Taking care of healthcare workers facing widespread burnout amid the pandemic

There have been many news reports — both locally and internationally — of widespread burnout and mass exoduses of staff in the healthcare sector.

Long hours and heavy workload, compounded by the gravity of caring for patients, are among the reasons. But the protracted pandemic and ever-changing advisories have exacerbated the situation, creating a pressure pot with no end in sight.

I always tell people that as healthcare professionals, working with people who are dying involves more than just using our professional knowledge and skills.

It is effectively a symbiosis between ourselves and those we care for, be they our patients, their caregivers or family members or our colleagues.

This is especially true for my organisation, Singapore's largest home hospice care provider. The context in which my colleagues and I work involves critical life events that impact the patient, their family members and ourselves in a deep way.

It draws on our personal reserves, that is, our thoughts, feelings, energy and soul.

How can healthcare workers take better care of their own well-being amid this long-running pandemic and crisis?

RUNNING OUT OF FUEL

Burnout happens when work stress becomes so overwhelming that one feels physically, mentally and emotionally exhausted.

It feels like our fuel is running out and no amount of weekend rest or short breaks are enough to bring our energy back.

We feel lousy because we are unable to perform our daily tasks to the best of our abilities, while also meeting the demands and expectations of people around us. We also find it harder to empathise and give space to others, as our emotional tanks are already depleted.

Those who experience burnout often struggle to take a longer break, because they feel bad about transferring the work to other colleagues.

But it is important to set aside time for ourselves, take a break and not feel bad about it, receive help when offered, ask for help when needed and settle for what is “good enough”.

CREATING A SUPPORTIVE ENVIRONMENT

Advocating for self-care goes hand in hand with organisational support in creating a healthy work environment that enables staff to speak up if they need help and support.

The management of healthcare organisations should empower, encourage and enable staff to have the time and space for self-care.

This goes beyond having a system in place that fosters team meetings, case discussions and personal therapy sessions.

It is about how to encourage staff to look out for each other and check in on one another.

Through our regular interactions with one of our team members, whom I will call Z, we observed that she seemed tired and said she found it difficult to keep up with the pace of the work.

We learnt that there were family needs that required her attention.

She was also affected by the recent deaths of her patients, on top of the high number of deaths that the team had encountered recently.

She had not had the time and space to process what had happened and continued to feel that things could have been done differently.

We asked what would help and she shared that an extended period of rest might be beneficial. We arranged for her to take a long break, including paid leave and no-pay leave.

Therapy can also be very beneficial in protecting the mental and emotional wellbeing of healthcare workers.

A recent study, which staff from HCA participated in and was published in the Frontiers journal, showed that group-based Mindful-Compassion Art-based Therapy (MCAT) was beneficial in reducing mental exhaustion and improving the participants’ overall emotional regulation.

MCAT integrates mindfulness meditation with art-based therapy, a combination that can be readily applied to many workplaces.

Following a thematic approach, each session of MCAT focuses on a different aspect of self-care, such as “understanding and transforming stress” and “renewing aspirations and meaning reconstruction”.

Similarly, the art-making and creative writing for each session are based on the theme of the week.

Using materials such as pencils, paper, acrylic, canvas and even clay, participants are asked to create an artwork to illustrate their reflections, based on the theme of the week.

This process of reflection and expression enables participants to develop a deeper understanding of their sources of stress and also promotes mindful living.

Drawing upon the group experiences of MCAT, my organisation implemented several programmes and measures to support our staff.

Every Monday morning, our team starts our day with 15 to 20 minutes of self-care rituals over Zoom.

Led by a colleague, Andrew, who is our lead in culture and organisational development, staff are invited to reflect on themes related to love, relationships, wellness.

The session will always end with watching an inspirational music video together, which helps to energise us and uplift our mood at the start of the week.

Our clinical staff also have the opportunity to seek paid personal therapy sessions with external consultants, without judgment, if the need arises.

We regularly hold team meetings to discuss complex cases as well. These meetings allow us to keep a lookout for each other and spot signs of burnout in our co-workers.

Elsewhere in Singapore, Khoo Teck Puat Hospital has an established peer support initiative called Peers Around Lending Support (Pals), which offers support to staff as they tackle increasing work demands.

Within small outreach groups, staff are able to share their struggles and tips on managing stress. This fosters a sense of solidarity and also allows them to manage stressors early.

FINDING SOLUTIONS

When we prioritise self-care, we build endurance by giving ourselves the time and space to recharge.

Having that mental break also refreshes our mind and gives us new perspectives. Self-care also means being upfront and saying no to new tasks and commitments that threaten to drain our reserves. 

Of course, this is not always easy to do, especially when the workload is high. That’s the challenge working in healthcare, which is why it is important to strike a delicate balance.

When resources are limited, we have to review, prioritise and plan our resources to ensure those with the most urgent and complex needs continue to receive the care they need.

When staff say no to their bosses, it is often a call to seek alternative solutions.

It is important to help find a yes to address the situation and not let staff feel that they are letting down the patients or organisation.

In the United States, the Office of the National Coordinator for Health IT launched a strategy plan to reduce the amount of administrative work that healthcare workers have to take on, in record keeping and fulfilling regulatory reporting requirements.

By improving the functionality and intuitiveness of electronic health records, work productivity is boosted and healthcare workers also have more time to factor in breaks for themselves.

It takes a multi-pronged approach to counter burnout.

But we can start with caring for ourselves and others around us — as we build our fuel tanks together, we allow our lights to shine ever more brightly.

 

ABOUT THE AUTHOR:

Tan Ching Yee is head of psychosocial services at HCA Hospice Care.