Most people who work in hospitals expect back-to-back shifts, sleep deprivation, every imaginable bodily fluid, difficult patients, frightened families and the emotional burden of witnessing death.
But the wave of infections caused by the delta variant of the coronavirus has pushed front-line medical workers beyond their limits. The health care workers who expect to be competent and caring in the midst of other people’s trauma are being blindsided by their own.
Kelly Brady-Pavelko, nurse manager at Legacy Salmon Creek Medical Center’s emergency department, said she and other hospital leaders are watching “staff fall apart.”
“Right now during the pandemic, you’re doing your three 12-hour shifts, and then you’re doing three more, and then you’re doing three more, because there’s no staff to cover you,” Brady-Pavelko said. “Maybe you get one day off but what are you doing on that day? You’re sleeping. It’s killing people.”
Coping with crisis
Licensed clinical social worker Jennifer Barber foresees a looming mental health crisis among front-line health care workers even more profound than what’s presently unfolding.
“Unless you have a friend or a family member working at a hospital or unless you’re a mental health worker yourself hearing these stories, you have no idea,” Barber said. “It’s just horrible what is happening every day. It is an absolute war.”
It’s a far cry from the encouragement offered to health care workers at the start of the pandemic — the colorful signs, car parades, donated meals and nightly cheering sessions.
“Eighteen months ago, everybody is a hero,” Brady-Pavelko said.
But now, she said, when frontline workers most need public support, it seems to have evaporated.
Clark County COVID-19 hospitalizations reached their pandemic peak in September and have yet to fall below winter’s record highs, according to public health data.
At one point in September, the 32-room emergency department at Legacy Salmon Creek held 105 patients “in every hallway, every nook and cranny, even the waiting room,” Brady-Pavelko said. A refrigerated truck had been stationed on site because the morgue didn’t have room for all the bodies.
“People don’t believe it,” Brady-Pavelko said.
Moreover, the pandemic has everyone on edge, and Brady-Pavelko said she’s seen a correlating uptick in the emergency department’s drug- and alcohol-related cases.
“The amount of violence, verbal abuse and physical abuse has been so much more,” said Brady-Pavelko, noting that several emergency nurses have transferred to other departments where the environment isn’t as chaotic. “They say to me, ‘Why should I continue to work where I am hit on and spit on and pooped on for 12 hours?’ ”
She said staff turnover, which was infrequent when she took the nurse management job two years ago, is now routine. When a nurse comes to her in crisis, she said she first rules out the possibility of suicide, then sets about rearranging shifts or extending a leave of absence.
“I have been seeing a lot more absences that have to do with stress and anxiety and failure to cope. I know that the staff who apply for that leave feel that ‘I’m letting down my team,’ but I say, ‘You have to take care of yourself first so you can take care of your team,’ ” Brady-Pavelko said.
Trained to be tough, staff may wait until they hit a breaking point before they seek help — and then have trouble getting it. The pandemic’s psychological toll on everyone has created long waitlists for mental health services.
“It takes a lot for a nurse to be able to admit that they need help, because we are always supposed to be there to help others, to be the heroes to save everyone,” Brady-Pavelko said. “It has a lot to do with pride and being able to admit that we need help. I think when it gets to that point, the help that’s needed is now.”
‘Help will be there’
That’s why Barber has created a program she calls Frontline to the Front of the Line, or FL2FL, in which mental health providers ask their less-critical clients to volunteer some of their treatment hours to create immediate openings for front-line workers.
The therapists listed with FL2FL.com are already registered with Barber’s resource directory, Local Health Connect, which also offers a podcast and blog highlighting resources for mental, physical and spiritual health.
Barber herself worked as an emergency department clinical social worker for 16 years, so she’s familiar with the grueling conditions. She said her heart belongs with the front-line workers — the doctors, nurses, hospital techs, housekeepers, social workers, chaplains and managers — who are trying to do their jobs while battling burnout, compassion fatigue and acute stress disorder.
“This is something that we call forward-facing trauma. You go in and it is just trauma every day and there is no foreseeable end,” Barber said. “If there is no foreseeable end, how do we come together as a community to ensure that people survive as they do their job, because it is so important that they do their job? That’s why the burnout is so bad right now because there’s the thought that, ‘Is this ever going to end? What’s right around the corner that we don’t even know about yet?’ ”
Brady-Pavelko urges staff to take advantage of free therapy sessions through the hospital’s employee assistance program, but even so, sessions are limited and it’s difficult to find a counselor who can work around changing shifts and fluctuating schedules. Brady-Pavelko hopes that FL2FL can help with that.
Trauma and the brain
“What FL2FL does is prioritize front-line workers so they are not being placed on a three-month waiting list. They can get right in, even if it’s just for a couple sessions, to work through the things that feel most important,” said Kendall Hagensen, owner of Vancouver Wellness Studio and a therapist who specializes in the treatment of trauma through movement.
Several of the studio’s practitioners, including massage therapists and acupuncturists as well as mental health counselors, are participating in FL2FL. Hagensen said she’s seen a definite increase in the number of front-line workers seeking treatment. They are displaying symptoms similar to those suffered by survivors of natural disasters, she said.
“It’s essentially an experience of collective trauma. Our brains have a really hard time processing the trauma when we’re still in it,” Hagensen said. “We can’t think our way out of trauma. Once we’re in that loop, our brains have a hard time getting out of it, so mental health care is extremely important for front-line workers, especially trauma therapy.”
Hagensen said everyone has a “window of tolerance” — basically, how much stress a person can withstand. During a time of sustained trauma, that window becomes much smaller. Everyday experiences become much harder, Hagensen said, and things that used to feel easy or manageable now seem impossible. Front-line health care workers may be more irritable and have emotional outbursts, making precious time with family and friends stressful instead of restorative.
“We can’t expect people to be kind and courteous and patient and think outside the box and give it their all in their jobs. We cannot expect people to be their best in trauma because the brain is no longer able to do that,” Hagensen said. “It’s an impossible task that we are asking of them, truly.”
Barber hopes to take “finding a therapist” off the list of front-line workers’ impossible tasks, though FL2FL is still in its early stages and Barber said that many more practitioners are needed. She said the platform is not limited to mental health professionals, but also includes those who tend to the body, such as yoga instructors and naturopaths, as well as spiritual-care providers of all faiths. Barber especially welcomes therapists who specialize in substance abuse, male practitioners, therapists who identify with the LGBTQ community and counselors of color. Barber emphasized that FL2FL is a joint effort between practitioners and patients, working together to ensure speedy treatment for front-line workers who most need it.
Barber says that those clients offering to give up therapy sessions are happy to do something to help. “The response from my current clients is, ‘I would be so honored. Thank you for asking me,’ ” Barber said. “I’ve had medical workers brought to tears because of the kindness of people stepping aside. That right there tells me that this is huge.”
Brady-Pavelko said that knowing the community cares enough to do something is, in itself, a major boost: “It actually makes me cry to know that there are people in our own community that are willing to give up their scheduled appointments to let someone go in front of them and take their space so that people can get help.”