{"id":14625,"date":"2018-09-26T11:00:23","date_gmt":"2018-09-26T15:00:23","guid":{"rendered":"http:\/\/lifeinsurance-orleans.ca\/Life-Insurance-Blog\/more-than-a-third-of-nurses-have-ptsd-symptoms-a-third-of-doctors-are-burned-out-what-are-we-doing-about-it\/"},"modified":"2019-04-30T22:05:45","modified_gmt":"2019-05-01T02:05:45","slug":"more-than-a-third-of-nurses-have-ptsd-symptoms-a-third-of-doctors-are-burned-out-what-are-we-doing-about-it","status":"publish","type":"post","link":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/2018\/09\/26\/more-than-a-third-of-nurses-have-ptsd-symptoms-a-third-of-doctors-are-burned-out-what-are-we-doing-about-it\/","title":{"rendered":"More than a third of nurses have PTSD symptoms; a third of doctors are burned out. What are we doing about it?"},"content":{"rendered":"
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\u201cIt was hell,\u201d says Sandy Buchman, president-elect of the Canadian Medical Association. \u201cI was doing more and more with less and less support. I was burning the candle at both ends and was definitely burning out.\u201d<\/p>\n

Buchman has held more than a dozen regional and national leadership positions and won multiple awards. In 2004, he was named Family Physician of the Year for Southern Ontario. A year later, he was closing his comprehensive family medicine practice of more than 20 years, where he did everything from deliver babies to care for the dying in their homes.<\/p>\n

\u201cI had to do it,\u201d he says, \u201cfor survival.\u201d He had recently seen one of his colleagues end up in hospital after burning out, and felt he was headed there himself. Buchman transitioned to full-time palliative care at the Temmy Latner Centre, where he still works. He describes mixed feelings about the move: \u201cI felt guilty for leaving my patients. I also felt like an impostor. I was the president of the Ontario College of Family Physicians and was no longer working as a family doctor.\u201d<\/p>\n

Themes from studies related to front-line health care providers are clear and grim: Burnout is common, as are mental health concerns and suicide, and their costs extend to patients and the system as a whole. In the U.S., these concerns recently culminated in a movement that proposes a holistic approach to health care wellness and engagement, known as \u201cJoy in Work.\u201d<\/p>\n

Canadian professional associations and institutions are also turning their attention to the issue of provider wellness and engagement. Below, we present some Canadian context to the statistics and the theories proposed to explain them, describe two examples of interprofessional initiatives, and clarify what the current challenges are and what still needs to happen in order to best promote wellness among Canadian health care providers.<\/p>\n

Joy and burnout in Canada<\/h2>\n

The Canadian Federation of Nursing Unions consistently reports<\/a> depression rates among its members that are double those of the general population, with up to 40 percent of nurses suffering symptoms of post-traumatic stress disorder (PTSD). Similarly, according to the Canadian Medical Association 2017 National Physician Health Survey<\/a>, 29 percent of working Canadian physicians report high levels of work-related emotional exhaustion, cynicism, and perceived reduced performance, the criteria used in 1974 to describe the syndrome of \u201cburnout<\/a>.\u201d The survey further reports that 33 percent of Canadian doctors screen positive for depression, and nine percent have had suicidal thoughts in the past year.<\/p>\n

Meanwhile, there is recent international evidence<\/a> that the state of health care providers affects the quality of care<\/a> they provide, and costs the system money through increased staff turnover<\/a> and absenteeism<\/a>. The quality-of-care and economic arguments for wellness have spurred institutions to take action, explains Shelly Dev, director of mentorship and wellness in critical care medicine at the University of Toronto. The majority of initiatives, however, have been focused on individual providers\u2019 resiliency.<\/span><\/p>\n

This focus is pragmatic, not evidence-based, says Gigi Osler, CMA president: \u201cIt is much easier to offer yoga than it is to change a system.\u201d Studies from the Mayo clinic<\/a> have suggested that solely addressing provider resiliency is less effective<\/a> than targeting stressors at the organizational level, and may imply that the individual carries the brunt of responsibility for wellness in a dysfunctional system.<\/p>\n

Coinciding with concerns<\/a> about the validity of burnout and calls for a deeper understanding of provider health, the Institute for Healthcare Improvement<\/a> (IHI) recently published a white paper<\/a> that proposes a move from focusing on burnout to adopting \u201cJoy in Work,\u201d a concept originating in other industries<\/a>. The IHI framework acknowledges individuals\u2019 responsibility for monitoring their own wellness while emphasizing that leaders and institutions should support and promote provider engagement. The white paper suggests the addition of \u201cJoy in Work\u201d to the traditional IHI triple aim: better patient care, better population health, and lower costs.<\/p>\n

While Canadian frameworks such as the Mental Health Commission of Canada\u2019s National Standard<\/a> and the Canadian Medical Association Physician Health Policy have contributed to the field of health care wellness and engagement, they have not been as comprehensive as the IHI. Nevertheless, most Canadian health care organizations are looking for ways to address provider wellness. Below we look at two Ontario examples.<\/p>\n

Michael Garron Hospital: Asking for feedback and adding resources<\/h2>\n

In 2016, Michael Garron, a community hospital in Toronto\u2019s southeast end, was recognized for its achievements<\/a> in promoting employee health. It has since been named one of \u201cGreater Toronto\u2019s Top Employers,\u201d and recently received the \u201c2018 Mental Health at Work Order of Excellence.\u201d Christine Devine, the hospital\u2019s wellness specialist, and Ian Fraser, chief of staff, both feel these accolades are due to Michael Garron\u2019s \u201cflat organizational structure,\u201d where employees have easy access to senior leadership. Whether through formal yearly engagement surveys, ad-hoc check-ins, or a mandatory daily safety check between senior leadership and managers of all clinical units, \u201cwe always start by asking [staff] what is important to them,\u201d says Fraser. He puts it in IHI terminology: \u201cWhat are the pebbles in your shoes?\u201d<\/p>\n

\u201cWhen asked about factors affecting their engagement, people most commonly [answer]: \u2018I don\u2019t have enough time for my job and I don\u2019t have enough resources for my job,\u2019\u201d says Devine. \u201cIf you don\u2019t address operational and environmental [factors], you can do all the work you want on the emotional component\u2014nothing is going to change.\u201d To that end, MGH recently invested $1.35 million in 600 pieces of small equipment such as blood-pressure cuffs that communicate directly with the electronic health record (EHR), increasing time spent at the bedside rather than charting. In the last year, the hospital hired for 117 positions, 90 of them new (albeit partly due to an increase in the hospital\u2019s number of beds).<\/p>\n

Despite Michael Garron\u2019s successes, the hospital\u2019s long-term disability claims and the amount spent on medications for staff mental health conditions have increased. Fraser sees signs of these changes in his clinical work and front-line call, and agrees with Devine that the increased number, acuity, and complexity of patients, recent traumatic events such as the Danforth shooting, and the broader impacts of the opioid crisis may be factors in these rising numbers. Fraser also worries about the emotional cost of continuous improvement and openness about adverse events, particularly in the context of a professional culture that internalizes failure and has a hard time reaching out for help.<\/p>\n

Still, both Devine and Fraser maintain that the trend in wellness is positive, and that they are committed to the organizational processes in place at MGH. \u201cThis is a journey for every organization in health care,\u201d says Devine. \u201cThe work is never-ending in terms of communicating with staff and understanding what their challenges are and relating it back to patient care.\u201d<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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Burnout in health care is common, as are depression and PTSD. Now people are looking for ways to help health care providers find “joy in work.” <\/p>\n

The post More than a third of nurses have PTSD symptoms; a third of doctors are burned out. What are we doing about it?<\/a> appeared first on Healthy Debate<\/a>.<\/p>\n<\/div>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[],"tags":[],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/14625"}],"collection":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/comments?post=14625"}],"version-history":[{"count":4,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/14625\/revisions"}],"predecessor-version":[{"id":14736,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/posts\/14625\/revisions\/14736"}],"wp:attachment":[{"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/media?parent=14625"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/categories?post=14625"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.lifeinsurance-orleans.ca\/index.php\/wp-json\/wp\/v2\/tags?post=14625"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}