Well-being and Burnout in Advanced Practice Providers During COVID-19

Kaitlan Bryant

Abstract

Concern regarding a decreased sense of well-being and increased burnout among healthcare providers has been a growing issue in recent years, with more than 50 percent of U.S. physicians reporting increased burnout, which can lead to increased rates of medical errors, provider turnover, and even provider suicide. Furthermore, the current pandemic has escalated the potential for even more severe declines in provider well-being, burnout, and in turn, mental health. Specifically, there is an interest in understanding how the mental health of advanced practice providers such as nurse practitioners and physician assistants may be impacted differently or more severely since they tend to work in different locations such as MD360 and urgent care where they often encounter and test potential COVID-19 patients at a higher volume more often than the emergency department physicians. The current research project applies a mixed-methods approach to understanding what factors might reduce or enhance a sense of well-being and burnout in the context of these advanced practice providers during the COVID-19 pandemic. Integrating current literature with survey data from a survey administered to these advanced practice providers, monitoring their well-being and burnout during this pandemic, as well as observations and interviews will offer important recommendations for these healthcare providers and their teams during these unprecedented times. 

Introduction

The burnout and well-being of the front line workers have been the main concern during this pandemic as it is crucial for these healthcare providers to not have their mental and physical health completely deteriorated in order to fight this pandemic. It is imperative to identify and analyze the factors that are decreasing well being and increasing burnout during this time in order to come up with tactics that will help. Specifically in this research, the interest is looking at advanced practice providers who work less in the hospitals and more in MD360s, urgent cares, etc. These providers may be experiencing a different impact as they may be dealing with different factors outside of the hospital. It is important to provide these providers with a plan to increase their well-being and decrease their burnout as well, as to better prepare them to continue this fight against this pandemic.

Materials and Methods

Some of this information on well being and burnout of healthcare workers during this time was gathered through literature review, though this literature is still developing as the pandemic continues. Interviews were also conducted remotely with some of the affected providers in order to get a direct understanding of their concerns. The bulk of this research, though, was done by analyzing survey data. A survey assessing the well being and burnout levels of these providers during the pandemic was given out in 8 waves and analyzed each wave to pull out concerns and in turn come up with tactics to improve in areas where issues were identified. Combining these three methods, critical recommendations were compiled for healthcare providers and their teams regarding well being and burnout levels within their teams during COVID-19.

Conclusions

Increased stress and burnout and decreased well-being in medical providers has become a prevalent issue and is an even larger issue during the COVID-19 pandemic. Some common recorded factors of burnout include a heavy workload, lack of support, and lack of or ineffective communication within teams. All of these factors are heightened during the pandemic. Other factors that have been reported to increase burnout and decrease well-being as a direct result of the pandemic are fears about contracting and transmitting the virus to family members, pay and/or hour cuts, and lack of PPE. Finally, advanced practice providers who work in MD360s in the area experience all of these factors that cause burnout and they have also reported more stress due to MD360 locations closing and therefore having their hours cut and lack of open communication about how to make up these hours and when the MD360 locations will be back opened. These results are collected during each wave of the survey and are communicated to the head of these departments. After each survey, there is a Town Hall meeting help where issues are discussed and plans for improvements are made. 

These factors are all still very much present during the COVID-19 pandemic and many of these factors are extremely exaggerated due to the conditions of the pandemic. There are even more issues with heavy workloads due to COVID-19 volume. There are even more complaints about the lack of communication surrounding COVID-19 issues and low support for provider concerns and issues during this time. These are all contributing to even lower well-being and higher burnout rates than usual due to this pandemic. There are also concerns beyond those that create stress and burnout on a normal basis that are specific to the pandemic. Some of these include the lack of or improper personal protective equipment, catching the virus and giving it to loved ones, and issues surrounding moral injury. It is widely reported that there is not enough PPE such as N95 masks, surgical masks, gloves, gowns, and face shields to adequately keep the front line workers protected. There is also a lot of fear surrounding the possibility of these providers catching the virus at work and giving it to their families. Also, there are a lot of concerns about moral injury during this pandemic. Providers are reporting that they are having a hard time dealing with things such as not being able to effectively treat their patients due to COVID-19 issues and restrictions, visitor policies keeping family members away, and having to watch many of their patients die due to COVID-19. All of these factors caused by the pandemic can be identified as causes for the sharp increase in burnout and a decrease in well-being for providers during this time.

There is a specific interest in how these factors and are affecting advanced practice providers such as nurse practitioners and physician assistants who are working not in the Emergency Department but at MD360s and who may be dealing with more COVID-19 contact. There is also interest in seeing what other factors might be affecting these APPs, due to their location of work, that do not affect the practitioners in the emergency department. The APPs reported issues with a heavy workload, lack of support and communication, and fear of contracting and spreading the virus, similarly to the physicians and nurses in the emergency department. There were also some issues reported that were specific to these providers and their location of work. These were severe cuts in hours, many MD360 locations closing, and the lack of transparent communication about the cause for the closings when these locations would open back up. Many APPs reported that they were suffering from large hour cuts due to MD360 locations closing and also reporting that they had little guidance on when and how they were to make up these hours lost. They also reported that there was little to no communication about why these locations were closing when the need for testing and practitioners during COVID-19 was extremely prevalent, as well as when these locations were estimated to be opening back up. 

Results

There are several factors that have been reported to contribute to a decrease in well being and an increase in burnout in medical practitioners on a normal basis, and these are extremely exaggerated during a global pandemic. Some of these common sources of burnout include a heavy workload, lack of support from higher-ups, and lack of communication or ineffective communication. Practitioners often complain that they have extreme work hours and cannot maintain a healthy work-life balance and in turn, their well-being suffers. They also tend to complain that they do not feel supported and that their concerns, well-being, and level of burnout are not taken into consideration and addressed by their departments and this can be a source of stress and burnout as well. Also, there are often issues reported regarding communication. Often times, there is a lack of communication or ineffective communication within and between teams that can create unneeded work or contribute to unequal work distribution, therefore producing more burnout for certain team members. For example, a lack of communication between nurses and physicians has been reported to create more work for each of these team members when proper communication would allow for this work to be split between the two and in turn, decreasing stress and burnout.

References

Mohammad JaliliMahtab Niroomand,
Fahimeh HadavandKataun Zeinali
Akbar Fotouhi 

Acknowledgements

I would like to thank Marissa Shuffler Porter and Pheobe Xoxakos for helping with the coordination and conduction of the survey and analysis of the results.

I would also like to thank all of the physicians, nurses, and advanced practice providers who choose to answer the surveys in the emergency department as well as in surgery at Greenville Memorial Hospital.