In recent decades, there has been increased attention to the growing prevalence of clinician burnout in the U.S. A 2012 national study of burnout among U.S. physicians found that rates of physician burnout are alarmingly high. Physicians in specialties at the front line of care access — emergency medicine, general internal medicine and family medicine — face the highest risk of burnout. Compared to other U.S. workers, physicians not only work longer hours but also significantly struggle with work-life integration.
However, it is important to acknowledge that physicians are not the only healthcare providers experiencing high rates of burnout. According to a 2021 insights report published by the New England Journal of Medicine (NEJM), physicians, nurses and advanced practice providers are experiencing serious or moderate problems with burnout, and the more clinical a provider’s role is, the greater the severity of their burnout.
Unparalleled changes in clinician work life caused by the COVID-19 pandemic have substantially exacerbated clinician burnout. A national study of trends in clinician burnout from 2019 through 2021 published by the Journal of the American Medical Association found that both burnout and intent to leave increased throughout the pandemic, reaching their highest levels in late 2021 — 60% and 40%, respectively.
Furthermore, vaccine administration and positive trends in COVID-19 treatment have not minimized growing concerns about the prevalence of clinician burnout. The aforementioned NEJM report also found that more than three-quarters of clinicians think burnout is going to get worse in the next two to three years, though the impact of COVID-19 is expected to be greatly reduced during this time period.
Although the pandemic has negatively impacted levels of clinician burnout, it is equally worthwhile to consider how this health crisis has highlighted the importance of maintaining a healthy workplace, developing efficient teamwork and promoting solidarity among clinical staff.
In an interview with The News-Letter, Cheryl Connors, a patient safety specialist at the Armstrong Institute for Patient Safety and Quality and the director of the Resilience in Stressful Events (RISE) program, raised awareness about some of the positive changes that have been driven further by the pandemic.
According to Connors, the RISE program, which offers confidential, nonjudgmental peer-to-peer support to individuals who have experienced a stressful or traumatic work-related event, was originally developed at the Johns Hopkins Hospital (JHH) in East Baltimore and officially began operating on Nov. 2, 2011.
Connors also shared that growing recognition of the critical need for a program like RISE can be traced back to the medical care of Josie King, an 18-month-old baby who died at JHH in 2001 as a result of teamwork and communication failures.
“[King’s] death was determined to be preventable, and we did a lot of follow-ups very well. We did an investigation. We did disclosure, but we did not take care of the people who were taking care of Josie,“ she said. “Years later, as we started to discover evidence that the ‘second victim’ phenomenon is a common issue in healthcare, we circled back to the Josie King event, and as a result, we decided to create a peer support program.”
According to a 2016 study of the development and implementation of the RISE program, “second victims” are healthcare workers who experience emotional distress following adverse events with patients or work-related situations.
Across the JHH system, the RISE team works to support second victims by providing responders, including physicians, nurses, respiratory therapists, social workers and chaplains, who can deliver emotional first aid to peers in a non-judgmental environment.
Connors elaborated on what the support process is like once an employee reaches out to the RISE team, which is available 24/7.
“We promise a timely response, so our commitment is that we will make contact within 30 minutes of the request, and we beat that turnaround just about all of the time,“ she said. “Once we make contact, we defer to the person who’s reaching out about what’s best for them — do they want to meet in person, virtually or by phone, and when? Once that’s decided, the encounter will sometimes happen right then and there, but usually, it’s some time that day.”
She also emphasized the program’s services are not only utilized by those who would traditionally be defined as second victims. The program broadly serves individuals and healthcare teams whose feelings of stress or ongoing struggles are connected to work, grief, death and/or trauma in the workspace, even if the underlying causes of their emotional distress are not all patient-related.
“Basically any individual who feels like they need to be supported through something that has occurred as a byproduct of their profession can reach out to RISE,“ she said. “At a minimum, one responder will show up and provide a safe, nonjudgmental space for colleagues to process the impact of whatever it is they’re experiencing.”
Connors highlighted positive changes driven by the pandemic, such as greater employee utilization of the RISE program and more employees willing and/or able to volunteer as peer responders. According to her, as work was reallocated, some employees were extremely busy while others, such as members of the psychiatry department, became more available after being sent home. These individuals trained to become peer responders, and the RISE team went from 40 responders to 78 responders in the months immediately after the pandemic started.
“RISE served as the backbone of support for our health system during the pandemic, virtually and in-person,“ she said. “Our numbers went from supporting 400 employees a year to — at a peak surge of the pandemic — 400 employees in a week. I think the pandemic not only normalized stress but also, more importantly, normalized asking for help and receiving support.”
Overall, Connors underscored the significance of developing programs like RISE to alleviate clinician burnout and normalize seeking help among healthcare providers and medical or nursing students, who fear they will face consequences for admitting they are struggling.
Deanna Rahman is a senior from Westchester, N.Y. majoring in Medicine, Science and the Humanities and minoring in Anthropology and Spanish for the Professions. “In for the Long Haul” aims to investigate and increase awareness about COVID-19’s impact on physical health, mental and emotional well-being and the functioning of society as a whole.
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