Some folk are so committed to the team concept they will not ask to come off the front line. The top-notch leader will note detrimental changes in behavior in a team member and pull them back.
Healthcare professionals are currently under significant stress that hitchhikes on the back of COVID-19. The stressors and coping mechanisms associated with COVID-19 may or may not make the “short list” of concerns the seasoned healthcare professional has. Yet I know, as a Master's prepared psychologist and as a 25-year Medical Practice Manager veteran, long-term stress unchecked will take its toll and leave a mark. Along with the obvious fact no one wants to be exposed to the virus, current stressors include:
· A shortage of Personal Protective Equipment (PPE) and equipment (ventilators etc.)
· Rapidly policy and procedure changes (often daily changes)
· The fact we are closer to the beginning of the disease curve than to the end
· Healthcare professionals’ numbers are being reduced by self-quarantine and illness
· The cavalry isn’t riding in to save the day. They ARE the cavalry!
My 4 adult children are nurses on the front line. Professionally, I’m amazed by their “get-it-done” and matter of fact attitude, but as a dad I worry…
It’s Personal to Me: My 4 adult children are nurses on the front line. All 4 work in hospitals in a state where there’s plenty of COVID-19 cases to go around. Professionally, I’m amazed by their “get-it-done” and matter of fact attitude, but as a dad I worry about them and others in the same boat.
Let’s Unpack the Stressors:
· PPE and equipment shortages: Forget the blame-game. Without proper PPE the healthcare professional feels extraordinarily vulnerable. Generally speaking they are accustomed to feeling protected. Feeling vulnerable is a new and very unsettling feeling. Ditto not having the right equipment such as ventilators.
· Rapid policy changes: It is understandable that as new data is available and interpreted, policies will change. However, a sense of security and routine is the casualty.
· Closer to the beginning than the end: Most of us rely on the expectation that “This too shall pass.” However, when no end is in sight, or seems too distant, it's hard to soldier on.
· Reduced numbers: It's simple math. When attrition takes its toll, those left in the fight must carry a larger load with longer hours, more patients etc. The military uses the terms “Combat Effective” (can fight effectively) and “Combat Ineffective” (cannot fight effectively). In short, once a fighting force falls below certain numbers it ceases to be effective. At some point a fighting force, with significant enough casualties of its own, becomes Combat Ineffective and can even become a liability itself. The US Army uses a 30% to 40% casualty rate as rendering a fighting unit as Combat Ineffective.
· No Cavalry Coming: Self-explanatory.
If an individual is predisposed to internalize stress in an unhealthy manner, the individual should be able to “take off the cape” without shame (i.e., be able to say “no” to requests for excessive hours etc.). They are no good to anyone if they become a casualty.
What can they and we as healthcare leaders and family do to take some of the edge off the above circumstances? Here are some ways the healthcare professional can mitigate the aforementioned circumstances:
· Admit, as tough as they are, everyone has their limit. People act differently under stress. If you are the healthcare professional, “know thyself” and keep an eye out for sleeplessness, unusual irritability and an increased use of alcohol etc. Family and colleagues should do the same (keep an eye out for...).
· If an individual is predisposed to internalize stress in an unhealthy manner, the individual should be able to “take off the cape” without shame (i.e., be able to say “no” to requests for excessive hours etc.). They are no good to anyone if they become a casualty.
· If someone says to you, as their leader, they need to come off the front line for a day or two to recharge their batteries, make it happen. This is preferable to them crashing and burning. Remember, we are talking about people who by and large handle stress very well. If they say they need a break, they need a break!
· Some folk are so committed to the team concept they will not ask to come off the front line. Therefore, the top-notch leader will note detrimental changes in behavior in a team member and pull them back. For example, Major Richard “Dick” Winters in the miniseries Band of Brothers said if he could take one his men showing signs of combat fatigue off the front line, even 50 yards back, it dramatically changed their outlook (most soldiers would not ask to come off the front line to remain apart of the "brotherhood").
· Limit daily news intake. Instead of watching the same news over and over, re-read a favorite book and/or revel in mindless fun TV viewing (or whatever brings you joy). BTW: Bugs Bunny and Roadrunner-Coyote cartoons are as funny now as they were then… maybe funnier.
· Listen to your favorite music driving to and from work vs. listening to the news.
· As hard as it is when working extra days and extra hours, do your best to keep up your daily routine such as personal devotions, eating well and exercising (or take these up). Maintaining these routines gives us the mental resilience we need to face each new hard day.
· Realize family feels the stress too and likely worries enough. Every family dynamic is different but consider resisting overwhelming family with horror stories and complaints. Instead, decompress with a trusted medical colleague.
We can get through this! But it won’t be by accident and it’d be great if we don’t permanently mar a generation or two of those medical professionals who run to the sound of the guns.
I was pleased to see the CDC put specific and useful information at our fingertips related to coping with the stress the COVID-19 causes (including advice specific to the healthcare professional).
Managing Stress and Anxiety: https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
Emergency Responders: Tips for taking care of yourself https://emergency.cdc.gov/coping/responders.asp