Dr. El

I was tempted to listen to the STAT News event, “The exhaustion epidemic: Examining the COVID-19 burnout crisis in health care,” while lying prone on the couch.

Instead, I took notes and considered how this hospital-heavy analysis might apply to the long-term care industry.

Two physicians, one nurse and one psychiatrist/researcher discussed at length how the pandemic has worsened what was already a dysfunctional and understaffed healthcare system.

In hospitals, they noted, the initial feeling during the pandemic was, “We’re all in this together,” with hospital workers considered healthcare heroes. This has given way to exhaustion, burnout and departures from the field.

For long-term care workers, there was never a feeling that we were all in this together. Aside from individual facility or team cohesiveness, nursing homes were ignored, disparaged and largely cast adrift to fend for themselves in the beginning of the pandemic.

LTC staff began the pandemic without societal support, risked their lives in the face of an unknown virus, and suffered tremendous losses of often beloved residents. From this lowpoint, facilities now have even fewer staff, with omicron-related absences increasing the burden on already overwhelmed workers.

It’s no wonder we’ve reached historic levels of staffing shortages.

Burnout and moral injury

Psychiatrist Wendy Dean, M.D., discussed her research on moral injury, observing that it’s a frequent precursor to burnout. As described on her Moral Injury in Healthcare website, “Moral injury occurs when clinicians are repeatedly expected, in the course of providing care, to make choices that transgress their longstanding, deeply held commitment to healing.”

This includes situations where aides are expected to care for far too many residents than they’re able to, nursing supervisors are asked to manage too many units, and other circumstances where staff are being put into positions where they cannot conduct their jobs in a safe and professional manner.

While burnout casts the problem as that of an individual having difficulty managing stressors, moral injury recognizes that the system itself is the problem.

Panelists encouraged listeners to engage in self-care practices that reduce the likelihood of burnout, while also advocating (together!) for changes within the healthcare industry. They advised workers to find others who are feeling similarly stressed in the workplace, talk with them, come up with solutions and bring them to management.

They also had advice for healthcare leaders.

Direction for leaders

The experts stressed the importance of leadership engagement at all levels, with an emphasis on communication. This includes having a clinician present during business discussions, trailing clinicians on the units to increase understanding of the day-to-day challenges of the job, and creating venues where staff can offer feedback, including anonymously for those who don’t feel comfortable speaking up publicly.

Good communication, they said, involved not assuming, but instead asking employees what they need to get their jobs done right and then getting it for them. Not surprisingly, this led into a discussion of the moral injury facing managers who know what their workers need but are unable to procure it due to financial, political or other constraints.

Other suggestions included offering paid time off for staff to prevent or recover from burnout, as well as acting as an advocate for staff by speaking up for their needs. As an example, they referred to hospital system leaders asking the larger community to wear masks to help contain the virus, even though it was an unpopular ask in their locale.

Perception of being valued

In his introduction as sponsor of the event, Mark Reisenauer, president of Astellas Pharma US, noted that healthcare workers were 40% less likely to feel burned out if they felt valued by their organization.

Given how unvalued nursing home workers felt at the beginning of the pandemic, this is an essential component in rebuilding our workforce.

Even if older adults are considered less worthwhile by some in our society, even if nursing homes are considered awful, dangerous places, even if working in a long-term care facility is considered somehow inferior to other jobs — nursing homes themselves can show workers that they are valued and important.

In relationships, we show people we care about them by being present, listening to them, and giving them what they need to be happy and successful. To retain and attract workers, facilities can do the same. This is the bedrock upon which we can rebuild the field.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements, visit her at EleanorFeldmanBarbera.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.