A New Era of Healthcare Burnout

Frank Aviles, PT, CWS, can remember a time before healthcare burnout. Today, though, the symptoms are all too frequent. The sleep disturbances. The physical exhaustion. The mental anguish. When only a few years ago those symptoms may have been an aberration, now they’re the norm.

He also knows he’s not the only one experiencing them.

Sobering statistics

A 2021 survey by the Washington Post and the Kaiser Family Foundation found that 55% of frontline healthcare employees in the United States had reported experiencing burnout during the COVID-19 pandemic.

Among those reports, the highest rate of those affected were the youngest of the industry’s staff members — those ages 18-29 — who reported signs of burnout at a 69% rate. This same cohort also reported the highest negative impact of the pandemic on mental health, with 75% of the more than 1,300 respondents claiming that the pandemic has contributed to mental health problems.

These alarming numbers are part of the reason that Aviles, along with other healthcare professionals, believe that the current rate of burnout will forever change the dynamic of the healthcare industry. It will also require the entire healthcare community to remain vigilant to the consequences of burnout.

“It’s my opinion that the rate of burnout happening today . . . will definitely impact the future of healthcare,” said Aviles, the wound care clinical coordinator at Natchitoches (LA) Regional Medical Center, where he is responsible for overseeing and assisting with wound care practices across the continuum of care for the hospital’s network.

Related: Ethics and Moral Distress for Healthcare Professionals

Burnout defined

Nearly 50 years have passed since German psychologist Herbert Freudenberger was credited with defining the concept of burnout at the research level when, while observing volunteers working at a free clinic in New York City, he described those affected by burnout as displaying “the loss of motivation, a growing sense of emotional depletion, and cynicism.”

However, it wasn’t until 2019 that the World Health Organization (WHO) officially began to classify burnout as a medical diagnosis, including listing the condition in the International Classification of Diseases.

Today, the healthcare community knows well that the scope of burnout is wide ranging. Burnout takes on many iterations, produces a cascade of symptoms, and can collectively impact individuals in a variety of ways.

For purposes of their 2021 survey, the Post and the Kaiser Family Foundation defined burnout as “mental and physical exhaustion from chronic workplace stress.” The consensus seems to be that burnout is present at the point in which one believes there’s no hope of improvement, whereas stress typically produces feelings that allow for the thought of change to produce better outcomes and feelings.

Rachel Montañez, a professional career coach, describes burnout as “when the old you has disappeared, and all you’re left with is the physical and emotional residue of burnout and a shell of yourself.”

Blyss Splane, BSN, RN, CNOR, describes burnout as also including depression, emotional exhaustion, headache, insomnia, increased frustration, and negative feelings of self-worth.

COVID and healthcare burnout

Prior to the arrival of COVID, many healthcare professionals had a different sense of what burnout looked like, as well as its long-term and short-term triggers, says Eve Bloomgarden, MD, Director of Thyroid Care at NorthShore University Health Systems and Chief Development Officer at Women in Medicine.

Based on her own experiences and observations, burnout was typically born out of burdens associated with “administrative tasks” such as overwhelming amounts of documentation and after-hours charting. The pressures of time management, constantly busy work environments, and work-life balance were also common burnout triggers.

Since COVID, however, these challenges have been exacerbated by the added need to care for more and sicker patients. “Patients are now sicker after not being seen for two years,” said Bloomgarden. “There’s also ‘long’ COVID and millions of people who have experienced tragic loss. Our patients are angrier, and [they’re] taking it out on healthcare staff.”

Aviles says that the trickle-down effect of increased admissions comes on top of additional difficulties like staff shortages, requiring a mobilization of existing staff members to cover critical departments. With many facilities stretched perilously thin, this staffing shortage has taken a toll nor only in his facility but in all healthcare organizations.

“As time has continued with new variations of COVID-19, it seems as the ongoing long hours, limited supplies, difficulty providing access to patients needing care has left us with no end in sight and has increased the tendency for all of us to experience burnout more frequently today,” said Aviles.

Related: Boundaries and Burnout: Strategies for Nurses to Maintain Self

Additional stressors

Bloomgarden says that the associated “white noise” about the pandemic has also had negative consequences for all healthcare professionals. “This includes the politicization of masks, vaccines, schools, and the task of caring for people who refuse to believe that the virus was real,” she said. “[Healthcare professionals] who advocated for public health measures on social media or to their patients, especially for vaccines, experienced so much bullying and harassment that they were often silenced.”

Burnout in nursing leadership

Though the increased rate of burnout has started to get more attention, Dawn Neuhauser, MSN, RN, executive director of nursing at City of Hope, Duarte, CA, one of the largest cancer research and treatment organizations in the United States, worries that not enough attention is being given to the pressures faced related to burnout, specifically by those who serve in executive, administrative, and staff management roles.

“There’s a lot of literature out there right now about how to help frontline staff through the pandemic, but we also need to acknowledge how to take care of our leaders so that they can continue to help to care for their staff members,” she said. “Management has always had to ensure that staff were taking care of their frontline workers as much as we could during this pandemic. We’ve needed to focus on supporting them while knowing that they have increased levels of burnout. But we are also experiencing the same stressors and the same burnout. We’re also less likely to be able to disconnect from work because we are more tethered by phone or email. And that has resulted in some to either retire early or make the decision to move into different types of work.”

The present and future costs of burnout

In what has become known as the “Great Resignation,” approximately 4 million employees in the U.S. quit their jobs in July 2021, with resignations peaking in April and remaining “abnormally high.”

In all, tens of millions of Americans have changed jobs or quit working during the pandemic. The effect on the healthcare industry has been particularly intense and could continue to be for some time, says Aviles.

“Simply stated, staff shortages have increased the responsibilities of others who now need to work longer hours to successfully provide patient care and to even keep doors open,” he said. “I’m seeing more of a need to cross-train staff. Additionally, new workers who are entering the workforce may be more enticed by other options that might include the opportunity to travel at a higher salary. And they are leaving facilities with no pool or a smaller pool of candidates to select from. Others are choosing to retire. This can all be overwhelming.”

Other trends that Neuhauser and her colleagues are noticing include fewer candidates at entry-level management positions. “Our sense is that people have observed how difficult that job can be and do not have the same interest in that type of position as they’ve had in the past,” she said. “We are currently having discussions about how to recruit into our entry-level management positions.”

Bloomgarden is particularly concerned about the potential fallout if certain trends do not reverse course.

“We have a limited workforce right now with a tsunami of people needing healthcare, which is creating an untenable work environment,” she said. “Staff members feel this and cannot work in an environment where everyone is burnt out. It takes months to years to fully integrate someone into a clinical workflow and to train someone in the needs of a specific job. There aren’t enough people in the job market now to run many outpatient practices, and nobody has the time to train a new person who is not permanent. Everyone is short-staffed. You just cannot quickly train thousands of doctors, nurses, and other staff.”

Related: Mindfulness for Healthcare Professionals

Counteracting burnout

Despite the bleak scenario, Neuhauser is not panicked about the future of healthcare. “It might still be too early to say that,” she said. “While we have seen staff retire early and people leave the profession altogether, we had already anticipated this due to the baby boomers getting older and not recovering until 2030, as far as the nursing profession goes. But we are still seeing new nurses coming in, so it’s just a matter of those numbers catching up. I haven’t seen anything yet to say that the pandemic is influencing the incoming new nurses into the workforce.”

Neuhauser also believes that understanding resiliency, a topic that has become the subject of multiple studies as a result of the pandemic, has the ability to assist in overcoming adversities related to burnout.

“Resilience has been identified as a critical attribute of strong healthcare systems following a pandemic or other disaster,” she said. “Resilience is required to mitigate burnout and influences the organization’s culture and work environment. [Recognize] when you have that burnout and do the things that you need to do to take care of yourself, whether that’s taking time off, or meditating, or perhaps considering therapy,” she said. “Forming bonds with peers that allow you to take care of one another during certain times of stress is also important.”

When he’s feeling particularly burnt out, Aviles said he likes to find escape by consulting with other facilities about their challenges and solutions, praying, and conducting volunteer work as an educator at both in-person travel opportunities and virtual events. The online learning model has especially brought him satisfaction given the circumstances and that he’s been able to reach students who cannot attend live sessions currently, he said. “The live interaction, hands-on approach, and having supervisors in the same room is so important for medical, nursing, and therapy students,” he said.

The U.S. Department of Health & Human Services offers resources for healthcare professionals who are experiencing burnout. Please visit these online resources for assistance.