The COVID-19 pandemic has touched everyone in some manner over the last 18 months, but those in the healthcare industry have not only been challenged in their personal lives but also in their professional lives in a unique way. Staff who were able to cope well, demonstrating tremendous resilience during 2020 and into early 2021, are not faring as well with the 2021 surge of the variant that is now sweeping across the land. Compounding their moral distress are conflicting feelings about the rights of individuals to make their own healthcare choices about receiving the COVID-19 vaccines versus the need for public health and safety by encouraging everyone to get the vaccines if they can. Healthcare staff may not know how to handle their feelings or the continued job stresses that are occurring. As a nurse, I know that those of us in healthcare are called to serve with compassion and caring, but now is the time for the caring and compassion to be provided back to our nurses and other frontline healthcare providers and staff that touch our patients every day.
It is easy to talk about providing care and compassion for our healthcare workers, but how do we really do that?
Reactivating the hospital crisis communication plan might be a needed process step as hospitals reopen dedicated units to care for many very ill COVID-19 patients. Utilizing these command centers does help to provide the essential information, resources, and basic support that research has shown enhances employee empowerment and engagement. But, giving staff what they need physically is very different from providing what they need emotionally and spiritually. We each react to stress differently and we all cope with stress differently. I have a friend who doesn’t perceive being stressed and methodically handles every crisis, big and small, with an outward calm and supportive nature that produces results and holds the team together. While this perceived coping may work in the short-term, high levels of stress over time, with associated high levels of cortisol and changes to other essential body chemicals, begins to take a toll in the form of subtle changes in personality and overall health. Relationships at home and at work may begin to suffer when things get to this stage.
This is the critical stage where supervisors and leaders need to be especially astute in recognizing some of the not-so-common signs of stress and burnout (overload) while conducting employee rounds. The staff with the most critical needs are often externally perceived as ‘doing great’ and they may even volunteer to take on more.
Exhaustion – feeling mentally and emotionally drained, physically run-down, and overwhelmed. Leaders may notice staff being especially tired, beyond the fatigue that comes from working additional hours.
Loss of enthusiasm for work - stress and frustration can make one increasingly negative, cynical, and resentful about work; feelings of dread about work may occur. Studies have shown that lack of control, insufficient recognition, and reward (financial, institutional, or social) makes people more vulnerable to burnout symptoms because they feel devalued.
Reduced work performance – difficulty concentrating, loss of efficiency, forgetfulness or difficulty dealing with new stressors can lead to reduced work performance. Stress affects the part of the brain associated with executive function. Executive function3 is a set of mental skills that include working memory, flexible thinking, and self-control. This is often one of the first things brought to the attention of the supervisor by others, especially if routine employee 1:1 rounds aren’t occurring.
Worry and anxiety - especially linked to work responsibilities or performance. Staff feel better when away from work and enjoy doing things, but the anxiety resumes with returning to work. Staff that seem to be overly concerned by things like the schedule, assigned lunch breaks, or missing patient medications may have work-related anxiety that is getting out of hand.
Sleep problems – difficulty falling asleep, staying asleep in the night, waking too early or inability to get back to sleep. Staff may be commenting on their sleep changes but may not be appearing tired. Consumption of caffeine or a higher anxiety level can mask these problem too.
Physical burnout symptoms – onset of headaches, back pain, general aches and pains, or gastro-intestinal issues. This may manifest as increased absenteeism for legitimate symptoms, that are not being imagined or faked and are unusual for ‘star’ employees.
Irritability and mood swings – stress also affects the part of the brain associated with fear and aggression, especially those areas linked to emotional distress. Small behavioral shifts can occur in staff who are outwardly coping, especially those with longevity and who are good at compartmentalizing work and home.
The usual means of controlling early-stage burnout2, such as finishing on time, regular work hours and breaks, or completely disconnecting for a few minutes often are not possible in an acute care setting. Even though a 12-hour shift may involve thousands of steps, this type of exercise, often including periods of standing, does not provide the usual benefits that sustained activity can deliver. In an arena where mistakes can cause serious harm events, our focus on quality and performance improvement can accentuate personal pressure for perfection that has proven successful in the past. Access to healthy foods and time to eat them are often challenges that cannot be avoided. The stigma around mental health issues causes many healthcare workers to avoid or delay seeking help for their feelings or their physical symptoms.
These are just some of the reasons why regular and purposeful leader rounding on employees should not be interrupted or reduced during prolonged environmental situations like the pandemic or even during temporary challenges like reduced staffing, the stress of a long-term disruptive patient, or conflicts that arise between roles or shifts. These are the times when leaders must make their staff feel valued and supported on a personal level, not just as a group.
But some leaders have been led to believe that appropriate communication in the healthcare setting must avoid conversations with staff that go beyond work-related issues or ideas. Every truly authentic leader I have ever met would argue with that logic.
Humans, by nature, are social beings with needs that extend beyond the physical and into the emotional and spiritual.
Spiritual health is not just related to faith, religion, or even self-acceptance. Participants in a 2018 study by Ahmed Ghaderi and associates4 defined the concept of spiritual health to include four types of connection – human connection with God, himself, others, and the nature. They pointed out that spiritual health “affects physical, mental, and social health; it dominates other aspects of health; there are religious and existential approaches to spiritual health; it is perceptible in people’s behavior; and it can be enhanced and improved.”
Nobl encourages our clients to utilize employee rounding best practices that meet ongoing needs at the unit level; but maybe now is also a good time to provide sample rounding questions to help all leaders to see the spiritual health and coping support needs of their direct reports.
I believe that we are all spiritual in one way or another. Now more than ever, leaders must become comfortable connecting with staff in individual, caring ways. Their spiritual health, overall well-being, and ability to remain in the work setting as fully engaged employees may depend on it.
Written by Teresa L Anderson, EdD, MSN, NE-BC, Nobl Chief Nursing Officer
1 https://www.google.com/search?client=firefox-b-1-d&q=subtle+signs+of+stress
2 https://www.livi.co.uk/your-health/7-early-signs-of-burnout/
3 https://www.understood.org/articles/en/what-is-executive-function
4 Ghaderi, A., Tabatabaei, S.M., Nedjat, S., Javadi, M. & Larijano. (2018). Explanatory definition of the concept of spiritual health: a qualitative study in Iran. Journal of Medical Ethics and History of Medicine, 11(3). Published online 2018 Apr 9. PMCID: PMC6150917. PMID: 30258553