On August 18, U.S. Surgeon General Vivek Murthy, M.D., issued a broad and yet also detailed, statement of principles and strategy around the enormous problem of healthcare worker burnout. Writing in The New England Journal of Medicine online, Dr. Murthy called for a coordinated, healthcare system-wide effort to address an issue that is affecting virtually all of U.S. patient care organizations right now.
Under the headline, “Confronting Health Worker Burnout and Well-Being,” Dr. Murthy’s “Perspectives” op-ed begins thus: “Early in the Covid-19 pandemic, when much of U.S. society shut down, health workers put their own safety on the line and kept going to work to care for patients. Although their communities initially banged on pots, cheered from their balconies, and put up thank-you signs, the pots have long since stopped clanging. Expressions of gratitude have too often been replaced by hostility, anger, and even death threats toward health workers, as health misinformation has exploded, eroding trust in science and public health experts. Yet doctors, nurses, pharmacists, social workers, respiratory therapists, hospital security officers, and staff members of health care and public health organizations continue showing up to battle the pandemic and its sequelae — long Covid, mental health strain, widening health disparities, and 2 years’ worth of deferred care for myriad conditions.”
Indeed, Murthy writes, “The toll on our health workers is alarming. Thousands of them have died from Covid. More than half of health workers report symptoms of burnout, and many are contending with insomnia, depression, anxiety, post-traumatic stress disorder, or other mental health challenges. An intensive care nurse in Miami told me, ‘There was a point when I could no longer contain the heartbreak of everyone I lost.’ He stopped counting after his 135th patient died from Covid in the pandemic’s first year. Caring for patients has always been emotionally and physically demanding, but as one Missouri physician told me, ‘There is only so much we can give. We are people, too.’”
Murthy notes that, “On May 23, 2022, I issued a Surgeon General’s Advisory on health worker burnout and well-being, declaring this crisis a national priority and calling the nation to action with specific directives for health systems, insurers, government, training institutions, and other stakeholders. The advisory is also intended to broaden awareness of the threat that health worker burnout poses to the nation’s health. Public awareness and support will be essential to ensuring sustained action.”
And, he writes, “Addressing health worker well-being requires first valuing and protecting health workers. That means ensuring that they receive a living wage, access to health insurance, and adequate sick leave. It also means health workers should never again go without adequate personal protective equipment (PPE) as they have during the pandemic. Current Biden administration efforts to enhance domestic manufacturing of PPE and maintain adequate supplies in the Strategic National Stockpile will continue to be essential. Furthermore, we need strict workplace policies to protect staff from violence: according to National Nurses United, 8 in 10 health workers report having been subjected to physical or verbal abuse during the pandemic.”
What might the solutions be? Murthy offers several suggestions. Beginning with the paragraph above, and including that “[W]e must reduce administrative burdens that stand between health workers and their patients and communities”; “we need to increase access to mental health care for health workers”; “we can strengthen public investments in the workforce and public health,” including “expanding public funding to train more clinicians and public health workers”; and, that “we need to build a culture that supports well-being.” As he writes, “It’s time to break the traditional silence surrounding the suffering of health workers. As gratifying as our work is, it can also be profoundly isolating, especially when we feel we can’t let our colleagues know if we’re not OK — a feeling that millions of health workers, including me, have had during our careers. Culture change must start in our training institutions, where the seeds of well-being can be planted early. It also requires leadership by example in health systems and departments of public health. Licensing bodies must adopt an approach to burnout that doesn’t punish health workers for reporting mental health concerns or seeking help and that protects their privacy. Finally, many health workers still face undue bias and discrimination based on their race, gender, or disability. Building a culture of inclusion, equity, and respect is critical for workforce morale.”
Murthy concludes his op-ed by stating that, “As a nation, we cannot allow ourselves to fail health workers and the communities they serve. We must build on these steps, boldly taking on entrenched interests, bureaucratic inertia, and the status quo. Health workers throughout the country have told me they are reaching their breaking point — that ‘something has to change.’ They are right. May our country never forget our moral obligation to care for those who have sacrificed so greatly to care for us.”