Early in my career I served for 2 years as the chief public health officer of a municipality in Connecticut. During that time -- and subsequent to it -- I became a regular reader of the CDC's "Morbidity and Mortality Weekly Report" or MMWR. It's de rigueur for public health officials at all levels and is followed by many clinicians, too, especially hospital-based infectious disease specialists, preventionists, and epidemiologists for news about the outbreaks of communicable diseases or the latest data about various chronic disease trends.
Even after switching to hospital administration, I continued to periodically read the MMWR to maintain a casual or working knowledge of epidemiological trends among both salient acute and chronic diseases.
So I was surprised when on October 24 the CDC's MMWR switched from its regular programming to feature the following deeply researched article: "Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health — Quality of Worklife Survey, United States, 2018–2022." Wait. The CDC has just elevated healthcare workers to a special at-risk population? Yes.
No one in medicine, nursing, or in mental health will be surprised to find that the mental health of healthcare workers -- all types, all levels -- has worsened between the period before and subsequent to the pandemic. And shows no sign of improving. Here’s an excerpt:
"U.S. health workers experienced a 249% increase in rates of work-related injury and illness between 2019 and 2020. The pandemic intensified existing risks and workloads because of staff member shortages, high patient loads, supply shortages, fatigue, and grief, exacerbating preexisting crisis levels of burnout (e.g., feeling emotionally exhausted and detached and experiencing a low sense of personal accomplishment at work). Health workers experienced increased harassment (i.e., threats, bullying, verbal abuse, or other actions from patients and coworkers that create a hostile work environment) and violence, which can increase the risk for symptoms of depression, anxiety, posttraumatic stress, and suicidal ideation."
Burnout. Depression. Anxiety. Grief. PTSD. Suicide ideation. Got all that? I mention this only as prologue for what I think are the important recommendations from the CDC about what's needed to counteract the intensifying stress of front-line healthcare workers. Here's my synopsis of what I think the CDC means to convey: "healthcare leaders need to lead differently and focus more on making significant changes in the work environment and workflow to better support front-line staff".
Now, here's the more extended and nuanced remonstration taken verbatim from the CDC study: "This report identifies modifiable working conditions that contributed to poorer mental health among health workers and suggests preventive actions for employers. Previous research found job stress interventions that changed aspects of the organization (e.g., increased manager social support) were more effective than were secondary (e.g., screening for stressors) or tertiary (e.g., individual stress management) interventions. A recent review of management interventions suggests that training managers on mental health awareness and ways to support workers and improve safety culture shows promise for reducing worker stress and improving well-being. Working conditions that support productivity and foster trust in management might be more readily addressed than providing sufficient staffing, which can be challenging in resource-constrained settings. More positive psychosocial safety climates, which include management prioritization of psychological health and stress prevention, were associated with lower burnout symptoms among health workers in this study. Previous research has demonstrated the link between psychosocial safety climate and reduced exhaustion, improved worker well-being, and improved engagement. Organizational policies and practices can be modified to improve security and reduce threats of violence. The International Organization for Standardization provides guidelines for managing psychosocial risks in the workplace to promote worker safety and health. Employers can also make changes that increase participation in decision-making and reduce workloads. Evidence suggests that attention to such protective aspects of work could reduce the number of days of poor mental health and prevalences of burnout and turnover intention."
Whether you prefer my unsubtle but succinct paraphrase or the CDC’s more elegant phrasing, either way, this should be another wake-up call to senior leaders in almost every healthcare organization: healthcare workers are suffering from conditions in the workplace. Those conditions can and must be addressed by leaders or there will not be a workforce to lead.
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