Battling staff burnout with intentional care

This article was orginally published by Catholic Health Association of the United States.

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The COVID-19 crisis has taken an especially harsh toll on the well-being of health care workers. For two years, hospital staff across the Catholic health ministry have treated wave after wave of seriously ill and dying patients, with little or no time to process their grief or regain their personal equilibrium. Nursing home staff are grieving too for the residents lost to COVID. They continue to draw deep into their reserves to offer emotional support and extra kindness to keep residents who are isolated from loved ones and the outside community from sinking into another winter of loneliness and even despair.

Amid the unrelenting pressure of COVID, so many caregivers have resigned from their jobs that there is a human resources crisis. The exodus has left many facilities short on staff and added to the strain on the depleted workforce.

Leaders at five Catholic health systems told Catholic Health World workers are exhausted and burned out. They say mitigating stress and restoring resiliency among the workforce is a top priority. They shared the many ways they are attempting to nurture the emotional, mental and spiritual health of their staffs.

amond W. Boatwright says the issue at the top of his agenda at Hospital Sisters Health System isn't a strategic, operational or financial one.

"My number one concern is the overall well-being of my workforce and then the workforce within the health care industry overall," says Boatwright, who took the reins of the Springfield, Illinois-based system in June after seven years of leading SSM Health Wisconsin.

He believes that the best way to stabilize the industry as it continues to reel from the demands of the pandemic is to see to the needs of its workers, including addressing the burnout many of them are experiencing. To that end, he says Hospital Sisters Health System has tried to be creative in reinforcing its gratitude and recognizing staff efforts and sacrifices.

One means of recognition the system started is the HSHS Appreciation Hub. The online staff portal is a space where managers and colleagues can post messages to encourage and celebrate one another. By mid-November, the portal had more than 2,000 posts from the workforce of 12,800.

"A lot of those messages are 'I believe in you,' 'Hang in there,' 'We're going to do it together,'" Boatwright says. "That's just very inspiring for me and that's part of what's helping boost the overall spirits of our staff."

The system has ramped up its wellness offerings, too. It is using its Live Well intranet site to push out content and promote activities such as webinars on self-care. The site has three parts: HSHS Community to let staff connect so they can encourage and support one another; HSHS Health Now that gives providers a platform to offer advice and information about self-care and wellness; and We Are HSHS to share motivational stories from within the workforce.

Another step the system took early in the pandemic was to review its health plan to make sure that the coverage included virtual visits with mental health care providers. The system also enhanced its employee assistance program to expand the free counseling and purchase more hours of mental health programming.

Boatwright says he has tried to ensure that workers and their families have easy access to well-being resources, too. He's also made it a personal mission to advocate for their use, even sharing that he has tapped those resources as he's transitioned to his new role in a tumultuous time.

"As the president and CEO of this organization, I use the employee assistance program for counseling myself, for help with stress and fatigue and self-care tips as well as helping practice overall mindfulness," he says. "It's helped me with balancing work with home life."

Boatwright's advice to care providers across the ministry is, along with using available self-care resources and assistance, to trust in prayer and divine guidance. He finds comfort in these words of Mother Mary Odilia Berger, founder of the Sisters of St. Mary: "Continue on courageously for the love of God."

Laura Kaiser underscores that the stress and trauma the pandemic has created for the health care workforce is weighing upon the thousands under her leadership as president and chief executive of SSM Health.

"There's been a tremendous psychological toll and the team is weary, very weary, because it seems unending," Kaiser says.

Part of the burden is due to the shortage of staff and the burnout that shortage is causing, especially for those on the front lines. When she talks and meets with other health care leaders, Kaiser notes, they all say that their staffs need reinforcements.

"The absolute number one thing that any of us would do, if we could, would be to find staffing relief," she says. "We would call in the cavalry. But there's literally no cavalry across the planet because we're all grappling with the same thing."

Kaiser says SSM Health closely monitors the results of its quarterly well-being index, a survey tool that measures the level of distress among care providers. The results are informing the tools and programs it is offering employees to foster emotional and spiritual health and overall well-being of team members.

Among the steps the system has taken is to enhance its employee assistance program so workers have unlimited access to counselors. Another is to ensure that the system's health care coverage encourages workers to connect with psychosocial counselors, including those with trauma training, through in-person or telehealth visits.

A third is a partnership with the Lifespan Research Foundation at Harvard University, a research project focused on improving people's lives. That partnership allows clinicians to join virtual support groups, participate in virtual chats on a range of wellness topics and take part in "Schwartz Rounds," sessions for open discussion of sensitive issues with other care providers.

SSM Health's hospital-based spiritual care and mission integration team leaders have increased their efforts to be more visible to staff — rounding more frequently to meet with clinical colleagues and being visible and approachable at staff gatherings.

Kaiser says she and other executives across the four-state system also are being more intentional about celebrating staff achievements.

Last spring, SSM Health produced an hour-long documentary, "Behind the Mask," that tells the stories of staff members who have been on the front lines of the pandemic. Kaiser says the movie is a way to acknowledge the extraordinary work caregivers are doing and to urge viewers to do what they can to stop the spread of COVID.

During rounds, Kaiser recalls a nurse manager in an emergency department urging her to ask the public for its help in letting health care workers get some much-needed rest by following protocols like masking, distancing and getting vaccinations.

Kaiser says at every opportunity she has done just that, urging people to follow public health recommendations. "It's what needs to happen so that there's additional capacity to rebuild. We all need a chance to recharge our batteries and catch our breath."

Joseph Impicciche says he's never been as humbled to be part of Ascension as he has been over the last two years.

"Throughout this pandemic, our associates and clinicians have remained steadfast in their commitment to providing compassionate, personalized care to those we are privileged to serve," he says.

To encourage staff to tend to their own emotional and spiritual needs, Impicciche notes that Ascension has launched several initiatives. One is the "Clinician Well-Being and Engagement" playbook for clinical leaders that the Ascension Medical Group developed. The booklet covers nearly 40 best practices to improve efficiency, personal resilience and well-being among clinicians. Among the practices cited is to create mentoring or coaching programs on how to handle stress.

Another example he points to is Ascension's Create a Positive Workplace initiative. It includes tools and resources such as webinars for nurses and nursing leaders "with the aim of increasing resilience, agility, self-care, self-compassion, and connection, while also mitigating workplace violence, stress, anxiety and burnout," he says.

Early in the pandemic, the system created a platform called "myCARE" and a website that put in one location links to all of the physical, mental/emotional, financial, occupational and well-being resources available to associates. The resources also are accessible in a customized mobile app.

Ascension set up virtual spiritual care to make chaplains available at all times to console and counsel associates. In addition, Impicciche says: "Throughout the pandemic, we have hosted a number of events to help leaders and associates gather as a community and reflect upon, share, process and find meaning in our pandemic experience."

Impicciche notes, too, that associates who participate in the system's medical plan, SmartHealth, have access to the Ascension SmartHealth Well-being Program. That program offers workers a variety of challenges, trackers and other resources to support and encourage their personal wellness efforts.

To stay grounded and focused himself, Impicciche says he is trying to start each workday with prayer and carve out some time for exercise. He encourages others across the Catholic ministry to develop similar habits to create a healthy work-life balance.

He says: "My best advice is to find time to pray, commit to regular exercise, stay connected with family, and do your best to find quiet time to reflect and recharge."

Janice Murphy plans to bring the same focus on staff well-being that she has had as president and chief executive of St. Vincent Charity Medical Center in Cleveland to her new lead role at the medical center's parent, Sisters of Charity Health System. Murphy took over the system's top post Jan. 1.

At St. Vincent, she oversaw the creation of "Code Lavender" to provide extra emotional and spiritual support to departments that are especially burdened by COVID-19 care. When the code is called, it summons a team led by a member of the pastoral care staff. The team brings a cart with aromatherapy tools and other relaxation-inducing items. The team also guides their colleagues in prayer.

"Code Lavender is a way for the whole organization to surround a unit with love and prayers and ways that we can help alleviate the stress," Murphy says.

She recalls that some of her most difficult days on the job during the pandemic came early on when the governor of Ohio ordered a temporary halt to non–emergency and elective surgeries. That order created a reduction in demand for service at St. Vincent that led to furloughs for more than 300 workers, creating emotional and financial stress.

Working with the Sisters of Charity of St. Augustine congregation, the hospital created an employee care fund to help the furloughed staffers. The fund has provided assistance to more than 200 staff members and it continues to accept donations and distribute aid, even though the unpaid leave has ended.

"It's kind of like the loaves and fishes," Murphy says. "It's never run out. It feels like just when we get low a donation comes in that helps get us through."

At Light of Hearts Villa, a Sisters of Charity memory care facility, managers have been intentional about urging the staff to overcome their hesitancy to use paid time off for fear of neglecting their patients. "There was a great effort at Light of Hearts to really say to the staff: It's important for you to have some time away and we encourage you to do that and not to feel guilty," Murphy says.

At Joseph's Home, a homeless service provider exclusively focused on medical respite care, the ministry started a partnership with the nonprofit College Now Greater Cleveland to help staff identify career goals and pursue education or certifications needed to accomplish them. The partnership can assist with accessing financial resources.

Across the system, Murphy and other leaders have stepped up their rounding to stay in close touch with — and offer support to — workers on the front lines of pandemic care. In warmer months, facilities have hosted appreciation events outdoors to laud staff and give them opportunities to socialize while still observing COVID-19 protocols.

"The greatest gift we have is the gift of each other and by lifting each other up whenever that's needed — because we all have different times when we're at a low ebb — I think that has been the most gratifying work of all," Murphy says.

For CHRISTUS Health, the challenges of the pandemic have come in waves across the ministry's sites in the southwestern United States and those in Mexico, Colombia and Chile. George B. Avila, the system's vice president of mission integration, says just as one ministry is catching its breath from a COVID surge, another is inundated with new cases.

To address the compassion fatigue within its workforce comprehensively, Avila says the system created a team early in the pandemic with members from various departments, including mission integration, spiritual care, human resources, change management and talent management. Its charge was to take a "holistic mind, body, spirit approach" to associates' needs.

The team has focused on the three R's: resources, recovery and response. One resource the team created is an online channel for associates with videos and resources on wellness and resiliency topics. Another is the CHRISTUS Moment, a weekly video reflection shared systemwide in English and Spanish that contains a message of hope and resilience.

On recovery, the team looks at results from employee engagement surveys. At sites or in units where scores fall, action teams of leaders and nonclinical staffers are sent in to round with staff and offer support. In addition, chaplains are deployed to the floors to counsel and pray with colleagues.

Avila says for cases of extreme crisis, CHRISTUS has trained a group of about 60 people on critical incident stress management to respond. They are sent in or connected virtually to debrief staff, defuse the tension and teach coping skills.

CHRISTUS entered a new contract with Stericycle Communication Solutions, a firm the company has long engaged to make wellness checks on patients by phone. Avila says CHRISTUS now also contracts with Stericycle to check in on the well-being of the system's associates.

"The point of the phone calls is just to say, 'Hey, we want to say thank you for all that you've been doing. We know that it's been a difficult time,'" he says. Stericycle nurses ask workers about their well-being, posing a question like: "What's bringing you strength during this time or what's been difficult?"

If clinicians indicate that they need immediate support, the callers can transfer them to CHRISTUS chaplains or to counselors with the system's employee assistance program who are at the ready to listen.

The pandemic hasn't been the only source of trauma within CHRISTUS ministries. Major weather events also have caused destruction and disruptions. The system's Lake Charles, Louisiana, facilities have been slammed by two hurricanes as well as a separate flood-inducing storm while dealing with COVID. In response, the system helped workers source generators and other necessities and it opened a grocery store where employees and their families could get staples.

Avila says CHRISTUS plans to stay focused on staff well-being and resiliency indefinitely. "We're not going back to normal, and the impacts of the pandemic aren't going to disappear once it's calmed down," he notes. "At some point, people are going to give themselves the time to deal with the trauma that they've gone through and so we just want to make sure that we've been thoughtful about developing programs to respond to that."

—By Lisa Eisenhauer, Catholic Health Association of the United States