[Editor’s Note: Every month, MCN’s Director of Witness to Witness, Kaethe Weingarten, PhD, shares stories, resources, and helpful tips to support health care workers during these ongoing unprecedented times. Dr. Weingarten also offers a twice-monthly newsletter, filled with resources, recent articles, and her news and views. Sign up for the newsletter on the Witness to Witness webpage.]

The last few months have seen a flurry, almost a blizzard, of articles on the pandemic’s toll on health care workers, in the form of research, newspaper articles, TV coverage, social media messages, and long-form magazine articles.  The toll is described in various ways: depression, anxiety, burnout, moral injury, compassion fatigue, empathic distress, and trauma, to name the most widely used terms.

Not surprisingly, these are the same terms used to describe how 40% of the American population feels!  Most of us who are health care workers are used to feeling well – or well enough -- and serving people who are doing less well than we are.  This is no longer entirely the case.  Patients and providers are swimming in a similar pool, a COVID-19 pandemic pool – and while our positions may differ, and what we are called upon to do may vary, our general feeling state may be more similar than not.

Surveys tell us both how health care workers are feeling – and what they are doing to take care of their distress.  In survey after survey, we learn that health care workers at all positions within the profession are reluctant to seek professional care when needed.  In most surveys, the number seeking support from a mental health specialist is less than 10%.  Perhaps the thought process is like an iceberg with just the tip showing.  Visible thoughts and declarations may be: “I’m fine.” “What’s the point in talking about this?” “It’s no worse for me than anyone else.”  But under the waterline, invisible, there may be quite a different set of thoughts: “What’s the matter with me?“ “I feel awful.”  “No one can know.”  “No one understands how I feel.”

The difference between what is visible and invisible is not a function of personality.  It is a function of a system that penalizes health care workers when they do request help.  Reports amply document this.  Surveys also clearly pick up the realistic fear health care workers have regarding stigma.

This may change.  The pandemic has laid bare how the health care system makes vulnerable the very people it relies on to deliver quality care.  There are initiatives underway at the federal and state levels to change policies that confer negative consequences on those who seek mental health services.  The Fact Sheet put out for President Biden’s State of the Union Address included this paragraph:
 

Promote the mental well-being of our frontline health workforce.

Three-quarters of frontline health care workers report burnout, while more than half say they lack adequate supports to cope. The Administration has already dedicated $103 million in American Rescue Plan funding to address burnout and strengthen resiliency among health care workers. The President will strengthen this commitment by signing the bipartisan Dr. Lorna Breen Health Care Provider Protection Act into law, which will invest $135 million over three years into training health care providers on suicide prevention and behavioral health while launching an awareness campaign to address stigmatization, promote help-seeking and self-care among this workforce. In addition, HHS will continue grant programs to support health systems and provider groups to prevent burnout, relieve workplace stressors, administer stress first aid, and increase access to high-quality mental health care for the frontline health care workforce.

This is urgently needed.  Any of us can advocate for those changes.

At the individual level, with our colleagues, family members, and friends who are health care workers, there are daily actions we can take to alleviate suffering.  One metaphor that the writer Anne Lamott offers in an article I read decades ago is to imagine that we are all in the waiting room of an emergency department, waiting to be seen.  Some of us seem to be sicker than others. Those of us who are well enough to get up and move around can offer juice and crackers to those who cannot do that. We can provide tender care.

What does tender care look like?  It looks like:

1. Listening carefully to what a person is telling us.  I call it “radical listening,” by which I mean welcoming, accepting, non-judgmental listening.
    
2. Asking what someone might need help with or just doing something you are pretty sure will be helpful.  Bring over a quart of soup; bake cookies; take in trash cans that have been left out for days.
    
3. Providing a frame that counters any embarrassment the person might express about showing vulnerability.  Your frame might be, “Why wouldn’t the helpers need help?” Or, “I feel closer to you now.”
    

Sometimes, people will accept your offers of care, sometimes not. In the case of a person who seeks your help but then rejects it, you may be able to feel sympathy if you ask yourself the question, “What life circumstances make this the person’s best strategy?”  You can always offer sympathy and support regardless of whether you expect success.

Our health care workers are hurting.  Over 23% say they plan on leaving the profession in the next year.  Each of us can take every opportunity we have when we interact with a health care worker to express appreciation.  This morning, I left a note to the nurse who responds to me in the electronic medical record as follows: “I do hope you know that what you do, your reliability, your tone, makes a huge difference. I feel I’m in partnership with you, which makes all the difference.  I am so grateful.”  That’s not poetry, but I hope she feels that what she does and how she does it matters. 

Access more of Witness to Witness’s resources to support health care workers at the W2W site. Most are available in English and Spanish: http://migrantclinician.org/w2w. 
Dr. Weingarten offers regular virtual learning sessions. Watch our Upcoming Webinars page or watch a past webinar on our Archived Webinars page.

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