By Dorothy Brooks
It is hardly a news flash to providers and staff in the ED that they often work long hours in a highly stressful environment, but according to new research from the Centers for Disease Control and Prevention (CDC), the levels of fatigue and burnout that all healthcare workers are experiencing have reached crisis levels, and administrators there are calling for urgent action to address the problem.
Speaking at a media briefing about the new report on October 24, Deborah Houry, MD, MPH, the chief medical officer at the CDC and an emergency medicine physician herself, acknowledged that healthcare workers have long faced challenges to their well-being and mental health. “Caring for people who are sick ... can be intensely stressful and emotional; exposure to human suffering takes an immense toll,” she said.
Houry shared how she still remembers some of the tough patient cases she had as an emergency physician where she had to deliver the news about an advanced cancer diagnosis to a working spouse, and another time when she could not resuscitate a toddler who had been in a car accident. “After a shift like this, I would have to put on a good front and take care of my own family, and in doing this, I didn’t always pay enough attention to my own wellness needs,” she recalled.
However, the new data show that the levels of stress and related problems that health workers are experiencing have been on an upward trajectory in recent years, beginning their ascent even before the pandemic caused unprecedented strain on the healthcare workforce. “The COVID-19 pandemic only intensified many health workers’ long-standing challenges and contributed to new and worsening concerns, including compassion fatigue, depression, anxiety, substance use disorders, and suicidal thoughts,” said Houry. (Also see: “AMA: Burnout is causing an increasingly serious physician shortage.”)
The new research highlighting these challenges, which was released online in the CDC’s Morbidity and Mortality Weekly Report on October 24, is based on data from the General Social Survey Quality of Worklife Module from 2018 to 2022.1 A co-author of the research, L. Casey Chosewood, MD, MPH, director and senior medical officer at the Office for Total Worker Health at the CDC’s National Institute for Occupational Safety and Health (NIOSH), also spoke at the briefing, highlighting the report’s most concerning findings.
“The number of days that U.S. health workers reported their mental health was not good in the past 30 days increased more than other workers between 2018 and 2022, the timespan before and after the start of the COVID-19 pandemic,” he said. “Healthcare workers were also more likely than other workers to report negative changes in their working conditions during this time. Notably, health workers reported the largest increase in being harassed at work compared to other workers.”
Chosewood added that the healthcare workers who reported being harassed were more likely to report symptoms of anxiety, depression, and burnout than workers who were not harassed. And he noted that more than double the number of workers reported being harassed at work in 2022 as compared with the findings from 2018.
Further, Chosewood stated that the analysis found that nearly half (46%) of all participating healthcare workers reported often feeling burned out in 2022. That is a significant increase from 2018, when 32% of health workers reported that they often felt burned out.
There also were strong signals in the analysis of growing job dissatisfaction among healthcare workers. Chosewood stated that 44% of healthcare workers said they intended to look for a new job in 2022. That is up from 33% reporting similar intentions in 2018, he said.
While the data are distressing, Chosewood noted that they also highlight where changes can alter the outlook for the healthcare workforce. “The report noted that poor mental health outcomes are less common when working conditions are positive, and where healthcare workers have the potential to thrive,” he said. “Supportive work environments had a positive impact on health workers.”
For example, Chosewood explained that the data show symptoms of depression occurred half as often when health workers could take part in workplace decisions. Consequently, Chosewood noted that healthcare employers can act to modify working conditions so that they build trust and increase supervisory support in the following ways:
- Allow health workers to participate in decision-making on how the work is done and what aspects of the work should be targeted for improvement.
- Empower supervisors to play an important role in supporting the work-life balance of health workers.
- Carefully monitor staffing needs and incidents of harassment.
- Design policies to help workers feel safe and to protect their mental health.
Further, Chosewood noted that previous research has shown that organizational, systemwide interventions are more effective than individually focused interventions or those that rely on the workers themselves to address their mental health concerns.
“Leaders must take a very strong role in being accountable and responsible for the safety, health, and well-being of their workers,” said Chosewood. “We need to do a better job of increasing the training for supervisors and managers, increasing flexibility, encouraging people to take time off, assuring adequate staffing, and building labor-management cooperation efforts. All of these things will go a long way toward helping to create better workplace environments.”
While NIOSH is urgently calling on healthcare employers to address all of these workforce concerns, the agency also has launched an “Impact Wellbeing” campaign that offers a range of resources to help healthcare leaders make progress in this area. For instance, the campaign includes a “Worker Well-Being” questionnaire that can assist leaders in identifying areas in need of improvement, a toolkit that can guide leaders on how to remove intrusive mental health-related questions from their credentialling processes, and an array of other tactics focused on how to advance overall worker safety and health.2
The American College of Emergency Physicians (ACEP) tells ED Management (EDM) that it welcomes the new CDC initiative, but notes that it also is working on several fronts to address the well-being of members. For example, through its well-being committee and wellness section, ACEP offers a range of resources to help emergency physicians address career frustrations, burnout, and stress. In addition, the group states that it is focused on limiting and combating moral injury through workplace best practices.
“Leaders in the ED should be aware of and seek to leverage tools that already exist — like ACEP’s 2023 well-being guide: ‘From Self to System — Being Well in Emergency Medicine,’” explains Jessica M. Maye, DO, FACEP, an emergency medicine physician in New Jersey and the chair of ACEP’s well-being committee. “The guide features 42 chapters that describe system best practices for a well workplace, and it can be downloaded for free [from ACEP’s Wellness Hub.]”3
Also through the Wellness Hub, physicians can access peer support, crisis counseling, and a range of other wellness resources, including webinars, papers, and guides, all aimed at boosting resilience, wellness, and supportive workplaces.
On the legislative front, ACEP is advocating for several measures it believes would be highly beneficial to both worker well-being and safety. “We have to make sure our healthcare workforce has access to [the] mental healthcare support and services that they need and deserve,” explains Ryan McBride, MPP, ACEP’s congressional affairs director. “We have to address the root causes of these problems. There is no one-size-fits-all solution, but ACEP supports several important efforts that can help.”
For example, ACEP is supporting legislation and policy solutions to address the ED boarding crisis, and it is working to pass the “Safety From Violence for Healthcare Employees (SAVE) Act,”4,5 a bill that would establish legal penalties for individuals who knowingly and intentionally assault or intimidate healthcare workers.
“ACEP [also] is calling out and working to curb insurer misbehavior, taking steps to ensure that the ‘No Surprises Act’ is implemented [in a way that is] consistent with Congressional intent, and [ACEP] supports measures to eliminate administrative burdens that hinder an emergency physician’s ability to do [his or her] job,” adds McBride.
Another step that ACEP has taken to improve the working environment for its members is to establish an ED accreditation program, an effort that will provide recognition to hospitals that meet key benchmarks in terms of staffing, capabilities, and working conditions.6
The Emergency Nurses Association (ENA) also is advocating for many of the same policy and legislative solutions as ACEP. Chris Dellinger, MBA, BSN, RN, FAEN, ENA’s president-elect, tells EDM that all emergency nurses deserve to have a healthy work environment that is supported by their hospitals, but she stresses that employers should take into consideration that this can mean different things to different nurses and be open to a variety of solutions.
“For new nurses, this may be a residency program or mentorship. For veteran nurses, it could be being a mentor, [or] professional development or resiliency resources,” observes Dellinger. “It’s important for employers to talk to their nurse leaders to see how they can best be supported.”
As with ACEP, ENA is addressing worker well-being from multiple angles. “ENA takes a holistic approach to improving the ED environment by providing education and resources that support nurse self-care while also providing guidance to ED leaders that helps them make improvements to the culture and environment without compromising the quality of patient care,” observes Dellinger. “Personal safety is the highest priority, which is why ENA continues to push for the Workplace Violence Prevention for Health Care and Social Service Workers Act,7 and remains committed to the No Silence on ED Violence campaign to raise awareness about the vital issue.”8
In addition, Dellinger notes that ENA launched a new business venture in 2023 that is all about creating healthy working environments. “Engage, Powered by ENA”9 uses collaboration with ED nurses and ED leaders to co-create and implement a healthy emergency nurse work environment plan that is unique to their emergency department, she explains.
When asked what individual emergency nurses can do to improve their own well-being or to help advance wellness in their own workplace, Dellinger said nurses need to always have a way to decompress after their shifts, whether that involves taking a course on resiliency, taking up a hobby, or any number of other things. “Also, always be open to conversations with other nurses, leadership, and the ENA ... so we can all work together to ensure that nurses are active in their own mental and physical health to help prevent burnout and keep them at their healthiest,” she said.
“ENA strives to improve emergency nurse mental health and well-being, increase collaboration with leaders on ways to strengthen ED cultures, and heighten awareness and advocacy about the issues that impact [the work of] emergency nurses every day — all with the goal of helping emergency nurses deliver the best care possible to their patients,” said Dellinger.
REFERENCES
- Nigam JAS, Barker RM, Cunningham TR, et al. Vital Signs: Health Worker-Perceived Working Conditions and Symptoms of Poor Mental Health - Quality of Worklife Survey, United States, 2018-2022. MMWR Morb Mortal Wkly Rep 2023;72:1197-1205.
- The National Institute for Occupational Safety and Health. Impact Wellbeing. 2023. https://www.cdc.gov/niosh/impactwellbeing/
- American College of Emergency Physicians. Physician Wellness Hub. https://www.acep.org/life-as-a-physician/wellness
- H.R. 2584 - SAVE Act. https://www.congress.gov/bill/118th-congress/house-bill/2584
- 118th Congress. S. 2768 - SAVE Act. Sept. 12, 2023. https://www.congress.gov/bill/118th-congress/senate-bill/2768
- ACEP ED Accreditation. https://www.acep.org/edap
- 118th Congress. S. 1176 - Workplace Violence Prevention for Health Care and Social Service Workers Act. April 18, 2023. https://www.govinfo.gov/app/details/BILLS-118s1176is
- No Silence on ED Violence. https://stopedviolence.org/
- Emergency Nurses Association. Engage. 2023. https://www.enaengage.com/
It is hardly a news flash to providers and staff in the ED that they often work long hours in a highly stressful environment, but according to new research from the Centers for Disease Control and Prevention, the levels of fatigue and burnout that all healthcare workers are experiencing have reached crisis levels, and administrators there are calling for urgent action to address the problem.
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