By A. Kevin Troutman, Partner, Fisher Phillips
While the COVID-19 pandemic continues to wreak havoc and uncertainty around the world, an extraordinary group of people has remained steadfast and reliable. That group of course is healthcare workers. Anyone who has been a patient in an intensive care unit has faced any frightening health predicament or has been with a loved one during a health crisis understands this: No hero stands taller than a healthcare worker who helps a patient and family through such dire situations.
These real-life heroes are human, however. Having jobs that are stressful under “ordinary” circumstances, many healthcare workers have continued to face even greater challenges during the pandemic. Every day, they feel the pressure of dealing with this new and evolving virus, one that did not even exist in humans until late 2019. They feel the weight of increased demands on the healthcare system, including the need for supplies, personal protective equipment (PPE), and more staff, to name just a few examples. They also confront the same worries and challenges as everyone else, including how to protect their families during this unprecedented period.
How serious is the impact of stress and anxiety among healthcare workers? The potential impact is enormous, especially in view of their unique circumstances. According to the New York Times, up to 25% of all nurses have experienced post-traumatic stress disorder at some point in their careers. Before the pandemic, in fact, a relatively high number of doctors, nurses, technicians and other health professionals reportedly struggled with abuse or addiction, mostly involving narcotics such as Oxycodone and Fentanyl. Reasons abound, such as the need to stay alert during long shifts, day or night, or the need to make quick decisions regarding patients’ conditions or to deal with the emotional pain of tragic patient outcomes. After a long shift, other substances such as marijuana may be seen as a way to unwind and rest. Estimates indicate that approximately 5.5% of medical professionals are involved in some sort of illicit drug abuse. Another factor is healthcare professionals’ relatively easier access to powerful prescription drugs. The use of opioids among medical workers is in the 10-15% range. Heavy alcohol consumption is another concern, even though the rate of abuse among healthcare workers was historically a bit lower than the rate among the general population.
An impaired professional is of course more likely to make a mistake, which only exacerbates the cruel cycle of stress and the need for relief. Impaired professionals often change jobs frequently, may fall asleep on the job, experience great financial and family stress and make errors in completing critical medical documentation. These observations are based upon surveys and studies done before the COVID pandemic. Data regarding the mental health impact of the current crisis is only beginning to emerge.
In July, one survey showed that over half of the adults in this country said that stress and worry over the coronavirus had negatively impacted their mental health. This represented an almost 70% increase in the percentage of adults who reported such stress just two months earlier, in March. Negative impacts included difficulty sleeping or eating, increased alcohol consumption or substance use, and worsening of chronic conditions.
In Wuhan, China, the point of origin for coronavirus, 50% of nursing staff reported symptoms of depression; 45% reported symptoms of anxiety, and over 79% said they were experiencing psychological distress. In April, the NY Times reported that a top emergency room doctor in Manhattan committed suicide after working in a hospital that was devastated by the COVID outbreak.
News stories abound, describing shortages of critical supplies and personal protective equipment (PPE) for healthcare providers. Fortunately, most Texas facilities have not faced such extreme circumstances, at least on a widespread basis. Yet, the uncertainties brought on by coronavirus and the medical community’s evolving understanding of it have undoubtedly heightened stress in an already pressure-packed environment. Even under the best of circumstances, amidst lockdowns and economic upheavals, healthcare workers must not only take care of their patients but also be even more mindful of their own safety and the safety of their families, in addition to dealing with changing childcare situations, school closures and family members’ job losses. In short, a very stressful environment has become even more so.
The obvious question is, how can healthcare employers help their workers manage this stress and stay healthy under these circumstances?
One of the first things employers can do is to put the issues squarely on the table, acknowledging the increased challenges of these unprecedented times and providing resources for employees when they are needed. Specifically, besides doing everything possible to ensure adequate staffing, supplies and PPE, employers should communicate their efforts to employees, welcoming questions and suggestions from those on the front lines. Make it clear that stress is not something to hide or keep bottled up. Encourage and help employees seek help in a confidential, respectful manner. If not already in place, consider providing Employee Assistance Programs (EAPs) and offering access to hotlines or virtual support sessions, handled by qualified counselors or psychiatrists who can respond to workers’ individual stresses and concerns. The best relief and assistance often come from peers who understand and relate to the challenges that healthcare workers are facing.
Healthcare employers should also train supervisors and front-line employees, through live sessions, postings, electronic and/or hard-copy distributions, to recognize signs of anxiety, depression, or worse…and explain how employees can seek assistance, without fear of retribution. Now more than ever it is important for everyone on the front lines to be aware of signs of addiction, such as volunteering to administer narcotics to patients; frequent bathroom breaks or unexplained absences; seeking night shifts or other assignments where there is less supervision; incomplete charting or increased errors; unusually friendly relationships with doctors who prescribed medications; glassy eyes or small pupils; and smelling of alcohol or excessive use of breath mints or mouthwash.
When a supervisor or employee identifies a possible mental health or substance abuse problem, employers must also keep in mind relevant legal parameters, which depending on the circumstances, may require them to engage in an interactive accommodation process under the Americans with Disabilities Act. In any case, it is vital from both a legal and practical standpoint to take prompt, effective action that protects both patient and employee rights. At the same time, employers must be cognizant of the impact of their actions on the entire workforce. While employers must safeguard the confidentiality of individual employees’ medical/mental health information, they should strive to maintain a culture that encourages employees who are stressed to seek assistance instead of struggling by themselves with anxiety or possible substance abuse.
In the end, these actions will strengthen the fiber of the organization, maintaining its position within the backbone of the nation’s front-line fight to protect the health of everyone.