George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity at the Milken Institute School of Public Health was awarded a $6 million grant by the Health Resources and Services Administration to help health institutions combat burnout among health care and public safety workers—the largest investment to date in addressing the mounting crisis.
Even before COVID-19 hit, physicians, nurses and other health workers were struggling with the stress of caring for patients amid a severe and growing shortage of staff in the workforce. The pandemic has only heightened the demands health workers are confronting.
“Almost two years into this pandemic, there is physical and emotional exhaustion” and “a feeling of betrayal by the system,” said Candice Chen, Milken Institute SPH associate professor and principal investigator for the three-year project.
Other research teams have found the rate of suicide among female nurses is double that of women in the general population. More than half of health workers said they were experiencing burnout in the past year.
“People held on in those early days. When everyone was scared to go to work, they went to work every day. They came home and quarantined from their families when they were uncertain about what was going on with COVID. They’ve held on as long as they could but some of them are being crushed by the system, creating this terrible cycle,” Chen said. “When people leave, it makes things even harder.”
The shortages are affecting frontline health care workers in hospitals, nursing homes, first responders and others involved in delivering crucial health care, Chen said.
Over the next three years, Chen and co-investigator, Patricia (Polly) Pittman, the Mullan Institute director and professor of health policy and management at GW, will lead the project, which includes a Health and Public Safety Workforce Resiliency Technical Assistance Center. Chen, Pittman and the team will work with 40 hospitals, clinics, community health centers and other health and public safety institutions that will also receive funding from the federal government to address burnout. The Mullan Institute will work in partnership with the Institute for Healthcare Improvement, Moral Injury of Healthcare and the American Federation of Teachers, an affiliate of the AFL-CIO that also represents nurses and other health care professionals.
In the initial phases of the project, the Mullan Institute will assist grantees in their work to address the immediate mental health needs of workers who may be at risk for suicide or leaving the profession, looking for organizational cultural and policy changes to relieve pressures on health care workers and strategies and tools to handle burnout.
Pittman said a major reason her team is so interested in this grant is that it will include the development of a national framework.
“We are eager to help shift the emphasis from an individual-level focus on burnout and resilience, to a more expansive view of the organizational and policy level drivers and solutions for this problem,” she said.
Pittman pointed to studies conducted by nurses as early as the 1990s on moral distress, particularly among critical care nurses, and an important critique of the concept of burnout published by physicians Wendy Dean and Simon Talbot in 2018. Dean and Talbot argued that the concept of moral injury was a better descriptor of the problem. The literature on moral injury grew out of the military’s understanding that post-traumatic stress among service personnel was often driven by a sense of guilt and shame when they were unable to do what they perceived to be their job because of constraints placed on them by authorities or circumstances.
There is a real question of whether we are facing a shortage of nurses or a shortage of nurses willing or able to work in the conditions that we have in our hospitals right now, Chen said. If you improve conditions, you might bring back some of those nurses.
“It’s not going to be just about money,” she said. “It’s the combination of fair wages and supportive working conditions where people can deliver the quality of care they are in health care to deliver and feel valued not just by the health care system but by society.”
