Healing Health Care Burnout and Lessons Learned From the COVID-19 Pandemic

Psych Congress Steering Committee members Saundra Jain, MA, PsyD, LPC, and Andrew Penn, MS, PMHNP, unpack the profound and lasting impacts of burnout among health care professionals in the wake of the COVID-19 pandemic. In this video recorded on-site at Psych Congress 2023 in Nashville, Tennessee, the pair share insights into systemic challenges, trauma-informed approaches, and the importance of collective support in fostering resilience and well-being.

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Transcript:

Saundra Jain, MA, PsyD, LPC: Hi, I am Dr Saundra Jain, and I'm a psychotherapist in private practice in Austin, Texas, and I'm also an adjunct clinical affiliate at the School of Nursing at the University of Texas in Austin.

Andrew Penn, MS, PMHNP: And I'm Andrew Penn. I'm a psychiatric nurse practitioner and a clinical professor in the School of Nursing at the University of California, San Francisco, in addition to being part of the steering committee here at Psych Congress.

Andrew: So, Saundra, here we are in 2023, now over 3 years into the COVID-Pandemic. We know that with our colleagues, it's had a tremendous impact on health care professionals of all stripes. We are hearing more and more about burnout. What's going on with that? What are we seeing? What sort of impact has this had on our colleagues in health care?

Saundra: Well, Andrew, it had an impact on patients. We talked about that at the very beginning, but very quickly, it became clear that [the pandemic], shined a bright light on things that existed prior to COVID-19. It is not like [these things are happening] just because of COVID-19, but as a result of COVID-19; I think we were just more aware of it.

We began seeing our colleagues, as you said, across all specialties of medicine and health care, all healthcare providers, really started to struggle. I think partly because we are taking care of our own families, our own individual needs, and what it's like going from being socially connected to socially secluded, that took a toll. But then many of the frontline health care workers were at work, so they had to leave their families, and then they were being exposed, potentially bringing that home. There was a lot of worry about infecting the family that was at home.

Andrew: I remember that.

Saundra: Right? I mean, it was horrifying.

Andrew: Yeah. Clinicians were sleeping in their garage.

Saundra: That's right.

Andrew: To not expose their kids to potential infection, yeah.

Saundra: And really, as you say: sleeping in the garage? How does the family inside the house make sense out of why one of the parents, or maybe both of the parents, are sleeping in the garage? 
Andrew: Yeah. And that's after a 12-hour day in a hospital that's overwhelmed with the pandemic.

Saundra: That's right.

Andrew: Yeah, it feels like in mental health, we're seeing the tail end of this. In the early days, we heard about people in ICUs and we heard about nurses working in ERs. And now it's almost like we've sort of moved on from COVID-19, but we're seeing the after effects of that, not only in our patients…I know I am seeing patients that are continuing to struggle with things like anxiety and depression from isolation… but also in our colleagues who are often exhausted and burnt out.

I worry about the future of our health care system if we can't hold on to our clinician colleagues because they're burnt out from this experience.

Saundra: I think one of the most heartbreaking things during the COVID-19 pandemic was when they would feature these stories on the news, and it would be where you're working, you're in an ER, you're on a COVID-19 floor, you're taking care of patients who are dying, and you are holding space and witnessing with families through an iPad or through FaceTime. Horrifying. But then they began experiencing their colleagues dying. And that is not that It's worse, but it's just closer.

Andrew: Absolutely.

Saundra: And we began getting calls from frontline... I mean, we are at least a little bit removed from that, at least as a psychotherapist, I was not doing frontline work, but my nursing [00:07:00] colleagues, physician colleagues who are frontline, it was horrifying to watch. And you think about it from a perspective of a system, they were all under-resourced. You couldn't get supplies. You were working... I mean, you would have to help me with this, but I think double shifts, no time to go to the bathroom, no time to have a break. That's cruel and unusual punishment. But maybe in response to what was happening, I just [00:07:30] think that we're going to see the after effects of this for a very long time.

CONTINUE EDITING Andrew: I think we are, too. Yeah. I think our work is cut out for us and really, as you point out, that these were not new problems, but really, the pandemic really cracked them wide open. And it's incumbent on healthcare systems to think about this in a long-term way, because this is not a problem that's going [00:08:00] to be solved with free lunches...

Saundra: Pizza day.

Andrew: ... Pizza day. We really need systemic change and we really need to think about how do we take care of the people who are taking care of us. That's really the big question.

Saundra: Well, we also knew that for patients, that if they had preexisting anxiety or depression or probably any other number of that, COVID just intensified that. But I think that's true for frontline healthcare workers, it's not like we're immune [00:08:30] to having our own mental health challenges. So those who came with a preexisting difficulty really took a harder hit.

Andrew: Yeah. Yeah. And I appreciate that we're having a more open conversation about this, because I think historically, there's been a lot of stoicism in the healthcare professions and you kind of suck it up and move on. And the reality is a lot of people in healthcare have witnessed a lot of traumatic things, they've seen some pretty horrible things, and that has an [00:09:00] impact on us. We see this increase in suicide rates in certain healthcare professionals. And so, as you say, this is something we're going to be dealing with for a long time to come, and we can't just look at it on the individual level. We're not going to prescribe and therapy our way out of this. We have to start changing larger systems so that we actually make healthcare not only a profession that people want to go into but can sustain once they're there. 

Saundra: Well, speaking of that, Andrew, how many people do you know after COVID or during that process left and never came back?

Andrew: Yeah, exactly.

Saundra: Right. They just were like, "I'm done. I can't do this anymore."

Penn: Yeah, it was the last straw. So, yeah. So the people who are coming into this now, we need to think about how can we learn from this so that we can protect those people from the same things that burnt out their previous colleagues and how do we retain the people that we have now? I think that's really the work that we have ahead of us.

Saundra: And don't you think, [00:10:00] Andrew, that's top down? That is, like you said, systemic, that's got to come from the top down. They've got to walk the walk and really take care of people.

Andrew: It does. And at the same time, the talk that we're giving here at the conference is talking about that maybe the cavalry ain't coming. That really we have to start looking at how do we take care of each other. This idea of mutual aid, how do we look out for each other in this and not wait for [00:10:30] some system to fix itself because they don't seem to be in a big hurry to make big changes. 

Saundra: Yeah. And maybe we do it in a parallel fashion.

Andrew: Yeah, we do both.

Saundra: That we take care of ourselves, mutual aid, and then we speak up and let the top down hear our voices that systemically you must make changes.

Andrew: Yeah. Yeah. Because if they're not, they're not going to have staff. 

Saundra: That's right. Well, everybody's going to leave and nobody's going to come back.

Andrew: Exactly. And we can't have that. We need a health care system that functions. So [00:11:00] this is incumbent that we got this right. Yeah. All right, well good talking to you about this today and looking forward to talking more. 

So, Saundra, you've been a pioneer in talking about wellness for many years now with the WILD 5 program, and that is a really straightforward means [00:13:00] of implementing wellness into somebody's life. Are those kind of things useful for healthcare workers to reduce their burnout and maintain sustainability during the COVID Pandemic? What'd you find? 

Saundra: Well, interestingly, one of the things that we found in one of the studies with nurses in the state of Texas licensed healthcare, nurses at all levels of licensure, that when they had been referred for mental health and substance use disorder challenges to an online program, [00:13:30] we enrolled them in the 30-day wellness program. And we thought, "Oh, this is going to be a great resource." And the data trended the same as all of our previous studies except in one area. 
Andrew: Which one?

Saundra: Social connectedness.

Andrew: Oh, interesting. That's one of the five things, trying to connect with two people a day. 

Saundra: Two times a day, with the families or friends. And we were really shocked by that. Instead of about a 25% improvement overall in 30 days, we only got about 9.5% change. And we went [00:14:00] back and talked with people and they talked about that they were just exhausted. They just didn't have the energy, because they're not doing it in person during COVID, obviously, we made that adjustment, but they just really didn't have it in them because many of them were working two jobs, on call, covering for people, double shifts, and they were just depleted.

Andrew: Yeah. Yeah. And one of the things that we've talked about is thinking about these interventions [00:14:30] in a trauma-informed way. And so one of the things that happens when people have trauma is that they often experience a lot of shame, they are like, "I should be able to do this better, why am I not able to do this?" And it feels like sometimes systems kind of capitalize on that. They say, "Well, you could go to employee yoga or something like that." I'm thinking back to the previous job I had and the organization was very interested in wellness, which is great, and they'd offer these things like yoga during lunchtime, but I was so [00:15:00] busy returning phone calls and patient messages and pharmacy requests and such that I was eating at my desk, I didn't have any time for employee yoga. 

So really in that situation, the system needed to change. I needed to have less work in order for me to be able to implement these wellness tests. So I mean, it sounds like that was the case with the nurses that you talked to, was that as much as they would love to be able to do these things, when you're working two jobs, you can't do it. And then to say, "Well, [00:15:30] the reason why you feel burned out is because you're not doing enough self-care"?

Saundra: There you go.

Andrew: I mean, talk about blaming the victim, right?

Saundra: That's right.

Andrew: So when I hear that kind of thing, I think, "No, it's not about self-care, it's about..." I mean, sure, self-care needs to be a part of it, but really the bigger issue is the systemic one that we're asking people to carry on an unsustainable load and then blaming them when they get tired. 

Saundra: Right. Yeah. No, I remember, Andrew, the first time you asked me about that. So how do you ask somebody to do that who's already depleted? Who's already under-resourced? However you want, they're just burnt out. They're burnt to a crisp. And I do think it is that trauma-informed conversation. It is making sure that we don't blame and shame. Because let's say that you are from a setting where you don't have access to a grocery store or it's five miles across town to get to fresh vegetables, that when we talk about eating healthy unprocessed food as part of WILD 5, we have to be more sensitive.

So once you've brought that to my attention, I've gone back to really motivational interviewing, and that when we enroll people in a study, or even when I have somebody call me who wants to do it with a small group in their community, is to really make sure they meet everybody in the group where they are. Like, if you feel like you can't do it, let's talk about it now. How are we all coming together? And interestingly, some of these smaller [00:17:00] groups would say, "Well, you know what? That's okay. I've got access too, I have a garden in my backyard. I'll put some food together." And they would really support each other in where their deficits were, right?

Andrew: Right. It goes back to that idea of mutual aid.

Saundra: That's right. I loved it. And mental health improved because when people did not fall into that isolation and expect less from their environment, but they saw, "Hey, my environment can actually... Other people do want to help me." [00:17:30] It's like fertilizer. You can just see people start to rise up in a good way and really benefit from helping each other and doing it together.

Andrew: Yeah, it really speaks to the power of a group.

Saundra: That's right.

Andrew: And one of the things that's happened during the pandemic was that there was a real increase in collective organization and labor when people started unionizing. Even at Stanford, the residents and fellows unionized, which is really unheard of in healthcare [00:18:00] to have doctors being unionized. And so that idea that we're stronger together in numbers is a really powerful one in many different contexts.

Saundra: Yeah. I'm reminded of that song by, I think his name is Jack Johnson, Better Together. I just love that, because it's true.

Andrew: Yeah, for sure. Well, excellent. Thanks for sharing that with us. Appreciate that and look forward to talking to you some more.

Saundra Jain, MA, PsyD, LPC, is an adjunct clinical affiliate in the School of Nursing at The University of Texas at Austin and a psychotherapist in private practice. Dr Jain is a co-creator of the WILD 5 Wellness Program and co-author of a workbook written for those interested in improving their mental wellness titled KickStart30: A Proven 30-Day Mental Wellness Program. She is co-creator of the Psychedelics and Wellness Survey (PAWS), exploring the intersection between psychedelics and wellness. She serves as a member of the Psych Congress Steering Committee, providing direction regarding educational gaps and needs for mental health practitioners, and Sana Symposium, providing psychedelics education for mental health and addiction professionals.

Andrew Penn, MS, PMHNP, is a clinical professor at the University of California, San Francisco, School of Nursing, where his teaching has received the UCSF Academic Senate Distinction in Teaching Award, among other recognitions. He practices as a psychiatric/mental health nurse practitioner, treating veterans and training residents at the San Francisco Veterans Administration Hospital. As a researcher, he collaborates on psychedelics studies of psilocybin and MDMA in the Translational Psychedelics Research (TrPR) lab at UCSF, serving as Co-PI on a phase 2 study of psilocybin for depression and is currently working on a study using psilocybin to treat depression in patients with Parkinson disease. A leading voice in nursing, he is a cofounder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses.org), advocating for the perspective of nurses in psychedelic therapy; he has published on psychedelics in the American Journal of Nursing, Frontiers in Psychiatry, and The Journal of Humanistic Psychotherapy. An internationally invited speaker, he has lectured at SXSW, Aspen Health Ideas Festival, the Singapore Ministry of Health, TEDx, and Oxford University and can be found at Andrewpennnp.com.