TJC releases advice to protect well-being of healthcare workers during pandemic

By John Palmer

Since the COVID-19 pandemic began in January, healthcare workers in U.S. hospitals have been working almost nonstop, often in high-stress environments without the proper support they need to do their jobs.

As usual, healthcare workers are asked to take on some of the hardest work during this pandemic, and many of them are doing so without taking enough breaks or getting enough sleep.

It’s taking a toll. You need only look at the nightly news to see photos and videos of exhausted healthcare workers working overlapping shifts to cover their colleagues—some of whom are getting sick themselves with the coronavirus.

It’s a given that work in the healthcare field is stressful. In normal times, healthcare staff are expected to do their jobs with competence while dealing with crisis situations that very few people in other industries experience.

Add to that things such as insufficient personal protective equipment, fears of infection, feelings of isolation from family members, and harassment from the community for enforcing strict infection control and prevention measures, and it’s not hard to imagine how staff can become overwhelmed both in their professional and private lives.

“The mental, emotional, and physical strain healthcare workers are experiencing during these unprecedented times of COVID-19 cannot be understated,” says Erin Lawler, MS, CPPS, human factors engineer at The Joint Commission (TJC)’s Office of Quality and Patient Safety.

The accreditor has joined the fight for protecting the mental and physical well-being of healthcare workers by releasing a guide designed to help staff support themselves, as well as help managers support them during the tough times of the pandemic, which is likely to stretch well into 2021 and perhaps beyond.

The June 2020 publication, titled Quick Safety Issue 54: Promoting psychosocial well-being of health care staff during crisis, acknowledges that the stresses and strains in healthcare settings are unavoidable during crisis situations, and aims to help remove the barriers that prevent healthcare workers from obtaining needed support.

“The Quick Safety advisory serves to support individual healthcare workers and organizations alike by providing recommendations for protective strategies and ways in which to build individual and institutional resilience during crisis,” Lawler says. “It is critical that we ensure healthcare workers have access to psychosocial resources and support now and in the future.”

The strategies that TJC recommends for healthcare workers include the following:

• Practice self-care and engage in healthy coping strategies. Eat healthy, exercise, and employ stress management strategies that work for you.
• Practice good sleeping habits. Strive for no less than seven hours of sleep to combat fatigue.
• Partner with colleagues to monitor each other’s well-being. Engage in a buddy system at work to provide support as needed.
• Stay regularly connected with friends and family, while practicing social distancing, to mitigate isolation.

“While physicians and nurses are often the first members of a health care team that come to mind when picturing frontline staff, leaders must remember that all staff who keep their facilities running—including environmental and food service workers, imaging technicians, respiratory therapists, pharmacists, physical and occupational therapists, security personnel, social workers, and chaplains, among others—may be dealing with mental health conditions aggravated or brought on by the COVID-19 pandemic,” the document says.

In addition to being able to support themselves, staff leaders must also be ready to step up and help support workers.

“Some health care workers may believe that seeking support from a mental health professional will adversely affect their career,” according to the Quick Safety document. “The anxiety, stress, and other emotions brought on by these challenging circumstances are real and justifiable; they do not indicate weakness or incompetence.”

TJC’s guidance recommends the following strategies for leaders and managers:

• Communicate regularly. Keep staff up to date about important information and announcements. Communicate honestly, sincerely, and empathetically. Ensure that communication reaches less visible service lines in an organization.
• Model behaviors that promote self-monitoring. Encourage staff to focus on their well-being by doing things such as leading a three-minute reflection before each shift change.
• Encourage sharing of concerns to build transparency and mutual trust. Create a safe environment that allows staff to openly share concerns with and ask questions of leadership. Acknowledge and listen to staff concerns even if answers to their questions are not known or readily available.
• Orient staff to psychosocial resources and services, including how to access them, and offer the basics of psychosocial first aid.
• Provide positive feedback. Share encouraging news and extend kudos to staff members. Consider sharing care recipient stories that are uplifting.
• Adapt staffing. Monitor staff well-being and rotate staff from higher- to lower-stress functions when possible.

According to the Occupational Safety and Health Administration, excess stress can lead to loss of appetite, ulcers, mental disorders, migraines, difficulty in sleeping, emotional instability, disruption of social and family life, and increased use of cigarettes, alcohol, and drugs. Stress can also affect worker attitudes and behavior, which in turn can affect the way they do their jobs and lead to mistakes.

Some simple ways to help employees relax and take a quick break from the stress of the environment around them include the following:

Promote a sense of optimism and humor. In a profession where sickness and death are a part of the daily grind, it’s important to make sure your staff stays optimistic.

A quick joke or a positive quote written on the whiteboard in the staff room can be enough to raise spirits. Donations of food or coffee from the community can provide a needed lift during a busy afternoon of seeing patients. In some communities, healthcare workers have been greeted after their shifts with applause from first responders and cheering groups of residents in high-rises, or praised on social media. Whenever possible, expose your workers to these positive experiences so they know their work is not going unnoticed.

Institute a timeout policy. Sometimes the best way to relieve stress is to walk away from the situation, take a few breaths, and gain some perspective. A surgeon in the middle of a risky heart surgery can’t necessarily do this, but a nurse or front desk worker can probably take five minutes in the back for a quick break.

Next, make sure those breaks actually happen. Institute a policy where at least once an hour, employees get rotated out of the work environment for a 10-minute break. Whether employees use their break to take a quick walk outside, read in the break room, or grab a cool drink of water, they need to understand that these breaks are non-negotiable.

Teach breathing techniques. There will of course be times when it is impossible for your employees to walk away from their job responsibilities, but they can control their reaction to the stress they feel.

Some experts say that breathing exercises can help workers relax. Try teaching this technique for belly breathing from the University of Michigan Health System:

• Sit or lie flat in a comfortable position.
• Put one hand on your belly just below your ribs and the other hand on your chest.
• Take a deep breath in through your nose, and let your belly push your hand out. Your chest should not move.
• Breathe out through pursed lips as if you were whistling. Feel the hand on your belly go in, and use it to push all the air out.
• Do this breathing three to 10 times. Take your time with each breath.
• Notice how you feel at the end of the exercise.

Lend a listening ear. Hands down, one of the biggest complaints from healthcare workers is that they feel like no one is listening to them, that there is no process in place at work to report patient violence or safety problems, or that they simply need an avenue to talk about their feelings—after all, they are working in one of the most stressful career paths, and helping other people with health problems can take its toll.

Some healthcare facilities have counselors on call—if not on staff—to help their staff members deal with life’s issues. Others have peer groups consisting of fellow coworkers to give staff a relatable group to talk to.

Provide help with personal struggles. Financial troubles, family issues, and childcare challenges can be stressors that affect a person’s work performance. Give your employees a hand by offering childcare services, or invite a CPA to come in and give them a primer on personal finance.

John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at johnpalmer@palmereditorial.com.