ensure we are ready for the next public health emergency,” Murthy noted. “Health disparities will worsen as those who have always been marginalized suffer more in a world where care is scarce. Costs will continue to rise.”
That is the glass half empty — or maybe completely empty — but there is opportunity to change this forecast if the nation makes “a collective commitment” to protect and empower the healthcare workforce.
“When health workers look ahead, they should see a future where their dedication isn’t taken for granted, and where their health, safety, and well-being is as much a priority as the well-being of the people and communities in their care,” Murthy wrote. “Never again should health workers be expected to work under the unsafe conditions that many of them faced during the pandemic.”
Beyond that, violence prevention legislation should be prioritized, and punitive policies for healthcare workers seeking mental healthcare eliminated. A non-punitive track to report substance abuse issues and seek help should be created.
“We can encourage vulnerability and open communication around mental health and substance use care, and promote care-seeking as a sign of strength,” Murthy said. “We can offer evidence-based training and practices that support prevention, early intervention, and treatment of an array of conditions, including burnout and mental health challenges.”
Murthy advocated reducing administrative and documentation burdens in electronic medical records (EMRs). The report states that for every hour of patient care, physicians spend two hours on EMR documentation. Nurses spend 42% of their time in the EMR system and other documentation.
As well as reducing this “cognitive load,” healthcare workers need increased flexibility in work scheduling, competitive wages, paid sick and family leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies including child care and care for older adults for all health workers.
“Health workers are the pillars of our collective health and well-being, and therefore should be valued and respected by their organizations and society,” Murthy said.
The report co-authors urged healthcare workers to be proactive about their own health and learn to recognize the signs of distress in themselves and colleagues. “Stay connected and reach out for help,” the report stated.
The surgeon general included a message to patients that probably should be added to signage at the entry of every healthcare facility: “As a patient, be kind to health workers. While you should absolutely expect quality care and professionalism, acknowledging the pressure that health workers are experiencing can go a long way. Many may be feeling undervalued, overworked, or isolated. Some have faced harassment, stigma, and violence. Health professionals are doing their best to care for you.”
The Hardest Hit
While all healthcare workers have been affected by the pandemic, the surgeon general report lists some particularly hard-hit groups, including:
- Healthcare workers of color. These employees hold a variety of jobs across the healthcare spectrum but are particularly represented in workers with the lowest wages. “They were more likely to care for patients with suspected or confirmed COVID-19, more likely to report inadequate personal protective equipment, and have been nearly twice as likely as white colleagues to test positive for COVID-19,” the report stated.
- Immigrant healthcare workers. While they comprise only 18% of the healthcare workforce, more than one-third of the deaths in pandemic’s first year were immigrants.
- Women healthcare workers. Comprising nearly 70% of the workforce, women experienced higher rates of burnout, depression, and anxiety before and during the pandemic. “They are also more likely than men to be responsible for child care, and as a result, face greater disruptions in their careers and widening disparities in professional advancement,” the report noted.
- Low-wage healthcare workers. Many have worked throughout the pandemic as phlebotomists, orderlies, housekeepers, and cooks. “More than 80% of them are women, and they are also disproportionately workers of color. Almost one-third live below the federal poverty level,” the report noted.
- Healthcare workers in rural communities. A trend of rural hospital closures began a decade before the pandemic and has continued to some degree. As of March 31, 138 rural hospitals nationally were shuttered or converted away from inpatient care. “In March 2020, rural areas had between 37% and 42% fewer ICU beds per persons who were at risk of developing severe COVID-19 based on age and comorbidities than persons in urban areas,” the report stated.
- Healthcare workers in tribal communities. Health workers in tribal communities are chronically under-resourced and face staffing shortages, particularly in behavioral health. “In addition, health workers in tribal areas may chronically experience challenges with safe water, food insecurity, and housing insecurity in their communities, which were exacerbated by the pandemic,” the report noted.
- U.S. Surgeon General. Addressing health worker burnout: The U.S. Surgeon General’s advisory on building a thriving health workforce. 2022.
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