A career in health care is physically, mentally and emotionally demanding. Even in the best of times, healthcare providers can experience symptoms of burnout.
Over the past year, and now in the midst of the current COVID-19 surge, our frontline healthcare workers have been dealing with tremendous stress, leading many to question: how can we take care of the very people we rely on to take care of us?
Host, Jonathan Fialkow, M.D., brought together a panel of frontline workers and physician leaders to talk about clinician wellbeing during the pandemic and beyond.
Guests:
Ana Viamonte Ros, M.D., chief well-being officer at Baptist Health
Yvonne Johnson, M.D., chief medical officer at South Miami Hospital
Dunia Acosta, R.N., Intensive care nurse at Doctors Hospital
A career in health care is physically, mentally and emotionally demanding. Even in the best of times, healthcare providers can experience symptoms of burnout.
Over the past year, and now in the midst of the current COVID-19 surge, our frontline healthcare workers have been dealing with tremendous stress, leading many to question: how can we take care of the very people we rely on to take care of us?
Host, Jonathan Fialkow, M.D., brought together a panel of frontline workers and physician leaders to talk about clinician wellbeing during the pandemic and beyond.
Guests:
Ana Viamonte Ros, M.D., chief well-being officer at Baptist Health
Yvonne Johnson, M.D., chief medical officer at South Miami Hospital
Dunia Acosta, R.N., Intensive care nurse at Doctors Hospital
Announcer:
At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist HealthTalk podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.
Dr. Fialkow: Welcome Baptist HealthTalk podcast listeners. I’m your host, Dr. Jonathan Fialkow, I am a preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute, where I am also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health.
A career in health care is physically, mentally and emotionally demanding. Even in the best of times, healthcare providers can experience symptoms of burnout.
For more than a year, our frontline medical personnel have been battling an unprecedented pandemic, working under challenging conditions – and it has taken an enormous toll on them. The question is: how can we take care of the very people we rely on to take care of us when we need them? The timely topic of clinician wellbeing was the focus of the latest episode of Baptist Health’s Resource Live program.
My guests were:
Dr. Ana Viamonte Ros, Chief Well-Being Officer at Baptist Health
Dr. Yvonne Johnson, Chief Medical Officer at South Miami Hospital, and
Dunio Acosta, a registered nurse in the intenstive care unti at Doctors Hospital
Let’s listen in…
Dr. Fialkow: So let me start with you, Yvonne, in that vein. You know, the COVID-19 pandemic's added layers of stress to clinical strain. We knew prior to COVID-19 the stress of being in the frontline of healthcare to nurses and doctors and clinical staff was high. In your experience, how heightened are these stress levels amongst the frontline healthcare workers now?
Dr. Johnson: Jonathan, I just have to tell you that this is the highest level of stress that I have seen among our frontline workers. And that's primarily because we're dealing with the highest census, the highest level of COVID patients that we've had through the pandemic. We have been dealing with this for now going on 18 months and we had a little bit of a surge in April of 2020. We saw a pretty big surge in July and August of 2020. We saw a very long surge in November, December, January, and then we all got the vaccine. And you'll remember that the healthcare workers were among the first to get the vaccine. And we really sensed this feeling of relief and gratitude that we had a vaccine. And we saw this light that we thought was the end of the tunnel. And so it's been a little bit dispiriting to find that that light was that proverbial train coming at us when in July of this year, we had this mountain of patients who have been a source of stress for the frontline workers. It really is the largest number of patients that we've taken care of throughout the pandemic in the hospital.
Dr. Fialkow: And I know you and I have spoken, as have others, regarding the lack of the real understanding of the public of the burden that takes. For the normal course of the hospital day, the doctors and the nurses have a general balance of really sick people, which we're used to taking care of, and people recuperating. These are sicker patients, right? These are not just the people with the colds that are admitting. We're really only admitting people with really significant medical problems. And that's a burden as well, isn't it, the acuity of the patients that you're taking care of?
Dr. Johnson: Yeah. I think that the overwhelming number of very sick people and also the number of people who don't recover, and even young people who don't recover. We're now starting to see people die and I think the fact that we understand that these are unnecessary deaths and unnecessary illnesses add to that stress because we know that this was a---preventable disease.
Dr. Fialkow: Ana, you've been tasked with making mental health, wellness, and overall wellbeing a priority across Baptist Health South Florida, a daunting task and certainly one that's well-needed. What can you tell us about the signs of burnout that our frontline workers are exhibiting? We use the term burnout a lot. Get into that a little bit and what are we s eeing?
Dr. Viamonte Ros: So again, a lot of issues, but specifically some of the signs, let's say, of burnout that we all should be aware of and cognizant of. Tardiness, calling out on shifts, absenteeism, and the retention issues that I'm sure you all are seeing in your hospitals. Not necessarily picking up shifts to cover for a colleague, something that would normally have occurred otherwise, irritability. And Jonathan, you and I have spoken about this, towards each other and even towards patients. Again, the frustration that these patients really do not necessarily have to be there if they would have done what is recommended to be done. Withdrawing actually from our regular support systems is something we need to be aware of. Obviously, this all then might translate into patient safety issues and the quality of care that we're providing if these issues of burnout are not caught early and addressed. You might see a change in appearance of some of your colleagues and something that might cause you to be aware that maybe something is happening. Unintentional weight loss or even weight gain. A lot of sleep disturbances we're seeing amongst our colleagues. Increase in the use of tobacco and alcohol, forgetfulness, memory issues, difficulty concentrating. It just goes on and on, and we just need to be aware, we need to be sensitive, we need to be compassionate and empathetic. And like we were talking about before you left now, Jonathan, on your trip, towards each other and towards the patients that we're caring for.
Dr. Fialkow:
Dunia, let's bring your experiences into the conversation a little bit. And again, we don't think sometimes that healthcare workers are not immune to an impact of COVID-19, whether it be for their own sick family members, deaths around them, and even getting the virus themselves or maybe fear of transmitting it to family members and kids. You've been in the thick of this pandemic as a nurse in the intensive care unit. Tell us about your experience with one of your patients that changed your perspective and led you to getting the vaccine.
Dunia Acosta: Well, just like some of the population, I had my reservations about the vaccine. At the beginning, I thought, you know, this only affects the older population, the population has diabetes, cardiac, pulmonary issues. I absolutely advocated for that population to get vaccinated, but as for myself, I chose to wait it out. Until recently, we started about two months ago, a month ago, we started seeing a new surge of patients coming into the ICU. These patients were in their thirties to fifties, no past medical history, healthy as can be, had little kids. They were coming in unvaccinated. They were coming in very sick. They were dying and they were dying fast. They were dying faster than the initial population that we had last year. Added to that, I had a patient that came into the ICU. She was 33 years old. She's a cop, healthy. Her family was completely vaccinated. She was not. Her complete family got COVID, as did she. Her family got over it. She ended up in the ICU requiring 100% oxygen support, almost got intubated. She was having trouble breathing. She could hardly talk. She was ashamed. She was like, you know, she was ashamed that she hadn't gotten vaccinated. I told her, listen, I'm not vaccinated. And she was surprised, she was appalled. She was like, please promise me you are gonna get vaccinated. You don't want to end up like this. Trust me, you don't want to end up like this. I regret it so much, is what she said. So two weeks ago, I went and I got my vaccine thanks to her. We still keep in touch. She was the first one I sent a picture of my COVID vaccination to and we're still friends.
Dr. Fialkow:
Thank you for sharing that really moving and emotional story. And honestly, with the expertise of science and healthcare and we certainly are confident about the technology of the vaccine and the science behind it, its safety, the way to get us through the pandemic, the ability to change your mind is difficult. And again, welcome that experience. And I'm sure you are now a ambassador to others to help other people who might be a little hesitant or resistant to move forward and become vaccinated for the public good. So again, thank you for that. Yvonne, back to the clinical part, and this is again, the frontline team nurses and physicians are well-represented here with Dunia. Ana talked about the manifestations of burnout. What are you seeing personally in those areas regarding stress? Bring it to a real personal level regarding any kind of signs of burnout that you're seeing. It's for Yvonne.
Dr. Johnson: I definitely see a lot of fatigue. I think people are just very tired and yet their services are still desperately needed. And so there's really not been an opportunity over the last few months of the surge to really rest and do what we know works for treating burnout and stress. So I think that's been the biggest part. And some of the things that Ana mentioned where people are less tolerant of each other and less tolerant of anything that they're being asked to do above and beyond. And yet even with that, I do see people going above and beyond because that's what's being demanded of them and they're answering that call. So I'm really impressed and very proud of our medical staff, and our nursing staff, and all of the ancillary staff that are taking care of these patients. But you can really see that there's a level of fatigue. And I think one of the other things is they're missing that communication piece. You know, families are not here in the hospital because of COVID, and particularly the families of the patients who have COVID are not there. And so that piece that, you know, even what Dunia talked about, having that connection with a patient. We're used to also having that connection with family and knowing who these people are in relation to other people. And they're missing that connection as well. So a lot of that human interaction that we're used to, you know, those patients in the ICU, many of them are intubated. They're not talking back to their clinicians and the clinicians are having such a hard time managing communicating with families. And the families are getting very frustrated because they're not getting that information, but we're so overwhelmed with care, with caring for the patients that they're not able to do some of those things that actually make our job wonderful is being able to talk to the families, and communicate, and be all part of that. So there's just so much that's missing in the positive side of practicing medicine because we're just so overwhelmed with the amount of patient care that's being required right now.
Dr. Fialkow:
And as you say, being in healthcare is stressful to begin with. And there's a lot of aspects of burnout as Ana mentioned. And there are things unique to the pandemic, the inability to communicate with family members, patients in the hospital not being able to. It's an added level of unique aspects to drive that to make it even worse that we're going through again. So, again, well said. Ana, chief wellbeing officer, I mean, a remarkable role. You and I have been for years pushing for these types of awareness and then resources to mitigate these circumstances. And healthcare systems across the country are striving to prioritize the wellbeing of their frontline workers. So speak a little bit of what in particular Baptist Health South Florida is doing to minimize the stressors and recognize the signs of distress in its healthcare workers.
Dr. Viamonte Ros: Absolutely. Well, one of the first things we're doing is bringing in relief staff exactly to try to support exactly what Dunia is saying and Yvonne, these individuals that are exhausted, they're physically and emotionally exhausted. So we're bringing in relief staff to help those teams. Honoring time off. When somebody says, I really, really need to step back. I need to do that. To be able to respect that and give them that opportunity. We continuously look for opportunities to remind staff of what they need to take care of themselves. Some of the things that we've done, make sure for sure that safety is preeminent, that we have the equipment, the gowns, the masks, et cetera, that's necessary to make sure that our staff feels that they're safe is very important. And we've done that. We created something called a Be Well newsletter where we curate on a weekly basis the internal as well as external resources in our community for individuals. We have opportunities like today. We had ongoing webinars, lecture series, this conversation that we're having today also that's available for everyone to look at. Yvonne and I have actually participated in testimonials of leaders within our system to show again and to go against a culture of silence, which many institutions have, and to make sure that we de-stigmatize and we normalize asking for help and how important that is. And that we all are vulnerable and that we all need to be able to feel comfortable doing it. The other thing that we did just recently is stood up, in every single one of our hospitals, critical incident response teams comprised of a mental health counselor with our pastoral care colleagues and all of our CEOs, CMOs, and CNOs in our hospital systems are aware that these individuals are gonna go in a preemptive manner to our different units, but also if there's anything that's identified or something that happens untowards that we can go in and try to debrief the group, the individuals, and help them deal with whatever issues that they have, which as we've talked about, they're much younger patients, they're much sicker. And a lot of times, it didn't have to happen and you have to deal with that sentiment I think amongst our healthcare staff.
Dr. Fialkow: I mean, and this really is well-received and making an impact, but this wasn't just you in a back room or you and me talking about it. This was supported by the top of the health system. This was an imperative put forth by health system leader, right?
Dr. Viamonte Ros: Absolutely. The corporate leadership was essential for this all to happen. One more thing I want to just to add, we stood up a 24/7 hotline that's not just for physicians or our nurses. It's for everyone in the staff that can contact someone if you truly are struggling in any way. And they can certainly help you and identify what type of resource and help, continued support that you need whether it's in-house or in the community and help you identify that. But you're absolutely right, Jonathan. If we didn't have that corporate support, this would not have happened.
Dr. Fialkow: Dunia, you've been living through this pandemic at the frontline. How has your job changed over the last year and a half through the pandemic? Do you feel that your passion and love of what you do, providing that incredible impact in people's lives for the better, do you feel that's changed at all?
Dunia Acosta: I still love what I do. If I could go back and change my profession knowing what I know now, going through what I've gone through now, I would still choose it again no doubt. Nonetheless, this last year has been very taxing, physically, emotionally. No amount of classroom knowledge or devotion to your job prepares you for what the magnitude of this pandemic has brought. I heard Ana speaking about ho w she's bringing support to the bedside. And that is wonderful. We need that, especially now that we're getting the surge all over again. Every sick patient needs a nurse. Sometimes, there is no nurse available so you stay extra until we find a nurse. Sometimes, that means staying more than your 12 hours shift or coming in to work on your day off to take a patient assignment or taking an increase in a patient workload just to make sure that every patient is cared for. So that takes a toll on you and that's been a change from the 13 years of nursing that I've experienced. This is is more taxing, this is harder. Taking that into account, taking all that into account, the stressors of being exposed to COVID, thinking that you might get COVID or exposing your family to it, the physical demands that we put on our bodies working 12 to 16 hour shifts, taking less days off so we could come into work and help out our coworkers and our managers, the compassion fatigue that we have that's felt by myself or my coworkers because of the high stressors that we're going through. Spending time with these 12 hour shifts in PPE is exhausting. The lack of physical connection to our coworkers, to our families because we're spending so much time at work. And when we do get a day off, all we do is rest. We sleep and we stay in. So all those things have changed in this last year. They've made it difficult to cope, but we manage. And like I said, Ana, thank you so much for all your efforts. We hear you. Thank you so much for your kind words and for bringing help to the bedside. We really appreciate it.
Dr. Fialkow: Dunia, again, your passion and your dedication clearly comes through. These are the lost stories through this pandemic. And when we talk about not getting vaccinated, not recognizing the impact of healthcare workers as you and others are expressing, would you feel that the majority of your coworkers feel the same way, both in terms of their continued dedication, doing what you gotta do even if it's not well recognized by society? Do you feel that's the culture that you're surrounded with within Baptist Health?
Dunia Acosta: Yes, absolutely. We're a team. We're a unit. We work together. We win together, we lose together, we support each other. So yes, there is unity in how we feel. I feel also there's a lot of maybe like denial, like we're okay, we're okay. We're fine, this is fine. But in reality, it's emotionally and physically exhausting.
Dr. Fialkow: Sometimes, it creeps up slowly so you don't have a moment and you sit back. So again, thank you. Yvonne, I'm gonna ask maybe an unfair question, but I've known you long enough that I'm going to ask it anyway. How, I mean, as a CMO of a large hospital, incredible responsibilities to physicians, staff, nursing, how do you protect yourself from burnout and the trauma of the pandemic? What do you find your means of keeping yourself mentally healthy are?
Dr. Johnson: Well, you know, I always say that this has been the professional challenge of a lifetime. I listened to Dunia and I could hear what she is saying. And even from an administrative level, I feel the same way. But I feel incredibly supported by my staff here, my medical staff, by the rest of the administrative leaders. And just to see the comradery of people coming together to face a challenge really is inspirational. We've also been inspired by our community. I mean, there was lots of times where we had parades of our community folks coming. We had Girl Scouts bringing cookies. We've had the firefighters and police bringing donuts. And we really did feel very supported by the community as well. And then I have my family, and that is really been my greatest support and retreat is just to be able to go home, and to have peace at home, and to have that support is been incredible for me to know that I go home to a haven.
Dr. Fialkow:
Ana, again, you and I have discussed, and others as well, the idea of clinician burnout prior to pandemic. Do you think the pandemic accelerated a little bit of our ability to start recognizing and providing resources for clinician wellbeing?
Dr. Viamonte Ros: Absolutely. And Jonathan, you and I, like you just mentioned, we were very concerned about this way before the pandemic. It was something that we needed to address before the pandemic, but certainly now, and certainly something way after the pandemic. It hopefully subsides and we're on the other side of this. We need to make sure that our corporate leadership understands that we have to commit to building a supportive environment for our clinicians. We need to, you and I have talked a lot about lessening the administrative burden with our electronic medical records, our documentation. Again, we have to make sure that we listen to our clinicians, we listen to the mental health needs. We, again, fight against this culture of silence, destigmatize and normalize the issue of asking for help. So we're in a place where we want to help our clinicians and ultimately help them help our patients. And everybody really go through this together in both a physical and mentally healthy way. And it will happen, I'm sure it will.
Dr. Fialkow:
I am sure too. And again, it starts with recognition, knowledge, passion, with again, leaders such as yourself. So again, we thank you for your commitment. Dunia, last question to you, and it's gonna be two questions and then be able to give some final comments. What do you wish you knew at the beginning of the pandemic when it comes towards clinician burnout, mental state of you and your coworkers? What do you wish now that you would have known then that could have helped you? And the second question is any messaging to loved ones or viewers on how to support nurses, doctors, or the clinical staff at the frontline that you'd like to express?
Dunia Acosta: I wish I knew the emotional toll the pandemic caused on my life, the life of healthcare workers around the world. I wish I would've known how effective and safe the vaccines are. I would have advocated for them sooner, not just for the older population, but for everyone. I think that would have lessened the demand we're currently seeing in all the hospitals and our staff. As far as what family and friends can do for us, just check up on us, you know? Check up on us regularly, make sure. Just like, take a look. Are we angry? Are we emotional? Do we feel withdrawn? Provide a calm environment for us. Distractions help a lot, distractions that take us away from the focus we have on work. Social support, helping us connect with others is also helpful. Maybe helping us with chores at home, especially if we're working late hours or extra shifts. All those things help. Just connection, connecting with others helps a lot.
Dr. Fialkow:
It's gonna be hard to add to that, but as we wrap up, Yvonne, any final comments or any points you want to emphasize before we wrap up?
Dr. Johnson:
Well, I'm just so pleased to hear Dunia talk about getting vaccinated and that calculus that she made. And it's the same calculus that a lot of young people made. And I'm not judging anybody. In fact, I told people a long time ago, months ago, I understood why young people were making that decision based on the information that they had that maybe I'm going to take my chances, but they need to understand that the game has changed, that the Delta variant has caused that calculus to change. And just like you don't keep your money in the same stock no matter what, you change that when the information and situation changes, you need to change that decision in terms of the calculus. The game has changed and we're all at risk. And we're not only all at risk of COVID, but when we have these kinds of surges, we're at risk of everything else. One of the most stressful conversations that I had in the last week was to tell a young woman who suffered from cancer that we couldn't do her surgery because her doctor thought she was gonna need an ICU bed post-op. And I didn't have an ICU bed for her because we were filled up with patients with COVID, most of whom didn't have to get COVID and be that sick. So make sure that you understand that your decision is not just affecting your life. It's affecting the lives of the people in your community. And I think we are a community that looks out for each other, so I hope we'll take that message and do that, look out for each other.
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Thanks for listening and stay safe and say yes to the COVID-19 vaccine!
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