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Small Changes May Help Exhausted Health Care Workers Combat Burnout


Many of the health care workers we all depend on - doctors, ambulance drivers, especially nurses - they are exhausted, burnt out physically and emotionally. And there were far too few of them to begin with. As COVID cases surge among the unvaccinated, many are calling it quits. Well, given all that, what can be done about it right now? NPR's Yuki Noguchi reports on smaller changes helping health care workers combat burnout.

YUKI NOGUCHI, BYLINE: There's a website emergency doctor Damian Caraballo checks. It lists open beds for critical care at other Tampa area hospitals. Lately, all of them say bypass, as in no beds available across the region.

DAMIAN CARABALLO: It's been pretty awful. It's been the worst we've seen here in Florida. Every hospital is basically max capacity for the past month.

NOGUCHI: Often, it isn't that there aren't enough actual beds.

CARABALLO: If they don't have a nurse to staff it, they don't have a real bed.

NOGUCHI: Caraballo has seen a fifth of his coworkers quit, leaving vacant jobs everywhere - nurses, respiratory therapists, lab techs.

CARABALLO: Even things as simple as, like - we're short registration people, and that puts a delay on everything. So it has a domino effect.

NOGUCHI: Before the pandemic, patients griped about waiting two hours. Now it's 10 hours. That in and of itself is a health risk.

CARABALLO: I basically tell everybody that comes in if you're unvaccinated here in our waiting room, you're going to get COVID. I mean, I don't see how they don't.

NOGUCHI: Because unfortunately, he says, two-thirds of patients are unvaccinated people with COVID.

CARABALLO: Day in, day out, seeing that, especially young people now, I think that combined with the staff shortages, everybody working harder, it just creates this really tough environment that makes burnout even worse.

NOGUCHI: Burnout isn't a synonym for exhaustion. It's also defined as a demoralized state, resulting in reduced job function. Studies show it ran rampant in health care prior to the pandemic. Now it's a full-blown crisis. Christina Maslach is a psychologist at the University of California, Berkeley. The World Health Organization adopted her Maslach Burnout Index as its definition of burnout. The term, she says, is often misunderstood as a mental illness or a personal failing. It isn't.

CHRISTINA MASLACH: It is chronic job stressors that have not been successfully managed that, you know, is really the source.

NOGUCHI: Nurses unions point to chronic short staffing and low pay as a primary cause of burnout. But Maslach argues better management can help alleviate it even under extreme conditions.

MASLACH: We have to get past this notion that the job is what it is. You can't fix it. You can't change it. You just have to deal with it, no matter what.

NOGUCHI: Maslach says, often, there are various irritants that add up to make workers feel undervalued, disregarded and eventually burnt out.

MASLACH: Little stuff - what are the chronic pebbles in your shoe?

NOGUCHI: So she says the fixes are often small and targeted.

MASLACH: People keep saying, what is the one thing we could do? There is no one solution. There are many.

NOGUCHI: One common complaint Maslach hears from health care workers - not having a functioning copier.

MASLACH: That's a little example, but it can mean a lot.

NOGUCHI: Because medical paperwork is already a giant bugaboo - so managing a crush of patients, then having to hunt for a working Xerox just fans angry flames.

MASLACH: It's out of paper, or it's not working. And nobody's taking care. So you have to run to another floor.

NOGUCHI: Tampa ER Doctor Caraballo agrees the pandemic makes bureaucratic hassles all the more stressful. He's a member of patient advocacy group Physicians for Patient Protection. He points to some recent changes that have helped. Florida recently relaxed rules for where patients could receive IV infusions of monoclonal antibodies to treat COVID, for example.

CARABALLO: We used to have to give it in the ER, and it would take, like, an extra two hours. So there's a clinic you could send people to. That made it a lot easier.

NOGUCHI: Also, his hospital recently started allowing remote monitoring of some COVID patients from home.

CARABALLO: All those things would take stress off the hospital because we wouldn't have to admit these patients.

NOGUCHI: Often, the best suggestions come from those who do the work. Massachusetts General Hospital realized that early in the pandemic. As the nation's supply of rubber gloves ran critically low, a triage nurse came up with an idea for a plexiglass wall at a patient's bedside. It had armholes cut into it with a set of sleeve-like rubber gloves attached. That way, caregivers could slide their arms through and adjust a patient's oxygen line or check a pulse quick and safe without using new gloves.

ALI RAJA: I thought it was a great idea, and so we implemented it very quickly. And the triage staff absolutely loved it.

NOGUCHI: Ali Raja is a vice president of emergency medicine at Mass General. He says that spurred other ideas - giving iPads to patients so staff could talk to them without suiting up in PPE. Raja says such ideas...

RAJA: Can not only acknowledge the staff's expertise and what they're going through, but quite honestly can give you some really great solutions that the leadership just won't have thought of because they don't have boots on the ground.

NOGUCHI: Fostering a sense of camaraderie, coworker support, is also key in battling burnout. Some hospitals converted waiting rooms left vacant because of visiting restrictions into staff lounges or for peer counseling. Ali Raja says he knows firsthand that type of support is meaningful.

RAJA: I've been asking my friends for help when I've needed it.

NOGUCHI: He also sought counseling for the first time.

RAJA: That's not something that I was willing to do before. But the fact is that so many of my colleagues have acknowledged that same burnout and told me just how much that helped.

NOGUCHI: ER doc Damian Caraballo says he encourages the same at his hospital in Tampa.

CARABALLO: Offer moral support for them - I think that's, in the short term, the best we can do.

NOGUCHI: He says there are a few quick solutions to burnout. One of the most powerful, he says, is up to the public.

CARABALLO: The fact that there's a vaccine available, there's an easy way to avoid about 90% of this.

NOGUCHI: But that is something neither he nor the hospital can control.

Yuki Noguchi, NPR News. Transcript provided by NPR, Copyright NPR.

Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.