1 in 5 nurses say they’ll quit their careers as pandemic takes steep toll on mental health, WA study shows

In the fall of 2020, a therapist in Seattle, Shelley Green, began taking appointments with health care workers whose lives were so bleak during the COVID-19 pandemic.

Green faced her own pressure. She had given birth in the spring of 2020, during some of the most uncertain days of the pandemic in Washington. As a member of the healthcare community, she felt fortunate to be able to carry out her remedial work remotely from the comfort of her home. For a small group of healthcare workers who don’t have that luxury, you decide to give them treatment for free.

I listened to their concerns. They were afraid of bringing the coronavirus home and accidentally killing a family member. As the months went by, I heard their disappointment. Some of them, she said, have not received so much support at work, from their communities and public officials, that they feel “left to die”.

These days, Greene hears their wrath.

They feel disrespected, even ridiculed, by those most at risk of getting sick or in need of their care: the people who don’t wear masks or refuse to get vaccinated.

Mental health resources from The Seattle Times

Green’s customer experiences are aligned with amazing new research. Repeated exposure to illness and death, and the sense of fear and anxiety that spreads across the medical and first responder communities during the pandemic, is crippling the mental health of many people in this vital workforce, according to a new study published in December. 16 in the Journal of General Internal Medicine led by Dr. Rebecca Hendrickson, MD, a researcher with the VA Puget Sound Health Care System.

More than half of frontline health care workers — and nearly 40% of first responders such as firefighters and paramedics — say the pandemic has reduced their willingness or ability to continue with their careers.

One in five nurses says it is “not at all likely” that they will continue to work in their field within five to ten years; About 17% of first responders said the same. Of the four free agents Green has worked with, she said, only one is still in the job they had before the pandemic.

Being a trusted caregiver – and then feeling helpless in that role – has caused serious feelings of loss and hopelessness.

“Everyone is quitting,” said Laura Wood, a Swedish-Cherry Hill social worker in Seattle, adding that nurses, emergency department technicians, respiratory therapists and social workers are leaving “left and right.” “Our staff is so tired. We are just so tired.”

But the research offers some hope: Even if someone is experiencing the stress of the pandemic, a supportive work environment has made all the difference.

The research suggests that people who felt their employer was looking for them, or not being asked to take undue risks, fared significantly better than those who felt unsupported.

We don’t need to protect people from every side [of their jobs]Hendrickson said. “If you can increase the amount of support people have… you can make a really big difference in people’s experiences and people’s ability to recover and effectively deal with trauma as part of their job.”

red flag

Early in the pandemic, Hendrickson was shocked by the way health care workers in the epicenters of the epidemic — Italy, then New York City — described their sleep.

Although they were exhausted, they struggled to drift off. When they finally did, their days were chasing after their dreams. Nightmares were common. Often they would wake up in a panic.

“That was worrying,” she said. The tales from health care workers sounded eerily similar to the reports from the veterans I worked with at the Department of Veterans Affairs. Hendrickson said that this particular brand of sleep disorder puts people at risk for persistent and long-term symptoms such as anxiety, depression and post-traumatic stress disorder. He was of particular concern to Hendrickson, because he noted that health care workers may continue to have symptoms even after pandemic stresses have subsided.

The overwhelming pressure on health care workers is well documented early in the pandemic. Large international studies on the well-being of health care workers have been published in major research journals. Emergency room doctor suicide making national news. Millions of people whistled and banged on pots and pans in honor of health care workers and their sacrifice.

What was not clear, Hendrickson realized, were the specific parts of pandemic life that had led some but not others to experience psychiatric symptoms — and why it may be difficult for some frontline workers to bounce back when the daily stresses are over.

From September 2020 to February 2021, Hendrickson and her colleagues enlisted 510 first responders across 47 states answered these questions. The researchers did not formally diagnose the participants, but did ask them to complete four standardized psychological assessments, an epidemic-specific questionnaire and questions about their profession. Although much of the study was done before vaccines were widely available — and health care workers found themselves treating COVID-19 patients who chose not to vaccinate — Hendrickson is now enrolling more participants and following up with early participants to see if anything might work. change for them.

In general, researchers have found that the greater the stresses associated with an epidemic a person experiences, the greater the psychological burden they will bear and the more likely they are to leave their profession.

The epidemiological experiences of participants have been associated with symptoms of depression, anxiety, insomnia, and post-traumatic stress disorder. Feelings of frustration, in particular, predicted high levels of psychological symptoms and a lack of interest in their jobs.

More than 12% of health care workers, and nearly 20% of first responders, have reported that they have thought about harming themselves, or they would be better off dying, at least several days in the past two weeks. Paramedics had a uniquely high prevalence of these types of harmful thoughts, suggesting that they in particular might benefit from mental health support.

“It was kind of overwhelming and a red flag,” Hendrickson said. “We have an urgent need to address these issues because there is a high level of suffering and distress…and we have a moral obligation as a society to address the kind of suffering in the people who have worked so hard to protect us all during this pandemic.”

caring for caregivers

Wood, who evaluates depressed and suicidal patients in the emergency room, has a unique window into the trauma of health care workers.

“Because that’s my specialty, my co-workers will come in and share their problems with me,” Wood said.

Her colleagues care for sick and dying COVID-19 patients alone. Some have reported falling ill, fearing the shock they will return to on their next shift. Those who eventually decided to quit, she said, experienced symptoms ranging from insomnia to suicidal thoughts to overwhelming feelings of sadness, anxiety and depression.

Wood, an executive board member of the Swedish Health Care Federation, said the facility had recently added a new mental health feature at the union’s request. Employees and their family members now have access to online mental health care and get 25 free visits each year. “You can see someone the same day or the next day,” she said. “It really increased the reach.”

The idea that the health care workforce needs better support isn’t new, said Elaine Walsh, an assistant professor at the University of Washington School of Nursing, but it “has reached its peak and really reached a moment of crisis.”

In addition to accessing mental health care, systemic changes such as ensuring workers have breaks — and that breaks are truly comfortable — will also help, Walsh said. Wood said the staff shortage at the Cherry Hill facility, for example, has made it difficult for employees to take time off.

Giving workers free parking or other benefits can also make a difference, Walsh said. Making sure workers have a way to provide feedback to employers about their needs also helps build trust, Hendrickson said. To combat burnout, health care workers here are also pushing for retention bonuses and incentive payments for employees who take extra shifts.

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Therapist Green said, employers also have a responsibility to train workers to recognize what’s called secondary trauma — when someone experiences psychological trauma or their experiences. As caregivers, there is a culture and an expectation that first responders and health care workers push through: they move into the next room, handle what the next person needs, take it home with them, and get up the next day to do it again.

Often, people in health care don’t acknowledge the damage this mindset does to mental health, and how it can make it difficult for people to do their job well, Hendrickson said. Of the clients she’s worked with, Green said, not many realize that this type of trauma has a name.

“She was like, ‘It’s too hard for us. We are always the last to ask for what we need because we see ourselves providing what others need,” she said of someone she spoke with.

Recently, when speaking with a friend who is a nurse, Green encouraged her to seek out a therapist among a growing network of mental health providers who have come forward to offer free care.

Her friend’s response was similar to what she had heard from others – one worried that what they had been through wasn’t bad enough – that they weren’t shocked enough by this pandemic to care about someone else’s money.

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