This article was contributed by Beatrice Adegboyega BSN, RN, PCCN on behalf of American Nurses AssociationCalifornia.
Everyone has been affected by the pandemic in one way or another. Healthcare workers in particular have been on the frontlines for nearly two years and the mental health consequences associated with everyday factors are becoming more evident.
Recently, at a hospital in Philadelphia, an employee shot and killed his colleague. The effects were tremendous. Many healthcare workers felt unsafe at work while the incident caused Post-Traumatic Stress Disorder (PTSD) for others.
This triggered the question: What is being done to assess the mental health resiliency of healthcare workers? And how has the pandemic contributed?
A systematic review and meta-analysis conducted by Li et al (2021), involving 65 studies and 97,333 health care workers across 21 countries, reported an increased prevalence of depression, anxiety, and PTSD among healthcare workers during the COVID-19 pandemic. This stresses the need for an urgent intervention. “Mental health is influential and evident at every stage of life, from childhood and adolescence through adulthood,” said Betsy Snook MEd, BSN, RN, CEO of the Pennsylvania State Nurses Association (PSNA). Therefore, healthcare organizations should enforce routine mental health assessment for healthcare workers to assess and promote their resilience.
What is being done to address this increase?
Resilience is the ability to adapt healthy ways to cope with trauma and stressful situations. Some studies refer to professional resilience as the ability to avoid “burnout” or one’s “bounce back” ability. A study by Matheson et al (2016) found that personal characteristics, organizational structure, social support, and workplaces challenges were reported as the major contributors to the resiliency of healthcare professionals.
Mental Health Resiliency Bill To Support Nurse Mental Health
The challenges of COVID-19 seem to have impaired personal and professional resilience for a lot of healthcare workers. Yet, in 2021, California Assemblymember Low proposed AB-562, a bill that would, under the jurisdiction of the Department of Consumer Affairs and through each of the professional boards (e.g. Board of Registered Nursing), establish mental health resiliency programs for health care providers who have provided or will provide in-person care to patients with COVID-19.
“Healthcare providers who have witnessed waves of death and anguish must prioritize their own care so they can continue to provide high-quality care for patients,” Snook continued. The goal is to provide mental health services such as wellness coaching, counseling, and any other treatment which improves the psychological and behavioral health of the healthcare worker. “One such initiative is California’s mental health resiliency program (AB 562), which will allow licensed healthcare providers to access mental health services to help them return to and lead healthy, safe, and productive lives.”
AB 562 (Low) passed through both the California Assembly and Senate without a “No” vote, however, was placed in the “Suspense File” by the Senate Appropriations Committee, typically meaning sufficient funding for the bill was still in question. Nurse leaders across the state of California monitoring the bill since February 2021 were frustrated with the decision, as funds were attributed by the State of California to other mental health initiatives for the public.
“The burnout, the depression, the exodus from our profession… to see these critical issues not be addressed or acknowledged is very disappointing,” said Dr. Marketa Houskova, DNP, MAIA, BA, RN, Executive Director of the American Nurses AssociationCalifornia. “Long hours under stressful and dangerous conditions, fears about contracting the virus, and separation from loved ones is leading to lasting consequences for our front-line professionals. AB 562 (Low) would ensure healthcare professionals have increased access to essential mental health services.” As of March 10, 2022, the bill was still in a rare legislative window – meaning the bill had passed all legislative deadlines but the respective committees had not officially voted the bill ‘dead.’
It is important to note that being a health care provider does not make one immune from physical and mental illness. One of the safety rules when boarding a flight is to place a mask on yourself before helping a child. Health care workers have been trained to put patients first, thereby neglecting self-care in the process. Nurses must be allowed the ability to take care of themselves so they can take care of others. Nurses with higher resiliency showed benefits including: decreased risk of workplace related violence, reduced stress, improved patient safety, increased productivity, and efficiency in the workplace.
Are there concerns with this approach?
It has been shown that enforcing mental health assessments may lead to conflicts with freedom of choice, loss of confidentiality and a risk of increased stigmatization. Some healthcare professionals feel that disclosing a mental health problem might be a sign of weakness and therefore keep things to themselves to seem more in control.
However, nurses should think of it like a wellness check – to make sure we can function at our best. A 12-week Randomized control trial using a multifaceted resiliency training program for ICU nurses showed a significant decrease in PTSD symptom scores after the intervention (Mealer et al, 2014).
Support the Bill
AB 562 (Low) is returning for the second half of a 2-year California Legislative cycle. Should the bill pass through the appropriate committees before January 30th, 2022, mental health services will be made free and available to healthcare professionals through their licensing board. The issue of confidentiality and stigmatization are addressed as these services will be provided through third-party vendors. Furthermore, the bill also notes that records related to the mental health resiliency program are exempt from the California public records, and participation will not be used for disciplinary action and will be kept confidential.
Although there are personal and social factors involved in developing resilience, it is essential health care organizations do their part to ensure an efficient program structure that provides resources such as counseling, debrief, and support groups for each employee. The passage of AB 562 (Low) would be a first step to improve mental health resilience.
I appeal to you to join the American Nurses AssociationCalifornia in supporting mental health for all healthcare professionals by signing your support for the bill here
Frontline COVID-19 Provider Mental Health Resiliency Act of 2021: Health care providers: mental health services, Cal Assemb. Bill AB-562 (2021).
Li, Y., Scherer, N., Felix, L., & Kuper, H. (2021). Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PloS one, 16(3), e0246454. https://doi.org/10.1371/journal.pone.0246454
Matheson, C., Robertson, H. D., Elliott, A. M., Iversen, L., & Murchie, P. (2016). Resilience of primary healthcare professionals working in challenging environments: A focus group study. The British Journal of General Practice : The Journal of the Royal College of General Practitioners, 66(648), e507–e515. https://doiorg.proxy.library.upenn.edu/10.3399/bjgp16X685285
Mealer, M., Conrad, D., Evans, J., Jooste, K., Solyntjes, J., Rothbaum, B., & Moss, M. (2014). Feasibility and acceptability of a resilience training program for intensive care unit nurses. American Journal of Critical Care : An official publication, American Association of Critical-Care Nurses, 23(6), e97–e105. https://doi-org.proxy.library.upenn.edu/10.4037/ajcc2014747