Imagine you are a construction worker. You build, repair, or remodel buildings all over your town with an array of tools, and your years of experience and training have taught you how much load a floor stringer can support and how to frame a doorway to code.
But one day a huge fire erupts, spreading quickly across town. You’re asked to help. You aren’t a firefighter, but of course you spring into action to help your community. You and your colleagues battle the blaze for days with barely any sleep, saving as many homes as you can. Finally, the fire is contained, the damage assessed. Now you return to your day job, which—not coincidentally—is even busier than before, and filled with a diverse array of clients ranging from those who lost everything in the blaze to some who say there probably wasn’t even a fire at all. Oh, and you keep hearing from colleagues that flooding is now a big risk, too, but no one wants to build homes on stilts or create new building ordinances, and your county says it doesn’t have funding to improve drainage.
You look around, overwhelmed, and start thinking of your friend the next town over who builds furniture. They have a much more stable job—one that won’t be dropped if the housing market collapses or sucked back into the chaos if a flood happens.
This may be a transparent analogy for the situation our health center workforce has had to cope with, but it also applies to all our allied health and administrative colleagues and many others. When the COVID-19 pandemic hit, we turned everyone—from HR and client services to mental health and even oral health, geriatric care, and home care staff—into frontline disaster responders.
Health Centers at the Forefront
In the science of stress and resilience—from Selye to Sapolsky to Stanley—we know humans have a fantastic ability to adapt or even benefit from stressors. When given the proper environment, we can face enormous burdens, recover, and grow more resilient. However, we also know that stress can be damaging, and even relatively benign events—such as having to find a way to conduct drive-up respiratory disease testing—can become significant stressors when they take us by surprise and are compounded with other unpredictable and hard-to-manage variables. Then there’s the issue of reduced or delayed recovery periods, moral distress, and burnout.
In so many cases, this wasn’t new to the pandemic. It goes back to long before.
For many reasons, we have an overburdened healthcare system that is facing ever greater demand. The lack of access to proper resources—from medical care to stable housing to mental health to basic nutrition—makes caring for people who are marginalized, systemically oppressed, and generally underserved and unseen a taxing job and seemingly unwinnable situation. This is where moral distress begins. We ask clinicians and support staff to “fix” health issues that are often symptoms of larger factors. That is hard work. And when faced with a problem one knows they cannot solve with all the resources, education, and experience at their disposal, seeing that situation negatively impact a patient—or an entire population—can be excruciating.
Then a global pandemic hits, and we ask those same people to simply take it in stride and continue their daily work even amid a disaster. Now we’re adding pronounced uncertainty and unpredictability (key stressors all on their own) to the mix. And this isn’t like the disasters our nation is used to—ones that have relatively short acute timeframes with outside resources available from other parts of the country. The pandemic far exceeded our national response capacities, leaving communities in many ways to cope with the pandemic themselves for quite some time.
To recount, we have an acute disaster, bringing unpredictability to an already strained workforce that never signed up to be disaster responders in the first place. And we’re asking them to work in environments of unknown risk for unknown durations with tools of uncertain efficacy. It’s stressful just writing about it, much less living it.
Where Do We Go from Here? Solutions to Support Our Workforce
So, does this ever turn to optimism? Is there anything we can do at the individual, organizational, or governmental level to at least mitigate the effects and better prepare our primary care and family medicine workforce for the next crisis?
Fortunately, yes. And some of the solutions are very manageable; they just need doing.
Perhaps the most attainable solution is building as strong a work environment as possible. While every health center and primary care facility faces different challenges—and many are doing incredible work with limited resources—there are still opportunities to build a healthier care team and support staff. We should first recognize that long days should not be the norm. If they are, it’s an indication that we need to prioritize staff recruitment and retention. Optimal productivity in the long term is not a fully-booked day, cramming in as many clients as possible. People need breaks to reduce cognitive load and to spread out decision-making. Multitasking not only produces greater error risk, but adds to stress. When we decrease the chronic stress of every workday, we stop drawing on the resiliency of our workforce and save those reserves for times of great need (like a public health emergency).
We can also prepare. While many preparedness and mitigation actions require local, state, or federal initiatives, we can also take very achievable actions at our individual organizations. Creating response plans for acute and long-term disruptions or disasters and sharing them throughout our organization can help reduce uncertainty when emergencies occur. The key to any good preparedness plan is communication. You will never be able to prepare for everything, but having a set of basic disaster response and communications plans will allow your organization to adapt to almost any event. Being communicative with our workforce both daily and during disasters—and keeping people in the loop with clear understanding of their roles, responsibilities, and safety measures—is a stress reducer that any organization can employ.
Finally, we need to build systems that enhance resiliency in our workplace and in our lives. Mental health, physical health, and financial health resources are critical benefits. Ensuring our staff don’t just have access to these, but are actively being shown how to use them is key. Adequate leave time, appropriate pay, a commitment to integrating justice, equity, diversity, and inclusion into every aspect of our work, and training people to communicate, lead, and support one another is also critical. And most importantly, when major stressors do occur, we need to help people work together to surmount the challenge, recognize their victories, and know what they did to succeed. When they have begun to recover from the stress, we can then address ways to improve and better prepare for next time. This formula helps turn stressors from trauma-causers to strength-builders.