Managing stress and burnout during COVID-19

Wayne Wenske

Stress and burnout have taken on even greater dimensions during the COVID-19 pandemic. Since March 2020, infections have continued to grow across the United States, as people are encouraged to stay home, practice physical distancing, wear face masks, and wash hands often.

While our at-large communities experience heightened levels of anxiety and fear, physicians have additional stressors unique to their professions and environments. In addition to being overwhelmed — intellectually and physically — while caring for large numbers of patients, physicians are also not immune to their own feelings of emotional overwhelm.

Not only are health care providers concerned for their patients, their patients’ families, and colleagues, they also have the health and well-being of themselves and their own family members to consider. How can I safely go home to my loved ones after seeing highly contagious COVID-19 patients? Am I exposing my family to serious illness? What happens if or when I become ill?

Stressors may also come from a lack of resources, such as available staff members and PPE; the effectiveness of treatments; or even the ability to definitively diagnose COVID-19 infection.

The American Psychiatric Association (APA) offers a number of recommendations to help health care professionals manage stress and avoid burnout. They include the following:

“Stay informed. Obtain current information about the outbreak from trusted sources, such as the Centers for Disease Control and Prevention and the World Health Organization.
Correct misinformation. Help correct inaccurate information and misperceptions when you encounter them by sharing credible, established public health resources.

Anticipate and address stress. “Keep in mind that it’s normal to feel stress in reaction to an infectious disease outbreak and be aware of signs of stress in yourself or family members. Take steps to minimize and address stress, such as keeping normal routines, taking part in enjoyable activities, focusing on positive aspects of your life and things that you can control; seeking support from friends and family; and engaging in stress reduction techniques and physical activity.” (1)

The APA also recommends that physicians and patients who are currently fighting COVID-19 follow these suggestions.

Meet basic needs. Eat healthy food, hydrate, and sleep regularly “to optimize your ability to provide care for yourself and others.” Also, engage in physical activity. Go for walks, work out, swim, or practice yoga.
“Take breaks. Rest and relaxing activities can provide a helpful distraction.”
“Stay connected. Giving and receiving support from family, friends, and colleagues can reduce feelings of isolation.” Due to physical distancing or self-quarantining, this may include using online or digital methods, such as video conferencing tools, or even keeping regular phone appointments with loved ones, even just to say “Goodnight” or have weekly check-ins.
Stay updated. Participate in work meetings where relevant information is provided.
“Self check-ins. Monitor yourself for signs of increased stress. Talk to a family member, friend, peer, or supervisor if needed.”
Honor the service you provide. “Remind yourself (and others) of the important work you are doing. Recognize colleagues for their service whenever possible.” (1)

The World Health Organization has additional stress-reducing recommendations for physicians managing a practice or a team of health care professionals. These recommendations include the following.

Rotate workers periodically from higher-stress to lower-stress functions.
Create a “buddy system” in which inexperienced workers are partnered with their more experienced colleagues. This encourages staff members to provide each other support; monitor each other’s stress levels; and reinforce safety procedures.
Encourage work breaks.
Offer flexible schedules for workers who are either directly affected or have a family member affected by a COVID-19-related event.
Ensure that staff are aware of where and how they can access mental health support services and facilitate access to such services.
Managers and team leaders are facing similar stresses as their staff members and may even experience additional pressures related to the responsibilities of their leadership role. If a manager decides to seek help, it may be useful for the manager to openly model self-care strategies. This can encourage staff members to seek similar help and reduce any stigma attached to seeking help. (2)

Additional resources

The American Medical Association hosts a webpage called “Caring for our caregivers during COVID-19” that provides a wealth of resources for health care leadership, including surveys to track trends in stress levels; advice on institutional policies designed to address stress; sections on PPE, childcare, and pet care; and “attention to emotional and mental well-being.”
The Center for the Study of Traumatic Stress offers a variety of helpful fact sheets and guides for health care workers, including:
- “Supporting Families of Healthcare Workers Exposed to COVID-19”
- “Fight COVID-19 with Better Sleep Guide: A Guide for Hospital Workers”
- “How Healthcare Personnel Can Take Care of Themselves.”
The U.S Department of Veterans Affairs offers a downloadable PDF document called “For Providers and Community Leaders: Helping People Manage Stress Associated with the COVID-19 Virus Outbreak.”

Sources

1. Morganstein J. Coronavirus and Mental Health: Taking Care of Ourseles During Infectious Disease Outbreaks. American Psychiatic Association. February 19, 2020. Available at https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2020/02/coronavirus-and-mental-health-taking-care-of-ourselves-during-infectious-disease-outbreaks. Accessed June 30, 2020.

2. Mental health and psychosocial considerations during the COVID-19 outbreak. World Health Organization. March 18, 2020. Available at https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_10. Accessed June 30, 2020.