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Preserving the Mental Wellness of Our Healthcare Heroes

During the pandemic and beyond.

As I write this, there have been more than nine million cases of COVID-19 diagnosed in the U.S. since late January. We have seen more than 229 thousand Americans die from the novel coronavirus, at least 1,700 of them healthcare workers. Yes, our doctors and nurses have paid a huge physical price for being on the front lines of the pandemic. But both the near- and long-term impacts on their mental health — as COVID once again surges — are of even greater concern.

People often choose a career in medicine because they have a desire to help, heal, and make a difference. They have the drive to fulfill and their accomplishments are often groundbreaking. But we can never forget that these healthcare workers are human beings, not robots. And as this pandemic stretches toward a second year, we cannot expect them to continue to do their jobs well without better support for their mental well-being.

No Training Could Prepare for This

Despite their years of education, specialization, and research, most medical professionals could never have anticipated the rapid spread of COVID-19 into and throughout our country. Once the highly contagious nature of the novel coronavirus became apparent, the stress began to mount quickly. Healthcare workers scrambled to get sufficient numbers of high-quality PPE for themselves and their colleagues. Many separated themselves from their families and friends in an effort to lower the risk of infection for their loved ones. In overcrowded facilities, they tried desperately to treat and save patients whose symptoms went from minor to dire in a matter of hours, and whose outcomes were as unpredictable as the disease itself. We heard about their exhaustion and frustration, about countless losses and miraculous victories.

In an April article in STAT, psychiatrist Jessica Gold, M.D., summed up the crisis already affecting the healthcare profession; “To an outside observer, health care workers look strong and resilient in the face of the unknown…Underneath it, many health care workers are barely keeping it together. They are anxious and they are afraid. They aren’t sleeping and they find themselves crying more than usual.”

From the Initial Battles to the Long Haul

That was at the beginning of the COVID-19 onslaught. Yet several months later, the virus has still been raging, while healthcare workers have tried to hold it together physically and emotionally. In July, an Atlantic headline put it bluntly: “This Is Not a Normal Mental-Health Disaster.” The article went on to highlight the ambiguity, uncertainty, and invisibility of the pandemic, contrasting it with many other types of natural disasters. And author Jacob Stern warned, “One thing that is certain about the current pandemic is that we are not doing enough to address its mental-health effects.”

It is not only hospital workers experiencing the mental fallout of COVID-19. Nurses and aides in long-term care and assisted living facilities have lost thousands of their residents to the virus – and endured many negative generalizations about the care they provide. In its recent article, “Pandemic Of Grief: A Mental Health Challenge For Nursing Home Staff,” Mental Health America says, “The combination of ‘public shaming,’ physical exhaustion, and lack of ready access to mental health services places this population at risk for deepening emotional distress and burnout.”

Although COVID cases diminished by late summer, healthcare workers knew they could not let their guard down. While still treating new patients every day, they vividly remembered what they had experienced for months in the overwhelming first wave. As part of its special series on the coronavirus, NPR spoke with nurses and doctors about their ongoing stress and anxiety, what it called “pandemic burnout.” As NPR’s Lesley McClurg reported, “The unflappable health care heroes of the current crisis are beginning to crack under the strain.”

Public, Private, Peer Support

Although the end of 2020 is now in sight, the end of the pandemic is not. What is being done to help the medical professionals still on the front lines, the ones who have had to step away, and those who are training to join the battle? Organizations are beginning to step up at the national, state, and local levels; here are just a few examples.

In conjunction with The Centers for Medicare & Medicaid Services (CMS) and the Quality Improvement Organization (QIO) Program, we are facilitating The National Nursing Home Training Series, to help our colleagues working in long-term care promote patient safety and staff well-being. The more they know about infection prevention and control, how to manage staffing challenges, and cohorting strategies, the better their response…and more their stress is alleviated.

Long-Term Strategy Needed

Healthcare workers are already suffering from PTSD, depression, and anxiety in record numbers. We need to continue to push for funding and programs to help them cope not only with the ongoing pandemic, but also look to a future where they will once again provide care under “normal” circumstances. From medical students to the most seasoned professionals, we must recognize what they have endured and not just expect them to repair that mental damage themselves.

As Rick Evans, Senior Vice President of Patient Services and Chief Experience Officer of New York-Presbyterian Hospital, recently wrote in Becker’s Hospital Review, “Those who work in healthcare have likely experienced its "suck-it-up" culture…It's part of why so many acknowledge the heroism in healthcare. But, heroes have hearts and feelings. Heroes get tired. Heroes need care and renewal.”

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