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Health Care Workers in Crisis


By Beverly Belton, MSN, RN,  field director

The persistent onslaught of COVID-19 pushed heath care workers beyond physical and mental exhaustion.

In honor of Patient Safety Awareness Week 2021, we’re saluting the dedicated health care workforce. These individuals have rightfully become the center of a national conversation and are absolutely indispensable.

To date, The Joint Commission’s Office of Quality and Patient Safety (OQPS) has received more than 2,000 COVID-19 related comments from health care workers, their loved ones and other community members during the pandemic. These comments are summarized in a new Sentinel Event Alert 62, Voices from the pandemic: Health care workers in the midst of crisis

This is first in a series of alerts that will address health care workers’ concerns and provide guidance on the often-overwhelming circumstances surrounding caring for patients during a pandemic.

No two individuals have had the same pandemic experience, and this is truer of health care workers than anyone. Some have been working  on the frontline in high impact intensive care and dedicated  COVID-19 units,  while others have expedited the expansion of telehealth and others have shouldered the unexpected  burden of furloughs in health care during a public health emergency.. This is the worst public health crisis we’ve experienced in a century and it’s had an impact on the entire industry.

As we have learned more about this virus, some of the initial fears have resolved but there are still obstacles. Staffing issues seem insurmountable due to:

  • health care personnel exposure to and or infection with COVID-19 and the resultant need to quarantine
  • a finite number of available trained health care professionals
  • a limited number of other health care personnel, many of whom already have two or more jobs 
  • unmet child and dependent care needs created by the unavailability of schools and other community-based care support options

Our workers are physically and mentally fatigued and morale is at an all-time low. More staff, more paid time off and  expanded compensation packages beyond dollars will likely eventually need to be explored. 

The Sentinel Event Alert highlights five ways organizations can support their most valuable asset: their personnel.
1. Improve communication. For leadership, rounding and having authentic discussions with staff makes a huge difference. This isn’t walking around the units offering free pizza.  Acknowledge the fear and frustration.

Leadership has to be authentic and sensitive to the conditions at the organization. Encourage personnel  reporting of concerns, unsafe conditions, and any other aspect that would affect performance expectations.

Two-way communication can work wonders. Share challenges the organization faces and ask for innovative ideas on managing them. These exchanges don’t always have to be verbal. Routine emails from leadership can be great discussion starters and some common topics include:

  • updates on changes that have been implemented
  • patient  volume trends
  • community epidemiologic data
  • current levels of critical equipment and supplies

2. Encourage individual resilience and remove any barriers to mental health services.

If you haven’t already, NOW is the time to de-stigmatize mental health treatment and assure personnel there will be no repercussions for seeking mental health treatment. If it’s helpful, The Joint Commission prepared a statement supporting removal of these barriers. Sharing this with staff may help legitimize your position.

Even if personnel  do not want to seek mental health treatment, promote psychological wellbeing. This Quick Safety includes strategies that health care workers and leaders can take to manage stress, and strengthen individual and institutional resilience during times of crisis and recovery.

Second victim syndrome remains a serious issue. Referrals to Employee Assistance Programs, off-site providers, hospital chaplains or even peers may provide the necessary support.

3. Protect worker safety using NIOSH Hierarchy of Control framework

The National Institute of Occupational Health and Safety (NIOSH) has developed a Hierarchy of Controls framework that helps organizations to reduce the risk of:

  • occupational exposure to a range of hazards encountered in the workplace, including COVID-19
  • other novel pathogens

 4. Develop a flexible workforce. 

Having only those workers who are absolutely necessary working onsite at facilities decreases the likelihood of transmission of  COVID-19 between co-workers. Among its many benefits, telehealth enables staff to work while in quarantine.

This trend may continue. The C+R Research findings revealed that 63% of organizations increased staff work from home in response to the pandemic, and 24% expect remote work to be a permanent change.

In health care, of course, not every job lends itself to remote work. The pandemic has uncovered the need for health care organizations to continually develop team members who can contribute within intensive care settings. Having a flexible workforce trained in this manner enables organizations to redeploy staff to intensive care during crises and to have rotating staffing schedules that allow for rest and recovery. Many organizations have engaged fellows, residents, medical students, and retired or returning health care professionals in these settings as appropriate and necessary. 

5. Provide collaboration and leadership opportunities.

Enabling clinicians to collaborate, lead, innovate and conduct rapid tests of change is another important aspect of a workforce strategy.

A recent paper published by the New England Journal of Medicine Catalyst describes seven areas of leadership opportunity for clinicians: 

  • clinical standards
  • capacity management
  • ethics
  • science
  • analytics
  • resilience
  • communication

Clinicians and leadership must work in concert to make agile and informed decisions within these seven areas. Those health care organizations that build flexibility and resiliency into their models and engage ALL are best positioned to come out ahead.

Whatever your role in the health system is, we know you’ve given your all mentally and physically over the last year and can’t begin to express the depth of our gratitude. With vaccine distribution expanding exponentially , we’re closing in on this pandemic. During Patient Safety Awareness Week remember to take care of yourself and each other. We appreciate you!

Beverly Belton is presently a field director, NCC and HAP Programs, surveyor management and support in the Division of Accreditation & Certification Operations at the Joint Commission. Over the course of her career, Belton has worked in a variety of settings across the health care continuum-including the United States Army Nurse Corp. She has held clinical, middle-management and executive level positions. Belton has co-authored several articles on topics related to patient safety and infection prevention that have been published in peer-reviewed journals. In addition, Belton has served as a clinical instructor for students in the Graduate Entry Pre-Specialty in Nursing Program at Yale University.