Health workers know what good care is. Pandemic burnout is getting in the way



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Matthew Crecelius, a traveling contract nurse who has worked in a dozen hospitals since the pandemic began, says that he can recall numerous instances where health care worker burnout has had a direct impact on patient care.

Elaine Cromie for NPR




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Elaine Cromie for NPR


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Crecelius says he can recall numerous moments like this one, when the crush of work and burnout among health care staff had a direct impact on patient care.

«That plays out again and again, day by day, at many hospitals, and in my opinion, I think it’s getting worse,» says Crecelius, a traveling contract nurse who has worked in a dozen hospitals since the pandemic began.

Many health care workers surveyed say they feel burnt out and that is impacting patient care. The prolonged battle against COVID-19 has left many doctors, nurses, medical assistants, respiratory therapists and others on the frontline of care exhausted and overwhelmed, fueling greater levels of burnout that were already high. The advent of vaccines against the coronavirus sparked hope of a return to normal — only to be dashed by the latest surge of cases, driven primarily by people who aren’t vaccinated.

«Medicine is a team sport. How many clinicians need to be experiencing burnout until we see an effect on quality?

Burnout is a common term many associate with sheer exhaustion. But the World Health Organization says it’s also characterized by greater cynicism and reduced effectiveness at work. It was a huge problem in health care long before the pandemic. But now the short staffing and crushing and unpredictable workload is contributing to epidemic levels of burnout.

«It’s not good for their mental health; it’s not good for the work environment. There’s increased chance for mistakes, medication errors,» says Ernest Grant, a specialist in burn care and president of the American Nurses Association. Many fellow nurses he talks to say they’re at the end of their rope, which Grant says presents a hazard for any patient needing urgent care right now. «There is no health without nurses,» he says.

Caregivers under extreme stress

But just how much burnout affects patient care is very hard to gauge. Multiple studies have linked burnout to lower quality of care. But many of those studies rely mostly on subjective measures, such as patient surveys and self-reporting by nurses and doctors. So drawing a cause and effect connection isn’t easy.

What happened to Carolyn Dewa in California illustrates why.

After her father was hospitalized in April with cancer, Dewa had a hard time reaching his physicians. Pandemic-related restrictions at the hospital limited when family could visit, and the sheer volume of patients left the staff no time to call the family with updates or to explain treatments.

At one point, doctors treating Dewa’s father halted his anti-stroke medication, thinking his throat might be too constricted to swallow the pills. «No one asked me,» says Dewa, who had been taking care of her father before the hospitalization and knew he was still able to eat and swallow.

As doctors rushed between patients, she says, they were relying more than usual on numbers and charts to make decisions about how to care for each person.

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Carolyn Dewa, a professor of psychiatry at University of California, Davis, studies how burnout affects medical care. She believes she lost her father, who passed away in April, to the effects of health care worker burnout.

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Salgu Wissmath for NPR

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Nurses tend to a COVID-19 patient in an intensive care unit in 2020. Burnout was already an issue among health care workers prior to the pandemic, but short staffing and unpredictable workloads have exacerbated the problem.

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Solutions are in the details

As the problem of burnout multiplies, some health care systems are trying to find solutions – discovering they often are found in the small details of the work.

For much of this summer, Tampa emergency doctor Damian Caraballo couldn’t staunch the flow of unvaccinated COVID-19 patients coming in. Nor could he stop the stampede of coworkers — nurses, EMTs, and lab techs — who kept leaving, making the pace of work more frantic for those who remained.

«Even things as simple as registration; we’re short registration people, and that puts a delay on everything,» Caraballo says. The average waiting time in his ER ballooned to over 10 hours. «So it has a downhill effect.»

«People keep saying, ‘What is the one thing we can do? There is no one solution. There are many.

On balance, the pandemic has made all the normal bureaucratic hassles of the medical system that much more grating, Caraballo says. But he can also point to recent changes that have made a difference: His hospital started allowing remote monitoring of some COVID patients.

«I’ve been able to send people home,» if they have sufficient Internet connectivity, says Caraballo, who is a member of patient-advocacy group Physicians for Patient Protection. Florida also recently relaxed rules about where patients could receive IV infusions of monoclonal antibodies to treat COVID, which also eased Caraballo’s patient load. «All those things would take stress off the hospital because we wouldn’t have to admit these patients.»

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Since the pandemic began, retirement rates of nurses and doctors have accelerated. Crecelius says that increasing reliance on less-experienced health workers can hurt patients.

Elaine Cromie for NPR


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Massachusetts General Hospital implemented a very simple idea from a triage nurse that cut down the number of rubber gloves needed to treat a patient.

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Kate Flock/MGH Photography


Shots — Health News
What’s Doctor Burnout Costing America?

ER doc Damian Caraballo says he encourages the same at his hospital in Tampa: «Offer moral support for them. In the short term, I think that’s the best we can do.»

For the most part, there are not too many quick ways to solve burnout, he says. It doesn’t help knowing the crush of work these days is largely preventable; two-thirds of patients he sees are people with COVID who didn’t get vaccinated — even though they could have — often young people. That fact, combined with staff shortages, » it just creates this really tough environment that makes burnout even worse,» Caraballo says.

Losing passion for the field

The worst part, say health care workers like traveling nurse Crecelius, is that burnout is robbing them of their sense of purpose — making it harder to care about the work itself.

«Last year this time, I had a greater sense of ‘This is kind of my duty.’ » says Crecelius, who says he’s always had an instinct to run toward disaster — wherever help is most needed. While working in the hotspots during the early months of the pandemic, he says, he told himself: » ‘I’m able, I’m young; I can make a difference. Let’s go and see if we can put this fire out.’ «

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Crecelius says that the nursing work he does feels different to him now than when he first began. Though he’s a fifth generation nurse, he is looking to switch careers.

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The Coronavirus Crisis
Nurses Are In Short Supply. Employers Worry Vaccine Mandate Could Make It Worse

  • healthcare workers
  • coronavirus pandemic
  • patient care
  • burnout
  • doctors and nurses



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