Well-being resources for health care workers ‘woefully inadequate’

Key takeaways

• Emotional exhaustion has risen about 10% among health care workers in the United States.
• Physicians specifically saw lower emotional exhaustion scores in 2020, but a spike in 2021.
• There was also evidence of a “social contagion effect of exhaustion,” researchers wrote.

Emotional exhaustion has increased about 10% for all types of health care workers since the beginning of the COVID-19 pandemic, suggesting that current resources are not enough to improve their well-being, according to researchers.

“These findings indicate that emotional exhaustion among health care workers, which was problematic before the pandemic, has become worse; increases in emotional exhaustion may jeopardize care quality and necessitate additional support for the workforce,” J. Bryan Sexton, PhD, an associate professor in psychiatry and behavioral sciences at Duke University and director of the Duke Center for Healthcare Safety and Quality, and colleagues wrote in JAMA Network Open.

To better understand how emotional exhaustion has affected health care workers in a variety of roles, Sexton and colleagues conducted a three-wave survey study that spanned 3 years.

The researchers administered the surveys in September 2019, September 2020 and September 2021 through January 2022. They received more than 100,000 responses from health care workers in both clinical and nonclinical roles at 76 hospitals in two U.S. health care systems. The respondents reported emotional exhaustion on a scale from one to five.

The researchers found that overall, from September 2019 through January 2022, emotional exhaustion increased from 31.8% (95% CI, 30-33.7) to 40.4% (95% CI, 38.1-42.8), with a proportional increase of 26.9%.

Physicians specifically saw a decrease in emotional exhaustion from 31.8% (95% CI, 29.3-34.5) in 2019 to 28.3% (95% CI, 25.9-31) in 2020. However, the level rose again in the pandemic’s second year to a new high of 37.8% (95% CI, 34.7-41.3).

“Despite the robust pattern of increasing exhaustion reported across HCW roles, physician respondents were unique. Their [emotional exhaustion] actually decreased from 2019 to 2020, then sharply increased the next year,” Sexton and colleagues wrote. “Flexibilities afforded by increases in telehealth and decreases in patient volume may explain some of the 2020 decrease in physician [emotional exhaustion].”

Along with their personal feelings, the health care workers also reported what they perceived from their colleagues. Notably, the researchers learned that “every role, at every time point, reported higher emotional exhaustion in their colleagues than in themselves,” a finding that aligned with “decades of research in social science” and indicate “people are unrealistically optimistic about their own health and well-being relative to that of others.”

Because of exhaustion score clustering in work settings, the researchers wrote that they found evidence of a “social contagion effect of exhaustion” — a phenomena in which health care workers “from the same work setting share an exhaustion norm that is considered to be nontrivial.”

“Before the pandemic, many institutions considered themselves progressive if they had convened a task force to examine HCW burnout,” the researchers wrote. “We now know that HCW burnout is a parallel pandemic that will be felt for many years to come. Leaders need tiered options for responding to burnout, but the evidence has not kept pace with the demand for well-being resources in health care settings.”

In all, Sexton and colleagues wrote that the findings offer “substantial evidence” that emotional exhaustion trajectories have increased overall since the beginning of the pandemic and that “there is a need for both institutional and individual resources for HCW wellbeing.”

“Ideally, organizations would realize that fixing systems intrinsically includes a focus on individual HCW well-being through the application of meaningful and evidence-based options to improve it,” they wrote. “Well-being resources for HCWs need to be broadly accessible and evidence-based, and their use should be role-modeled by leaders. We are only beginning to understand the toll of the pandemic on HCW well-being, and much more will be revealed over the next few years.”

Though they also wrote that “existing programs and resources to facilitate HCW well-being were inadequate before the pandemic and now appear to be woefully inadequate,” they added that there is a silver lining:

“On a hopeful note, the magnitude of the increase in [emotional exhaustion] is within striking distance of the decreases in [emotional exhaustion] achieved in clinical trials of bite-sized interventions used by HCWs.”