- Researchers reviewed studies that looked at triggers of stress for female healthcare workers and interventions in preventing burnout during the COVID-19 pandemic.
- Most women reported stress related to issues like unclear and inconsistent protocols and lack of support at work.
- Self-focused solutions, such as yoga and therapy, receive more research attention than system-oriented solutions, but may be less effective.
During the pandemic, healthcare workers have been praised for working to help patients on the frontlines. But the stress they’ve been under for nearly a year now is leading to sector-wide burnout, particularly in women, a new study finds. Researchers are now asking if praise alone is enough to sustain healthcare workers through the end of the pandemic.
“It’s about time we start writing about this,” Jay-Sheree Allen, MD, a family medicine physician based in Minnesota, tells Get Meds Info. “I see this so much firsthand just at my job.”
The authors of a new analysis define burnout as “the experience of emotional exhaustion, depersonalization, or cynicism, along with feelings of diminished personal efficacy or accomplishment in the context of the work environment.”
Researchers reviewed 47 global studies published between December 2019 and September 2020. All addressed one or both of the following questions: “What are the triggers of stress and burnout in women in health care?” and “what interventions are effective in preventing occupational stress and burnout?”
Of the 47 studies reviewed, representing more than 18,600 women working in health care throughout the world, researchers found that structural factors—such as work-related policies, staff shortages, and access to personal protective equipment—were the primary force of “stress and burnout in women in health care during COVD-19.” The January review has not yet been peer-reviewed and was made available for preview on medRxiv.
“It takes just one evening on Med-Twitter, and you see so many of us talking about similar experiences,” Allen says. “At some point, you just need to laugh about it because if not, you’re going to cry.”
Lead author Abi Sriharan, D.Phil, MSc, BSc, professor and expert in human resources in the health sector based in Canada, tells Get Meds Info that COVID-19 sheds light on organizational problems that were already there. “The pandemic has helped to show that this is a systems issue that we need to address now,” Sriharan says. “Otherwise, we are going to have a crisis of not having enough healthcare workers in the future.”
“We’re approaching almost a year in this,” Allen says. “It’s one thing to do something for three months, for six months—but as we’re dragging on for a year, it’s like, this is not sustainable.”
Stress in Female Healthcare Workers
The researchers focused on female healthcare workers due to the responsibilities they tend to take on in society, and because they make up 75% of all healthcare workers globally.
Researchers found that the primary source of stress was structural, or systems-based. For instance, many providers struggle to deal with the stress of providing emergency services in unpredictable environments. There were also concerns about “ambiguous patient care protocols” and “perceived lack of infection control guidelines,” as well as perceived lack of support among colleagues.
“You show up to work, and it’s a new policy today, a new policy tomorrow,” Allen says. “Absolutely nothing is constant.”
These factors are then only magnified by stressors beyond the workplace. Researchers found that the majority—66%—of female healthcare workers reported that “safety concerns and fears of getting infected with COVID-19 and putting family members at risk” was contributing to burnout. These women are “being pushed in multiple directions,” Sriharan says, and are being praised for it, yet are avoided by others because of their proximity to infected people.
Researchers also highlighted that some women may be more susceptible to burnout—particularly young women with no family, or mothers with young children. New healthcare workers, too, may be more vulnerable given that they have less work experience and perceive themselves as lacking the competency to care for COVID-19 patients.
Allen sees many of her female coworkers worrying not only about work, but also their young children and providing them with a sense of normalcy in a pandemic. For those who are caregivers to aging parents, some have taken their parents out of assisted living “just to be able to see them, because a lot of these facilities have restrictions in place.” Others can’t see them because of these restrictions. “If I get something and I take it home—that’s a lot to live with,” Allen says.
Burnout Is Not Just a Mental Health Issue
“When you talk about burnout, the first response is that it’s a mental health issue,” Sriharan says. “I’m not saying it’s not, but it’s not only that.” Yoga and therapy may help female healthcare workers cope with the pandemic, but they won’t improve structural problems.
Although “burnout” is used in many different cases, it is defined in this analysis as emotional exhaustion in the work environment. Meanwhile, the majority of studies reviewed labeled burnout as “a psychological or individual issue.” Only 38.3% of the studies considered workplace interventions to support the workers, and most prioritized “self-focused” ones, such as exercise, yoga, therapists, and hobbies.
These recommendations stand in contrast to the idea that stress is structural, or “systems” issues, underlining a gap in the research, as well as in practice. Sriharan emphasizes how much structural changes could support healthcare workers, explaining that a lack of established state or nationwide patient care protocols is what we’re seeing in California now.
A fifth of studies did identify systems interventions, including work modifications, clear communication about policies, measures to support health professionals financially, and rest areas for sleep and recovery. “All [some] need is just some flexibility in terms of work hours,” Sriharan says, or even “a place they can go sleep if they have a short break, or access to healthy food so they don’t eat junk food.”
When healthcare workers are offered yoga classes or training sessions, Sriharan says, “overwhelmingly, people are saying, ‘That’s not enough. Thanks for offering this, but I just need time for myself.'”
Allen suggests that the workflow of the day be modified. “Ideally, we should have a certain number of patients per day, a certain time limit,” Allen says, which would allow physicians time to recover from the emotional burden. If not, she says, we can already hear “all these rumblings of a mass exodus from healthcare.”
“We really should start looking to our leaders and organizations to put forward solutions,” Allen says. “The onus can’t just be on the individual.”
The Irony of the Frontline “Hero”
If self-focused interventions don’t cut it, then praising female healthcare workers, researchers found, as “heroes,” isn’t enough, either. The authors write that ironically, it might increase stress and burnout. “The societal and media portrayal of health care workers as ‘heroes’ increased moral responsibility and caused increased stress to meet these expectations, yet health professionals faced increased social isolation and stigma as they were considered as contagious by the general population,” the authors write.
Imagining what female healthcare workers are going through in the pandemic can make them seem like miracle workers. But Allen invites us to remember that at the same time, they’re “juggling so many different glass balls.”
“I think the hardest part is continuously reassuring our parents because the doctor’s office is one of the last socially-acceptable places to still go,” she says. “We are underestimating the loneliness, the anxiety, the depression that our patients are currently struggling with right now, and the doctor is the only outlet they have to turn to right now. I wish I had a prescription for hope.”
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