Burnout in healthcare workers is issue that deserves our attention
Burnout—you associate the term with healthcare workers right away.
It is so often projected as an internal quality of the person who experiences it. But dissatisfaction is not a pathologic response to what is happening in healthcare – it is an appropriate one.
Nearly half of U.S. healthcare workers plan to leave their jobs in the next two to three years, per Elsevier Health’s “Clinician of the Future” report. I’ve known many healthcare workers and they are quite strong people. The difficult professions self-select excellence. And strong people can endure an awful lot when they must, but “must” is an important word.
Viktor Frankl, who survived something much worse than COVID and made his life’s work into understanding the purpose and endurance of the human soul, explained that “He who has a ‘why’ can endure almost any ‘how.’” Do we today have a ‘”why” – that is, can we hold up a justified and unavoidable reason to have subjected these great people to the recent state of things? It’s doubtful.
COVID-19 adds to burnout
COVID – its destruction of lives and spirit – was and is outside of the control of any healthcare system. COVID did not create new problems, but rather pushed systems’ pre-existing conditions to the surface: many hospitals tend to run pretty lean; it’s more profitable to provide costly services than to solve complaints cheaply; we work through a tangled mess of misaligned incentives toward an unclear end.
Monumental responsibilities have come before, and burnout has not been their inevitable result: World War Two comes to mind, as does the tireless commitment of the late Paul Farmer. When one can make a difference in proportion to the time and energy and emotion than he pours into his work, exhaustion may be a result, but not burnout.
A sense of unfairness has in part fueled this fire – while many stayed home, healthcare workers alone shouldered a burden which should have been distributed among all.
Frustration is a normal response to observing the same reckless decisions ad nauseam: not frustration with the people who refute common-sense until it became too late to change course, but for them.
A continuous tug of war
The relationship between our nation’s whitewalled profit centers and their clinical workers is often enough an abusive one: like our education system, an unsustainable arrangement continues forth only on the backs of skilled and dedicated individuals who answer a higher calling. This is not a market inefficiency for savvy finance people to capitalize on – it is the best of humanity looking an unfair deal in the eye and choosing to transcend concern for themselves.
Although the difference in patient outcomes produced by a great healthcare provider over an average one is staggering, executives eager to cram complicated systems into spreadsheet cells sometimes see these thinking and breathing clinical people as commodities. This is both immoral and a strategy mistake, which together ought to cover everyone’s concerns.
To compound perversion, we’re one of few countries in which healthcare represents private industry rather than public service. This means that government has got at any given time only a few levers with which to effect quick change. But these are problems of leadership, not of finance.
Clinical work is deeply engaging and superbly rewarding.
It is no small failure to allow the environments of that work to become so noxious that the people attracted to these professions have no choice but to turn away.
The fact that state laws about nurse-to-patient ratios were relaxed never meant that hospitals needed to sink to the lowest allowable level.
What are we doing now to make things better for the people this system is meant to support?
Who will bear responsibility when we fail them again?
Burnout is not predetermined for our healthcare workers. Its present ubiquity must not be confused with inevitability. Like wrong-sided surgeries, burnout is a “never event” – each occurrence a failure representing total breakdown of a system. Burnout is a symptom of defective leadership and flimsy strategy.
The dismal performance of the past two years should raise serious questions about the workings of the medical system, and it should be clear to all that as patients deserve much better, so too do healthcare workers.
John Corsino is an intensive care unit physical therapist.