Burnout in a Time of COVID-19

“My colleagues, both physicians and nurses, they cry every day.”

The 17 March interview on the NYT’s Daily podcast with the medical director of a hospital in Bergamo Italy highlighted the pandemic’s impact on the physical and psychological wellbeing of healthcare providers. On the day of the interview, the hospital had 460 nurses away from work because of illness. Some are in quarantine due to their patient contact, some are sick themselves, and some are burned out from the experience.

It is important to realize that the exhaustion, cynicism, and inefficacy that defines burnout does not emerge simply from too much demand. And it does not imply that healthcare providers are lacking in resilience. Instead, reflecting on six core areas of worklife provides a broader perspective on the current situation and what may be done to alleviate its impact on health care providers.

Workload: The demands on the healthcare system are extraordinary. In this 1000 bed hospital, they receive 50-75 people in severe respiratory distress every day. More than 50% of the hospital is dealing with corona virus infection.

Control: People are working outside of their range of expertise. Scheduled surgeries and clinics are canceled and doctors of any specialty must immediately provide treatment for respiratory distress. Medical professionals experience control with working within protocols reflecting their expertise. They are working with inadequate supplies including gloves and respirators needed to do the best for patients.

Reward: The relevant intrinsic reward for medical professionals is witnessing the impact of effective treatment. The virus makes that experience less available.

Community: In terms of the emotional impact, “the main problem for us is to treat our colleagues.” People with whom they have worked for years are now struggling to stay alive under their care. And they have so little to provide in terms of effective treatment or even symptom alleviation.

Fairness: Diseases strike without concern for whether their targets are good or bad people. But the most immediate fairness issue for health care providers is setting priorities for treatment when more people are in desperate need of respirators than the available supply of the equipment. While people struggle to establish an ethically sound triage system, implementing those rules can violate sensibilities.

Values: A pandemic that overwhelms the capacity of healthcare systems violates providers’ core values of caring and applying sophisticated expertise to complex problems. Many resent the scant attention that has been given to preparing for such an outbreak, despite wide recognition of the impending threat for years.

Burnout as an occupational conditions associated with risks to employees’ physical and mental wellbeing is so relevant to the current crisis with COVID-19. Looking at burnout as simply exhaustion or as inadequate resilience fails to meet the moment. Supporting healthcare providers requires extensive and thoughtful responses that address the full range of worklife areas related to burnout.

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