The Pandemic’s Toll—A Case for Clinician Support

Abstract

Healthcare providers perform lifesaving work in unusually stressful work environments due to the challenges and related risks of battling the unprecedented COVID-19 pandemic. The potential personal and professional toll is substantial. This article describes how one healthcare facility benefited from existing peer support resources to address workforce well-being, ensuring that resources were available to support workforce resilience throughout the protracted COVID response.

Introduction

On January 4, 2020, the initial World Health Organization’s announcement alerted the healthcare community to an outbreak of pneumonia in Wuhan, China.¹ Two weeks later, on January 19, a 35-year-old male became the first known coronavirus (COVID-19) positive patient in the United States.² Over the past months, with more than 85 million cases confirmed globally, and more than 20 million cases diagnosed in the United States, our lives have changed dramatically because of this worldwide pandemic.³ When the first Missouri COVID-19 case was diagnosed on March 21, 2020, little did we realize the long-term implications on virtually every aspect of our lives.⁴ As we gain global insights into coronavirus care experiences from frontline clinicians, the importance of addressing the overall needs of the workforce, specifically emotional trauma, is becoming more apparent.⁵

The battle with COVID-19 has introduced unique occupational stressors for our clinicians and healthcare workforce. Providing such care threatens the individual clinician’s physical, mental, and emotional well-being. The acute stress and uncertainty associated with the continual influx of critically ill patients, resource challenges, and ongoing risk of infection pose a unique dilemma to the healthcare team.⁶ Hectic and extended work hours, combined with the countless uncertainties of the rapidly growing pandemic, contribute to workforce fatigue, anxiety, depression, and professional dissatisfaction. ⁷ The need to quickly modify care delivery practices in the face of a pandemic also introduces challenges.⁸ Some of the occupational stressors are not new but have been amplified during the pandemic surges, while others have not been previously encountered. The pandemic has propelled us into a new healthcare environment and has forced us to make changes in how we do things each day. From an organizational and leadership perspective, the COVID-19 crisis has highlighted the need for clinician support. This article describes how one healthcare system established a comprehensive clinician well-being tactic capitalizing on pre-existing peer support networks.

Safeguarding the Clinicians

Each healthcare organization has a responsibility to protect not only their patients but their clinicians as well. The potential personal and professional toll on clinicians is substantial as providing pandemic care threatens physical, mental, spiritual, emotional, and financial well-being.⁶ An evidence-based, proactive approach to address the emotional and mental well-being of clinicians is essential as healthcare settings navigate the pandemic. Supportive care for clinicians and the healthcare workforce must begin sooner rather than later and continue throughout the pandemic.

To address overall well-being, organizational leaders must understand and actively focus on the fears, concerns, and anxieties of their workforce. Leaders should be particularly vigilant for the harmful effects of repeated vicarious traumatization and the potential for associated anxiety, depression, grief, and burnout associated as clinicians work amid so many pandemic unknowns and a seemingly relentless uptick of patients. A proactive, holistic approach that supports emotional well-being should become a gold standard in the design of institutional responses as we progress forward.

History of the University of Missouri Health Care’s Peer Support Program

University of Missouri Health Care (MU Health Care) is a mid-western academic healthcare system with approximately 1,200 attendings, fellows, residents, and advanced practice providers. MU Health Care has a proven track record for safeguarding the emotional needs of their workforce through the execution of the ‘first of its kind’ peer support initiative, the forYOU Team. ⁹ Team members offer support to clinicians and other members of the health care team via confidential peer-to-peer interactions discussing the individual’s responses to events and discussing their individual unique needs. The trained peer supporters recognize triggers of psychological trauma in their colleagues, provide immediate emotional support, and, if necessary, offer informed referrals to professional counseling services for those co-workers requiring additional support. Program success can be attributed to team members who were carefully selected for their professional maturity, exemplary interpersonal skills, and communication abilities. These team members, representing a wide variety of professional roles and clinical settings, received training on the care of healthcare’s second victims and individual crisis interventional support for colleagues needing assistance during the aftermath of challenging clinical events. For team member qualifications, refer to Table 1. During the first ten years of service, the forYOU Team peers have documented emotional support in the form of one-on-one support and group debriefings for more than 1,931 MU Health Care clinicians/team members.

Table 1.

forYOU Team Member Qualifications

Must be a member of the MU Health care team (Faculty, staff, student learners, and volunteers) with a minimum of two years of experience Personal characteristics Exhibit exemplary interpersonal communication skills Ability to maintain confidentiality Emotional maturity Empathic Non-judgmental Culturally sensitive/aware Natural confidante for team Ability to work within established guidelines Nomination endorsed by departmental leadership

During the past 13 years of advancing clinician support, the forYOU Team created a relatively unique organizational response to the provision of supportive presence for the healthcare team member in crisis.¹⁰ Over time, the team has undergone an evolutionary transformation adapting to the ever-changing clinical environment and the various clinical scenarios facing the clinician. The peer network of supporters was initially designed in 2007 with a concentrated focus on the care of the clinician after an event involving a medical error. Team coordinators quickly realized that there were additional incidents that involved unanticipated clinical outcomes not associated with a medical error, and the scope of service expanded to address these clinical events. Within weeks after official team deployment, a request was made to support a manager with the unexpected death of a young co-worker. As one of the few MU Health Care resources trained specially in group crisis debriefing, the forYOU Team leaders convened the interdisciplinary team and assisted with the emotional processing of this unexpected event. The team soon became the ‘go-to’ resource for helping local leadership with the death of a co-worker. New tragic clinician events (workplace injury, catastrophic diagnosis of a co-worker, serious career-ending injuries) soon expanded the scope of responses. Approximately a decade later, the team’s scope of service expanded once again when an upsurge of requests was received to assist clinicians exposed to workplace violence. The team continues to expand its scope of service by offering assistance to colleagues and co-workers during the COVID response. With each evolutionary advance, team members received supplemental educational support, guidance, and the tools necessary to address the newest threat to clinician well-being. The natural outgrowth and evolution of support services over time have provided MU Health Care with a reliable platform for ensuring clinician support.

A foundational element of MU Health Care’s forYOU Team is the commitment to maintaining a pool of trained clinicians throughout the healthcare system, available to offer supportive discussions with distressed colleagues in the aftermath of emotionally challenging clinical events. In our experience, only a small percentage of clinicians will reach out on their own behalf to receive emotional support. It is quite rare for the clinician leader of a healthcare team to seek mental health support following an emotionally challenging case. The forYOU Team provides an organic approach to addressing the stigma of receiving support by capitalizing on the unique skillsets of qualified peers and by utilizing existing FTE. The team focuses on normalizing expectations, so when an emotionally challenging event occurs, a peer will be readily available to offer supportive and healing conversations proactively. Over time, the forYOU Team strengthened a culture of trust by supporting healthcare clinicians at their most vulnerable moments and by normalizing the fact that supportive presence should be an expectation and not an anomaly.¹¹

The Contribution of Peer Support to the Pandemic Response

The most recent expansion of services occurred when MU Health Care’s COVID-19 response command center charged forYOU Team leadership with the task of developing strategies to support clinician well-being through the duration of the pandemic. The team formalized a comprehensive plan of action to address healthcare workforce well-being as part of MU Health Care’s overall COVID-19 response initiative. The expansion of the scope of peer support services over the years positioned the skilled and dedicated peer supporters well to be able to address the collective trauma now associated with the COVID-19 challenges.

The forYOU Team leaders partnered with leadership from the MU School of Medicine’s Office of Clinician Well-Being to formalize a plan of action, coordinating internal, campus, and community resources relating to the care of the healthcare workforce. A Workforce Well-Being Task Force, composed of key stakeholders and leaders, was established to ensure that the action plan would be holistic and address clinician needs throughout the protracted crisis response. Refer to Table 2 for Task Force Members. Members of the task force were selected based on expertise in aspects of well-being, representation of those providing front line care, and/or leadership roles needed to influence or deploy interventions. The task force established the following goals to support the health care workforce: attend to the basic care needs and safety of the workforce, facilitate connection with appropriate resources, create strategies for leaders at all levels to address clinician well-being, and enhance communication to correct misinformation and improve morale.

Table 2.

MU Health Care’s Well-Being Task Force

Co-Leaders forYOU Team Coordinators Office of Clinician Well-Being Leadership Task Force Members Chief Wellness Officer Communications/Marketing Counseling & Clinical Psychologists Education Department Expert Health Psychologists Human Resources – Employee Relations & Engagement Nurse Scientist Nursing Leadership Psychiatrists Resident Physician – Wellness Expert Spiritual Care Staff Council Representatives

Peer support is one of the most essential, evidence-based interventions healthcare institutions can implement.

The task force continues to meet virtually on a routine basis to assess the current status of the workforce and to identify unmet needs that have been detected by a member of the forYOU Team or Well-Being Task Force. Having forYOU Team supporters embedded in clinical environments throughout the healthcare system on every shift has proven valuable in promptly gaining insights regarding existing threats and concerns for the frontline. The peer supporters have become an essential conduit of information relating to new well-being resources. The forYOU Team peer supporters once again have risen to the challenge of supporting their co-workers.

A supportive and nurturing work culture is vital to maintaining the overall well-being and resilience of clinicians during the prolonged battle against COVID-19. As clinicians will be caring for patients through this pandemic, addressing clinicians’ mental and emotional well-being is a smart institutional priority for any healthcare entity. Indeed, adapting supportive institutional resources to meet clinician needs during this healthcare crisis is a fundamental intervention that every healthcare entity should seriously contemplate. Selected strategies should be evidence-based interventions that address a wide range of services and are tailored to various workplace settings to address the many needs of today’s healthcare clinicians and workforce. While these strategies should be carefully considered, they should also be deployed in a timely manner.

Historically, health systems have offered numerous mental health resources (e.g., Employee Wellness Teams, Employee Assistance Program, Spiritual Care, etc.) to care for the everyday stress and emotional strain on clinicians. The need to expand these mental health support resources has become increasingly evident as healthcare organizations continue to fight against COVID-19 and have prompted many institutions to augment existing resources.¹² Tapping into existing internal and external resources, such as wellness committees, employee assistance programs, and spiritual care services, are potential resources to coordinate supportive interventions at the organizational level. To complement these efforts, physician and professional organizations now provide a variety of ‘just in time’ resources for healthcare organization leaders to aid in supporting clinicians during the COVID-19 crisis.^13–15 These updated resources are invaluable in assisting leaders in navigating the redesign of clinician support during this unprecedented healthcare crisis and in the future.

MU Health Care was fortunate to have a track record of clinician well-being by investing the supportive infrastructure of both the forYOU Team and the Office of Clinician Well-Being. Because of these resources, MU Health Care was well-equipped, agile, and flexible to promptly develop a comprehensive and holistic interventional support plan to care for its clinicians and healthcare workforce. The knowledge and skills of forYOU Team peers have been incredibly useful in strengthening the institutional strategy of offering supportive presence to colleagues in distress. The establishment of peer support programs should become a common resource in addressing the unique and changing needs of healthcare workers during the pandemic and post-pandemic era.

Conclusion

The health and economic crises brought about by the COVID-19 pandemic are not only dramatically changing the lives of the public but substantially impacting the overall healthcare system and the delivery of care. When the crisis begins to resolve, and we move towards our ‘new normal,’ healthcare institutions must continue to strengthen the overall well-being of their clinicians and workforce by deploying comprehensive approaches to support both personal and professional resilience. Before COVID-19, clinician burnout and poor mental health indicators were already a well-documented national pandemic; this crisis might be exacerbated in the wake of COVID-19.^16–20 Peer support is one of the most essential, evidence-based interventions healthcare institutions can implement. This article shared experiences and insights so that leaders, peer supporters, and healthcare workers can recognize, explore, and ‘normalize’ supportive interventional responses within their organizations. Working together, caring for each other, we can thrive and not merely cope with and survive the pandemic challenges that lie ahead.