A Word On Wellness, Burnout and Mental Health

For nurses, social workers and other healthcare professionals, awareness of proactive wellness programs may be the solution to burnout and other mental health challenges.
(This is the second in a series of articles that will address mental health and the healthcare professional.)

We’ve all seen the statistics. Heart disease is responsible for more than 600,000 deaths in the United States each year, the No. 1 killer according to the National Center for Health Statistics. Cancer ranks as a close second with nearly 600,000 deaths per year, followed by medical errors and chronic lower respiratory diseases. According to a recent study by Johns Hopkins University, more than 250,000 people in the U.S. die each year as a result of medical mistakes, in fact. But if you ask Bernadette Mazurek Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN, what or who is most responsible for the majority of deaths in this country, she will tell you that it is none of the above.

“If you take into consideration all causes of death and disease in the United States, it’s really behaviors that are our No. 1 killer,” said Melnyk, the chief wellness officer, dean and professor in the college of nursing at Ohio State University (OSU). “Behaviors count for more premature deaths than our genes and the healthcare we receive.”

Those behaviors, for example, lack of physical activity, not eating enough fruits and vegetables, smoking, not sleeping enough, not practicing stress reduction, drinking in excess and using drugs, are not unique to the general population. Many healthcare providers are guilty of the same poor habits, all of which have physical and mental health consequences for clinicians and patients alike.

“Studies have shown that the majority of clinicians aren’t engaging in the recommended number of healthy lifestyle behaviors that they should be,” Melnyk continued. “Thirty minutes of physical activity five days per week, five fruits and vegetables per day, don’t smoke and limit alcohol intake to one drink per day if you’re a woman and two if you’re a man. But a lot of people ask the question, ‘How big can that one drink be?’”

As the first chief wellness officer of any kind appointed in the U.S., Melnyk believes that a lack of awareness among healthcare staff members and their employers for the importance of wellness programs in the clinical work setting is a major contributor to an unhealthy rate of clinician burnout and turnover. According to a 2017 survey by Kronos Incorporated, 98 percent of nearly 300 hospital nurses said their work is physically and mentally demanding while 85 percent said their nursing jobs make them fatigued overall and 63 percent reported that their work has caused burnout — this despite the fact that 93 percent of respondents said they are generally satisfied with their jobs. Additionally, 44 percent said their managers don’t know how tired they are and 43 percent of nurses said they hide how tired they are from their managers. More than 80 percent also said hospitals today are losing good nurses because corporations and other employers offer a better work/life balance and that gaining more control over work schedules is the top factor that can help nurses alleviate a significant amount of fatigue.

“The turnover rates that we are seeing in nursing today are astronomical,” Melnyk said. “Up to 60 percent of new grads leave their first position in the first two years — that’s huge.”

While the statistics related to the rate of burnout experienced by social workers are not as concrete, a 2016 study by California State University, San Bernardino, found that social workers appear to be potentially more burned out and have less feelings of personal accomplishment than other human service workers.1

According to Melnyk, the lead author of a new national study on the connection that physical and mental health has on medical errors,2 recently spoke with ADVANCE to offer strategies that employers can consider in the development of their own wellness programs. These programs should begin with the appointment of chief wellness officers tasked with spearheading the health and well-being management of employees within any health system or hospital. The components of a successful program are wide-ranging, she said.

“Part of it is not only screening people for personalized wellness assessments, but also offering biometric screening, health coaching and wellness programming,” she said. “We need to equip people with evidence-based interventions that we know work, such as cognitive behavior skills building, mindfulness training, coping and stress-reduction programs — and this should all be done proactively. We shouldn’t wait until people are in crisis to then do something about it.”

Biometric screening is intended to provide a clinical assessment of key health measures that may be used to identify certain health conditions or to indicate an increased risk for conditions. Screenings are often paired with a questionnaire about lifestyle behaviors and health status to provide an assessment of one’s individual health, and tend to be conducted at health fairs and similar events, at a provider’s office or at home by using a kit.

Goals of these screenings should be, in part, to identify those who would benefit from health coaching, provide data for results-based incentive programs and help employees make healthy lifestyle choices.

“There are many skills that people can be taught proactively that will improve their ability to cope with stress, compassion fatigue and other things that cause clinicians to be less engaged or less satisfied in their roles,” she said.

It is also incumbent upon employers to realize that a real investment is necessary in these types of programs. The benefits are clearly evident, she assured.

“We have many studies showing that for every dollar that a workplace invests in wellness for their employees there’s a $3-4 return on investment. You can’t look at wellness as ‘an expense.’ You have to look at it as an investment.”

Also a member of the National Academy of Medicine’s Action Collaborative on Clinician Well-Being, has established a series of goals for her wellness program at OSU that could translate well into anyone’s organization, including an emphasis on communicating and sharing of best practices that can impact change and population health outcomes with others.

“Employers, hospitals, healthcare systems all have to recognize that, if their clinicians are healthy and happy they’re going to be more engaged and productive,” she said.

1. Taylor Kimes A. Burnout Rates Among Social Workers: A Systematic Review And
Synthesis. California State University, San Bernardino. Accessed online: http://scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?article=1452&context=etd
2. Mazurek Melnyk B, Orsolini L, Tan A. A national study links nurses’ physical and mental health to medical errors and perceived worksite wellness. JOEM. 2018;60(2):126-31.

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