Emergency medical workers, already at increased risk for burnout compared to other professions, continue to be challenged by the fallout of COVID-19.
Stretched to breaking point by increased workloads, highly contagious and acutely ill patients and with limited resources, their risk factors for burnout have been amplified.
One obvious solution is to fix critical staffing shortages, but emergency health worker burnout was an issue before pandemic-driven staff shortages, and will likely continue into the future.
There is no easy fix, but the World Health Organization has been calling for action to better protect workers. Many are leaving the profession.
What is burnout and how prevalent is it?
Burnout is a workplace syndrome characterized by feelings of exhaustion, depersonalization (a sense of detachment and that one's surroundings are not real), and compromised work performance, according to the WHO’s International Classification of Diseases.
Researchers at the BlackDog Institute propose additional fundamental symptoms including lack of feeling, lack of concentration and lack of motivation, among others.
Burnout has previously been reported to be experienced by anywhere between 26 percent to 82 percent of clinicians working in emergency departments, much higher than other areas of medicine and the general workforce. But during the COVID-19 pandemic these figures were found to be consistently high, between 49.3 percent and 58 percent.
What does the research say about fixing it?
Despite the common self-help resources available online there is only a modest amount of high-quality scientific evidence for what works to address burnout in emergency medical workers.
Several systematic reviews of interventions broadly categorize interventions into two types: individual-focused - for example mindfulness or small group stress management education; and organizational-focused - for example limiting shift lengths, flexible working arrangements and building a positive workplace culture. Both types of interventions can lead to a meaningful reduction in burnout among health workers.
At the organizational level, a recent, high-quality study concluded organizations needed to take more ownership of implementing effective burnout reduction strategies to make workplaces less stressful and supportive of workers’ mental health.
There is also some evidence for job training and education, such as training by qualified psychologists on coping strategies, in reducing occupational stress and burnout compared to other organization-based interventions.
A paper on the determinants and prevalence of burnout in emergency nurses found evidence of the need for a “good person-environment fit” where a person’s values, beliefs and personality traits match the norms of an organization, to prevent burnout.
On an individual level, mindfulness-based interventions, in which people develop the ability to be present in the moment and not judge their experiences, have been found to be effective. Another study of nurse burnout also found implementing mindfulness-based interventions, as well as other positive thinking training, at regular intervals was key to ensuring long-term change.
Several studies have found a combination of individual- and organizational-level interventions have the greatest effect for general medical workers. For instance, studies have reported that implementing physician-targeted interventions like exercise and mindfulness techniques alone do not have a significant effect on burnout reduction but can be effective at reducing burnout when combined with organization-directed interventions like good communication, interdisciplinary collaboration and team spirit.
Specific to the COVID-19 pandemic, studies of workers in ICU and ED found that work environment, communication, and support by supervisors had an established role in burnout both before and during the COVID-19 pandemic.
One study suggested organizations need to engage their workforces, listen to their concerns, and design targeted interventions based on the specific needs of their staff.
Finally, a study of nurses during the COVID-19 pandemic found the psychological support health care workers receive significantly influences their feelings and emotions and can support their ability to handle the negative effects of such an event. It also found that social support from sources like family, friends, co-workers, and their organization can help workers control and avoid negative feelings and emotions that can lead to burnout.
What are the caveats?
There are notable limitations in current research, for instance, evidence is limited about organizational interventions. Studies evaluating individual targeted interventions to reduce burnout are more common than organizational interventions because they are easier to implement.
Moreover, two studies found the overall sustainability of the effects of interventions is poorly understood. Lastly, a study focused on medical workers more generally that compared person-directed versus organization-directed interventions found that some organizational interventions don’t target burnout directly or may have unintended effects on other factors that shape burnout.
(The article is based on a rapid scan of systematic reviews focused on interventions to support emergency medical workers experiencing burnout, as well as interventions for medical workers more broadly. The scan was undertaken by a specialist Evidence Review Service at Monash University.)