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For health workers, exhaustion mixes with a sense of betrayal

Beneath the bone-deep exhaustion, burned-out health care workers say they are grappling with another feeling: betrayal.

Many clinicians have felt that with the waves of Covid have come waves of abandonment — by employers unable or unwilling to protect workers, by lawmakers undercutting public health measures, and by a public resigned to the ongoing crisis. And ultimately, health workers can feel betrayed by themselves, as circumstances outside their control make it painfully difficult to care for their patients or colleagues.

“This isn’t an individual frailty. It isn’t that health care workers aren’t resilient enough,” said Wendy Dean, co-founder and CEO of Moral Injury of Healthcare, in a virtual STAT event discussing health worker burnout on Monday. Dean said that a confluence of crises has resulted in health care workers facing moral injury, a diagnosis created decades ago to explain why returning military service members treated for post-traumatic stress disorder remained haunted by their inability to act in line with their moral compass when it mattered most. And, in the case of the Vietnam War, they grappled with having been betrayed by the government during a life-or-death situation.

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It’s a feeling health workers have struggled with during the worst stretches of the pandemic, when swells of patients flooded into hospitals facing cascades of shortages, and some had to be turned away. Therapies looked promising, and then didn’t work. The virus mutated and medical know-how evaporated as quickly as it had materialized. Those who died did so without loved ones present to send them on their journey. Clinicians absorbed suffering and death for weeks on end during surges. Miraculously fast development of effective vaccines served as a life raft, but the crisis didn’t abate, and taking time off remained often unrealistic. Many health care workers — up to 20%, by some estimates — resigned.

Before the start of Covid-19, about a third of nurses said they experienced burnout, said Amanda Bettencourt, president-elect of the American Association of Critical-Care Nurses. That rate has more than doubled, and a staggering 92% of critical-care nurses surveyed by the association said pandemic stresses would shorten their careers — a gloomy outlook for a nation that had already been dreading a projected nursing shortage. In some hospitals, swaths of health care workers have also left for higher-paying travel jobs, or been fired for refusing to comply with vaccine mandates.

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And day after day, health care workers, like everyone else, were still living through a global disaster.

After hours of treating patients with heart problems, clinical cardiac electrophysiologist Kamala P. Tamirisa, went home to her family. One day early in the pandemic, she and her partner, who is also a physician, sat down and wrote a letter to their young children planning what would happen if they died of Covid. “And I don’t think that was just us alone. Speaking with our colleagues, people were doing it,” she said.

Clinicians have also noted anecdotally an increase in the abuse and threats they face, panelists said. It’s a danger that has also taken a toll on public health officials across the United States, who have faced an onslaught of harassment for trying to do their jobs. Some hospitals even advised workers to change out of scrubs before leaving the hospital in order to dodge targeted attacks, Bettencourt said. “Violence against nurses has been a problem for a long time. And it’s much worse now.”

Political divides and misinformation — about vaccines, drugs, data, science, and even the existence of the virus itself — have led to situations that didn’t exist before. In one instance, Tamirisa said, a patient declined her care because she shares a name with the vice president. “Getting politics into medicine, it almost kills that empathy,” she said. “Empathy has a limit.”

What has become abundantly clear is that systemic problems cannot be solved with individual solutions, said Dean, of Moral Injury in Healthcare. Clinicians know how to take care of themselves to perform at high levels under immense pressure. But leaders must also do their part, immerse themselves in the experiences of their employees, invite those who have lived through these crises firsthand to sit at the decision making table, and offer workers whatever support they need, panelists said.

And just as structural faults can’t be fixed at the personal level, neither can deep psychological bruises be repaired by monikers like “health care heroes,” which flatten clinicians from complex humans into infallible, indestructible caricatures, panelists said.

“We’re just doing our job in a very stressful situation,” said Ritu Thamman, assistant clinical professor of medicine at the University of Pittsburgh School of Medicine. “Just give us the support that we need. We don’t need a name, but we do need PPE.”

Being called heroes, while intended to signal appreciation, simultaneously perpetuates “this idea that it’s on us if we’re not doing what we need,” Bettencourt said. “We’re doing things that are extraordinary. We care in the face of incredible challenges…but it’s not at the sacrifice of ourselves, our humanity, and certainly not our livelihood.”

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