Ashley Choudoir, MSN, APNP, NP-C; Fahad Aziz, MD
WMJ. 2024;123(1):9-10.
In the United States, the first case of COVID-19 infection was announced in early 2020. Soon after, the COVID-19 pandemic profoundly affected frontline health care workers, including advanced practice providers (APP). Despite limited resources, hospitals were filled with patients. Nonclinical staff adjusted to remote work, causing a delay in elective surgeries and widening the gap for social distancing. In this new situation, medical professionals faced the challenge of constantly changing treatment protocols against an unknown enemy. Despite the difficulties, they remained dedicated and worked tirelessly in short-staffed wards, risking their own health and personal sacrifices with unwavering determination.
Equipped with a broad set of skills adaptable to inpatient and outpatient settings, APPs were deployed across the country to address acute staffing shortages and manage COVID-19 cases from frontline positions, including urgent care, emergency departments, and critical care units. Hospitalists, including APPs and physicians, comprised the primary providers treating patients hospitalized with COVID-19.
A multicenter study showed that these frontline workers also faced several psychological conditions, including depression, anxiety, guilt, fear, and insomnia. It’s worth noting that APPs had lower overall well-being compared to physicians, and there was significantly less focus on the well-being of APPs compared to physicians and nurses.1 As a result, six in 10 APPs reported being burned out, and four in 10 reported being depressed.2
APPs played a critical role during the pandemic and are essential to the health care workforce. It’s important for us to recognize the factors that cause APP burnout and support their overall well-being.
FACTORS ASSOCIATED WITH APP BURNOUT
Just like physicians and nurses, APPs also experience many stressors in their everyday lives that can lead to burnout, especially during the pandemic. These stressors can be divided into four main categories: personal stressors, patient-related stressors, organizational stressors, and other professional stressors (Figure 1).
UNDERSTANDING APP WELLNESS
Striking a balance between APP workload and feeling supported is necessary to cultivate APP wellness, and that support can be broken down into the following areas:
- Organizational support: Organizational support is essential and includes:
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- Sufficient resources for medical practice, such as medical equipment, pagers, computers, and phones.
- Sufficient training in electronic medical records.
- Appropriate support for technical issues.
- Sufficient time to meet work demands.
- Appropriate compensation.
- A culture of wellness: Creating a wellness culture relies on fostering organizational values, attitudes, and behaviors that support self-care, and personal and professional development.
- Developing resilience: Being resilient means being able to handle stressful situations in a positive and adaptive manner. Medical professionals who are more resilient have the ability to quickly recover from stressful situations and become even stronger. Resilience is based on three factors:
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- Self-awareness: Knowing and understanding one’s weaknesses and emotions are key to self-awareness.
- Self-limitation: Recognizing personal limits is key to building resilience. APPs, as medical professionals, are accustomed to handling challenging duties. Yet, it’s vital to acknowledge our human boundaries and seek assistance from colleagues or supervisors when necessary.
- Public awareness: APPs play a crucial role in any medical organization. However, their importance is often not fully recognized by the public, especially when compared to nurses and physicians. It is important to have a better understanding of the crucial roles that APPs play in order to foster healthy relationships between patients and APPs. This is also a significant factor in promoting APPs’ well-being.
The well-being of APPs is a complex issue that depends not only on their own resilience, but also on the support and culture of health care organizations. It’s important for these organizations to recognize that APPs, while highly skilled and adaptable, still face challenges in their demanding roles. To truly support their wellness, health care institutions must create an environment that actively promotes the mental, emotional, and physical health of these valuable team members. This goes beyond just acknowledging their struggles and involves investing in substantial support systems, such as mental health resources, professional development opportunities, and a workplace culture that encourages balance and self-care. The commitment to APP wellness should be deeply ingrained in the organization’s values and practices, ensuring that APPs feel appreciated and supported as they navigate the complexities of patient care.
References
- Dugani SB, Fischer KM, Geyer HL, Maniaci MJ, Croghan IT, Burton MC. Psychologic wellness of PA, NP, and physician hospitalists during the COVID-19 pandemic. JAAPA. 2022;35(5):45-53. doi:10.1097/01.JAA.0000824964.37126.d8
- Robbins R. Medscape Nurse Practitioner Burnout and Depression Report 2022. August 17, 2022. https://www.medscape.com/slideshow/2022-np-burnout-rpt-6015568?icd=login_success_email_match_norm#2