Rebuilding America’s Healthcare Workforce During and After Covid-19

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AEmergency physician and director of emergency management, I participated in humanitarian and disaster responses in Sri Lanka after the Indian Ocean earthquake and tsunami, in Haiti at the height of the AIDS epidemic and elsewhere. I often felt a “comeback” afterwards – the disjointed feeling of returning to the place and activities that I had left behind. I didn’t expect to experience a comeback working in my own hospital in Northern California, yet that’s how I feel today.

I know from experience that going back to school often looks like an assault. Disaster relief workers live in harsh and unpredictable environments, and they can witness gruesome scenes or experience personal deprivation. Back to home can be as shocking as relief: workers often have haunting memories and feel profoundly changed, and they are prone to culture shock and post-traumatic stress.

This is what many of the estimates 22 million healthcare workers in the United States are now facing nearly two years of the Covid-19 pandemic. For the sake of the country’s ongoing pandemic response and long-term health care, U.S. healthcare workers urgently need to determine how to effectively reintegrate what is decidedly a new normal.

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Emergency managers see disasters as having four phases: mitigation, preparedness, response and recovery. Mitigation and preparedness is the careful planning, relationships forged and guidelines created before a disaster occurs. The response phase is characterized by rapid thinking and action in the midst of a disaster.

The recovery phase – including returning to normal operations and regular tasks – is extremely complex, but it is often a less popular part of the cycle. Recovery is the process of negotiating short-term needs with long-term goals and balancing the desire to return to normal with the goal of reducing future vulnerability.

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It is during the recovery phase that individuals and nations begin to truly understand the tangible losses of a disaster and its hidden costs.

It is a mistake to view the four phases as linear, as both short and long term recovery should begin even while the response phase is underway. The length, extent and speed of change of the recovery phase compels disaster responders to strive for recovery even in the context of an ongoing response.

The Covid-19 pandemic has brought unprecedented challenges and changes for everyone. For healthcare workers, he launched a deployment in a disaster response that seemingly never ends. During the first few months, doctors, nurses, respiratory therapists, paramedics, hospital food service workers and others suffered from fear, isolation and a lack of personal protective equipment and other supplies. They struggled with the double anxiety of dealing with this puzzling and potentially deadly new disease while fearing to bring it home to their families.

The last few months have been devoted to exhaustion – physical, mental and moral. Patients in tents, patients in hallways, entire families lined up in cars to be tested or sitting in chairs connected to oxygen tubes. One day, I spent eight hours in a pop-up tent treating patients with an ice pack strapped to my neck as the temperatures soared to 108 degrees. Then came the middle of winter, when it didn’t seem possible that more patients could be treated, but they still came. Later, I often felt empty from the endless onslaught, experiencing the same exhaustion and compassion fatigue that so many frontline responders felt during the Covid pandemic.

Rescuers are at risk for mental health problems following disaster deployment. The risks are even higher when the deployment is prolonged, when aid workers are at risk of personal harm, and when responders identify with disaster victims as their neighbors or community – all factors as workers. of health experienced during the Covid-19 pandemic.

In his “Tips for Supervisors of Disaster Responders” fact sheet, the US Substance Abuse and Mental Health Services Administration describes a range of reactions return responders may experience, including relentless fatigue, cynicism, dissatisfaction with routine work, easily evoked emotions and difficulties with colleagues and superiors. Some responders get stuck at this point – they are under severe stress and may show symptoms of disorientation, anxiety and hopelessness.

The United States is now in a complicated recovery phase, and Americans have only begun to deal with the moral and psychological fallout from the pandemic. Many exhausted clinicians experience indirect trauma, anxiety and depression, moral outrage and compassion fatigue as the country faces a fourth wave of Covid-19, a surprisingly transmissible variant, and patients who have refused preventive vaccines and vital.

How do caregivers heal? How do they find the resilience to support themselves again? It can start with Americans recognizing the inspiring work of healthcare workers throughout this transformative experience and the toll the pandemic has taken on them. It continues with health workers and their communities having open conversations about the effects of trauma after disaster deployment and creating safe spaces for clinicians to share, reflect and process.

Post-disaster social support from humanitarian worker communities and employers is essential for successful reintegration. Health care organizations can overcome barriers to care by normalizing the need to seek mental and emotional health support. Clinicians should have the necessary, evidence-based tools to rebuild themselves, such as practicing self-compassion, participating in peer support, and the intention to sleep, feed, move and rest. connect with other people. Finally, the nation must listen and offer healthcare workers the respect, compassion and support they have given to their patients and their communities throughout this extraordinary time in our history.

Most healthcare workers will experience some form of reintegration during the recovery phase of the pandemic. As a society, we are all accountable to healthcare workers and their recovery because we expect them to be accountable to us.

Mary Meyer is an emergency physician and regional medical director of emergency management for The Permanente Medical Group, Kaiser Permanente Northern California.


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