Stress, anxiety, and burnout were chronic problems among healthcare professionals long before the COVID-19 pandemic hit. But what impact are the huge added challenges and stresses of this prolonged crisis having on the emotional well-being and performance of nurses and physicians, and how do they cope?
A new study funded by MI4 (McGill Interdisciplinary Initiative in Infection and Immunity) and led by the Faculty of Medicine and Health Sciences’ Jason Harley, BA’09, MA’12, PhD’14, and Dr. Tina Montreuil, BA’02, MA’06, an assistant professor in McGill’s Department of Educational and Counselling Psychology (and an associate member in the Department of Psychiatry), offers some illuminating answers to these questions by examining the levels of psychological distress and coping strategies of nurses and physicians. More specifically, their study includes responses from 64 nurses and 55 physicians who participated in a survey at the McGill University Health Centre (MUHC) network in August 2020.
The report’s most striking finding and barometer of distress is that amongst respondents 50% of nurses and 20% of physicians expressed intentions to quit their jobs. “An intention to quit is one of the most worrisome effects of stress and psychological distress. Even 20% is high and 50% is alarming,” says Harley, who is a scientist at the Research Institute of the McGill University Health Centre (RI-MUHC), the newly appointed director of research at McGill’s Steinberg Centre for Simulation and Interactive Learning (SCSIL) and an assistant professor in the Department of Surgery.
Harley’s research team, which included two nurses and three physicians, found that both nurses and physicians experienced significantly higher levels of burnout, stress, depression and anxiety than they remembered feeling before the pandemic. For nurses, who generally reported higher stress levels than physicians, the greatest stressor was worry about the health of their families, followed by work-life balance and keeping up with information on management strategies. For physicians, work-life balance and worry about family health were the top two stressors.
Maintaining their mental health is essential for healthcare professionals’ performance in delivering the best care to patients. Both nurses and physicians reported that stress negatively impacted their job performance, increasing professional self-doubt and decreasing perceived quality of patient care. “The detrimental effects of stress and burnout are important issues not only because we care about how healthcare professionals are doing, but because prior research has shown that they are associated with decreased workplace performance and an increased incidence of medical errors,” says Harley, also director of the Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab.
That is why the study’s in-depth look at adaptive and maladaptive coping strategies, and perceived supports and needs in personal, hospital and healthcare system resources is particularly useful in providing practical guidance and direction for remedies to help reduce distress, enhance healthcare professionals’ emotional well-being, and improve patient care. Surveyed nurses and physicians reported the most frequently used coping strategies and helpful sources of personal support were acceptance at work, support from family and friends, hobbies and spending time in nature.
“There’s no vaccine against healthcare worker burnout,” says Harley. “But it is encouraging that surveyed healthcare professionals generally engaged in adaptive coping strategies and we didn’t see a high level of substance abuse, for example. For nurses, there was a high level of venting, which in the absence of other more adaptive coping methods isn’t that helpful.”
Harley recommends that healthcare workers administer a higher dose of adaptive coping and support strategies with greater frequency as a preventive antidote to stress and burnout: “People need to use these methods in an ongoing way to reap the beneficial effects.”
Dr. Mélanie Lavoie-Tremblay, a nursing member of the research team, is working closely with the nursing leaders at the MUHC to implement changes to better support the emotional well-being of nurses, based on the report’s findings. “About 50% of surveyed nurses reported an intention to quit, when normally it would be less than 20%, and it was significantly higher than for physicians. We presented the key takeaways to the nursing leadership, who are applying what’s been learned to strengthen hospital and system support for nurses,” says Lavoie-Tremblay, a nurse scientist at the MUHC, associate investigator at the RI-MUHC, and an associate professor in McGill’s Ingram School of Nursing.
Clear, open and rapid communication of pertinent information from managers is vital to the well-being and safety of nurses in a fast-changing pandemic environment. “Nurses want reliable information about how to have a safe environment. Managers need to communicate the information quickly and transparently, and to share the realities. The leaders need to be present so nurses can ask questions and be reassured that it’s a safe environment for them and the patients. Nurses also need to have someone there to support them when a patient is dying,” says Lavoie-Tremblay.
A key gap in institutional support was the underuse of hospital counselling services which were available to all physicians and nurses. Although 88% of nurses and 77% of physicians for whom counselling services were available perceived that counselling was helpful, only 10% of those physicians and 13% of nurses used this resource.
Stigma and cultural resistance are likely factors in some physicians failing to seek or take advantage of psychological support services, even in a crisis. “There is still a culture where asking for help, or addressing wellness, is admitting a weakness. From a healthcare system point of view, we need to normalize discussions about wellness and physicians’ mental health. Make it acceptable for physicians to reach out and get support, and to find ways to support healthcare professionals before larger issues arise,” says research team member Dr. Farhan Bhanji, PGME’04, director of education for the SCISL, a pediatrician at the MUHC and a professor of pediatrics (critical care) in the Department of Pediatrics at McGill University.
Bhanji sees the ramped-up levels of stress, anxiety and burnout among physicians amid the pandemic as a wake-up call to address a longstanding issue that is harmful to both physicians and patients, and as an opportunity to focus on wellness as a priority in medical education and clinical practice.
“Healthcare professional wellness is a huge issue and it’s been amplified in the pandemic. The medical profession hasn’t done a good job of recognizing problems around wellness and needs to do better. This would allow us to take better care of ourselves and of our patients,” he says. “The public can help during the pandemic by following public health guidelines and limiting the burden on the healthcare team—both the added workload of caring for more critically ill patients and the emotional distress of caring for dying patients, which are preventable.”
Harley is encouraged that the MUHC has been advertising and increasing the number of services (interventions) available so that more healthcare professionals might use these resources. But the issues of stress and burnout among healthcare professionals are not likely to disappear soon, or after the pandemic ends.
Harley believes that training future physicians and nurses to cope with the inherent stresses of their work can help. “Simulation education has an important role to play in educating healthcare professionals about how to use adaptive coping strategies in different types of settings and how to assess your own psychological state so you can apply the strategies early and when you need them,” says Harley.
In the SAILS lab and as research director at SCSIL, Harley is developing, testing, and evaluating virtual simulation training tools to help medical and nursing students develop and enhance their emotional resiliency skills. “Simulation has an incredible power to elicit emotions. We are developing some training tools and education services for medical and nursing students at McGill so they can learn to cope with stressful situations, and how to regulate their own emotions and those of others on the team. Simulation training gives them an opportunity to go through high-stress scenarios, make some mistakes and learn these coping skills, without harming patients,” says Harley.
The members of the research team who conducted the study and produced the report include Jason Harley (pictured above, right), Tina Montreuil (pictured above, left), Nigel Mantou Lou, Liane Feldman, Gerald Fried, Farhan Bhanji, Mélanie Lavoie-Tremblay, Heather Kennedy, Pepa Kaneva and Susan Drouin. The full study results will be presented at the upcoming Canadian Conference on Medical Education to be held April 17-20. Read the report in French: https://www.mcgill.ca/sails-lab/files/sails-lab/white_paper_french_mi4_project_20201120.pdf