COVID-19 has brought unprecedented changes and challenges to the health care workforce. Prior to the pandemic, physicians, nurses and other caregivers were already experiencing record rates of work related burnout or depression. Research on health care workers caring for COVID-19 patients during the pandemic shows an alarming increase in rates of anxiety, depression, insomnia and burnout.

“We’re living in a different world right now – everyone’s wearing masks, we can’t hug each other, everyone is guarded,” said Jeannine Loucks, MSN, RN-BC PMH, manager of the emergency clinical decision unit of the emergency care center at St. Joseph Hospital Orange. “We’re doing whatever it takes to get the job done for maintaining the safety of our patients but it’s the uncertainty, the fear of the unknown, that’s difficult. Staff are asking themselves, ‘Am I going to bring the coronavirus home to my family? How do I manage my own fears?’”

The Hospital Association of Southern California (HASC) and Communities Lifting Communities (CLC) invited three hospitals – St. Joseph Hospital Orange, MemorialCare Orange Coast Medical Center and Dignity Health California Hospital Medical Center – to share their efforts to address workforce burnout via a Nov. 9 webinar titled, A Workforce Burnout Crisis: Exploring Signs & Solutions.

ST. JOSEPH HOSPITAL ORANGE

When COVID-19 first hit California in March, St. Joseph Hospital Orange moved quickly to ensure the safety of patients and staff. “We started holding drills. We looked for best practices or developed our own best practices and were proactive in getting the most recent evidence-based information out to our staff on a daily basis,” Loucks said. “We obtained extra PPE and made sure our employees knew how to don and doff it correctly, through repeated drills.”

One way the hospital supports employees experiencing pandemic-related stress is through its Code Compassion team. “If someone’s having a bad day, a team of folks from the hospital goes and sits with them, debriefs and coaches them, and provides support,” Loucks explained. The team includes a member of senior leadership, an employee assistance program (EAP) representative, as well as members of the human resources, security and employee health teams.

Unlike many hospitals, St. Joseph has its own on-site EAP representative – who is a licensed marriage and family therapist. “She is available to our staff and their immediate families if they need counseling,” Loucks said. The hospital pays for up to five counseling sessions for each staff member.

To help alleviate staff concerns about getting infected, the hospital also provides COVID-19 tests on request. More than 300 employees have been tested over the last six months. “We will swab any employee who feels they are either symptomatic or have been exposed to COVID-19, because we know they’re fearful of contracting the coronavirus and giving it to their families,” Loucks said. “We can get them the test results within one hour and help them isolate, if needed.”

To further reduce employee burnout, St. Joseph allows staff seeking more hours to work extra six-hour – rather than standard 12-hour – shifts. “A lot of our staff are working extra hours,” Loucks explained. “We offer partial shifts because we don’t want them to burn themselves out.”

MEMORIAL CARE ORANGE COAST MEDICAL CENTER

“One of our biggest commitments to our staff is communication, communication, communication,” said Shela Kaneshiro, MBA, RN, BSN, NEABC, CPHQ, vice president of patient care services and CNO at MemorialCare Orange Coast Medical Center in Fountain Valley.

Kaneshiro and the hospital’s chief operating officer both round constantly. Employees receive regular email messages from senior management. MemorialCare’s chief medical officer provides regular clinical updates. “Communication has been crucial, particularly early in the pandemic when everyone was quite scared and still learning about COVID-19,” Kaneshiro said.

To address staff and physician burnout, Orange Coast offers a wide range of support services and programs. Most were already in place prior to the pandemic. Some had to be adjusted due to the new COVID-19 restrictions. Others were specifically designed with pandemic stress in mind.

Together, they provide a wealth of resources to promote mental and physical wellness and to boost morale through positive affirmation and staff recognition.

One program is called RISE (Resilience in Stressful Events) that provides confidential peer-to-peer counseling for staff and
physicians during the workday. Staff can also access via their computer or phone The Good Life wellness program, which, in addition to offering services to enhance their physical well-being, provides social and community support, and a host of free online classes, including assistance with managing personal finances. The hospital also set up a SELF (Sleep, Exercise, Love and Food) Care room where employees could take time away from the pressure of work, when needed.

Prior to the pandemic, the hospital’s popular Tea for the Soul program allowed day- and night-shift staff once a month to get away from their unit and be served tea in a quiet environment, with chocolate, hand massages and aromatherapy included. “We didn’t want to stop it altogether but, due to COVID, we couldn’t have people congregating so we took a cart to our staff and had our leaders serve them tea,” Kaneshiro said. “Our staff mean everything to us. We can’t take care of our patients if we don’t have staff here who are thriving and healthy and want to come to work.”

DIGNITY HEALTH CALIFORNIA HOSPITAL MEDICAL CENTER

Located in downtown Los Angeles, Dignity Health California Hospital Medical Center has cared for a disproportionate share of COVID-19 patients.

“At first, our staff had to deal with two kinds of stress – one due to their own anxiety about this unknown viral syndrome that so many people were dying from, and the other due to the heavy workload because we were so incredibly busy,” said Trudy Johnson, MA, RN, NEA-BC, FNAP, the hospital’s chief nursing executive officer.

The hospital emphasized increased leadership communication with staff, especially face-to-face communication. “During the peak of the pandemic, we had a frontline clinical director present 24/7,” Johnson explained. “They were out there talking to staff and solving problems in real time, not just sitting in a command center.”

The hospital’s president sent out regular email messages, first daily then weekly. Rounding by the leadership team throughout the entire hospital was also increased. “Staff really appreciated seeing our non- clinical executives showing their support,” Johnson said.

To address workplace stress, the hospital offered employees mental health counseling and helped arrange same-day appointments, if needed. In addition, the hospital distributed information from its EAP provider designed to help staff deal with stress and offered a webinar on resiliency and coping with uncertainty.

Because many employees were working overtime during the pandemic peak, the hospital was able to secure hotel rooms donated by the business community for employees concerned about bringing the virus home to their families – or if they just needed some time to recharge. “The risk for burnout can start with physical fatigue, which then leads to emotional fatigue,” Johnson said. “Sometimes, it’s nice to just get a little break.”

And when elective procedures were halted, the hospital allowed staff from those areas to voluntarily assist in COVID-19-impacted units such as the ICU. “We were creative in our use of staff who had the right skills and were willing to participate,” she said. “Our ICU staff felt a sense of teamwork and support, which also helps avoid burnout.”

For additional information about Communities Lifting Communities, contact Karen Ochoa, CLC Project Manager, at (213) 538-0765 or kochoa@hasc.org.