the situation is dire but not hopeless: more must be done to protect our health-care workers

within canada,  critical burnout levels doubled within the span of one year , from spring 2020 to spring 2021, and there are no indications that this trend will plateau anytime soon. in fact, based on trends observed from the  2003 sars outbreak , post-pandemic burnout is expected to continue well after the height of covid-19.

the  world health organization defines burnout as  “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed,” consisting of extreme exhaustion, negative feelings toward work and reduced professional and personal accomplishment. burnout is a complicated occupational hazard that can be affected by  multiple factors , including increased workload, patient acuity, work-induced moral or ethical distress, employee-management relationships and leadership support.

burnout also has a significant economic cost due to  increased turnover , absenteeism,  lower productivity and early retirement . a 2014 study estimated that physician burnout costs the health-care system  $213 million per year.  health-care burnout also leads to decreased patient outcomes due to reduced  physician availability  and  increased medical errors .

however, no one is more gravely impacted than our health-care workers. the negative outcomes of burnout are not contained to one’s work environment, with an overall reduction in mental health leading to  depression and anxiety ,  substance use  and  suicide .

concern for rising levels of burnout  among health-care workers and the  need for mitigation strategies  was expressed early in the pandemic. increased workload and pandemic-induced trauma were predicted to have a significant impact. what was not predicted was the cumulative burnout that would arise from a constant wave of  misinformation  that began in the initial stages of the pandemic and has resulted in increased  hostility and violence toward health-care staff .

a lack of governmental proactiveness over the past 20 months has resulted in workforce losses, with significant proportions of health-care workers leaving their jobs and even their professions. the health-care industry has seen a higher “ year-over-year increase in job vacancies than all other sectors ” with a 39 per cent overall vacancy as of the first quarter of 2021. this has and will continue to  further perpetuate the levels of burnout  due to mounting patient cases as health-care worker numbers decrease.

about 20 per cent of physicians at acute care centres in  vancouver  and  montreal  expressed intentions of quitting the profession as a result of covid-19 related burnout. similarly, 16 per cent of registered nurses surveyed in ontario reported  plans to leave nursing within the next year , with younger professionals being at highest risk of leaving the profession. however, covid-19 burnout spans across all health professions, including  hospital and community pharmacists  who have continued to work tirelessly, taking on increased workloads and often being the only  accessible in-person primary care health-care professionals  throughout pandemic lockdowns.

in march, healthcarecan sent out a public  call-to-action  to the federal government to help protect health-care workers by addressing the causes of escalated burnout levels, enhancing mental health supports and establishing a national health-care workforce plan to help reduce staffing shortages. more recently, on oct. 6, the canadian medical association (cma) and the canadian nursing association (cna) gathered at an “ emergency covid-19 summit ” along with “40 national and provincial health organizations” to discuss the urgent need to address covid-19 crisis mismanagement, associated health-care burnout and the detrimental consequences to our health system and staff.

recommendations focused on staffing retention and recruitment or redeployment of staff to areas with critically high case numbers, including mobilizing the red cross and military health-care personnel to these areas; redeploying health-care workers from covid-19 controlled zones to provinces in need if  provincial licensing restrictions  were removed; and creating a national licensing program to meet the needs of the pandemic. redeployment between regions or clinical practice areas requires adequate  training for out-of-scope staff . however, this has not always been prioritized throughout the pandemic, further contributing to increased psychological and professional distress.

mental health prioritization was  discussed  as both an acute and long-term solution to maintaining a sustainable health-care workforce. there needs to be a coordinated, significant effort toward quickly scaling our mental health resources while also  incorporating more protective strategies .

at an organizational level, there is much that can be done to protect health-care workers. the american medical association has created a  17-step guide to strengthening health-care workforce resilience , to help organizations create resilient teams during crisis situations. one of the key steps to establishing resilience is to “ assess stress and needs within the workforce .” thankfully, organizations across canada have access to resources such as the  guarding minds at work  survey and  caring for health-care workers  toolkit that facilitate assessment of workplace psychological health, particularly in the context of covid-19.

prioritizing the mental health of our health-care providers requires more than simple signposting. organizations should invest in  easily accessible on-site mental health professionals  with expertise in burnout and trauma. interdepartmental strategies could include creating  formal peer support groups  that may produce  organizational benefits  while changing the workplace experience for individual employees. even informal peer support can have a significant influence on the well-being of employees. early in the pandemic, staff at the vancouver general hospital created a “ wobble room ” for individuals to come together and support one another.

leaders play an important role in reducing the levels of burnout their employees experience. it is time for leaders and managers at all levels of the health-care system to become strong advocates for front-line staff. a  2020 study  identified several protective measures for psychological distress that can be implemented by managers and leaders during health-care outbreaks, including engaging in open and clear communication with staff; providing appropriate training; recognizing employees’ hard work; encouraging daily breaks; supporting vacation time; and implementing departmental “staff support protocols.”

to ensure ongoing open communication with staff,  frequent check-ins  between leadership and team members or employees also has been recommended. above all, leaders should help foster  cohesive and supportive teams  while maintaining a culture focused on employee wellness and self-efficacy.

for more information on mental health resources for health-care workers during covid-19, please visit the  camh website .

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