Staff safety and wellbeing

Summary

An original article that explores the significance of both staff physical safety in the workplace as well as their psychological safety and wellbeing. In particular, I highlight the impact the COVID-19 pandemic has had on both these areas, and discuss the importance of ensuring all aspects of staff safety.

Content

All healthcare workers, from nurses to pharmacists, housekeepers to consultants, should be kept safe as they carry out their essential duties in caring for others. Not only is their physical safety important, but their psychological wellbeing is paramount too.

Healthcare workers should be kept safe from all forms of physical occupational hazard, including infectious agents, chemical hazards, workplace violence and ergonomic problems.[1] Specific measures have been put in place to protect the occupational health and safety of health workers, and there are consequential duties, rights and responsibilities for healthcare organisations to uphold.[2]

However, just as significant is the psychological safety and wellbeing of staff, as this can have far reaching implications at both a personal and work level. Over-stretched staff can experience fatigue, anxiety, depression and, ultimately, burnout, which is a state of emotional, physical and mental exhaustion caused by excessive and prolonged stress.[3]

Presently and perhaps most prevalent is the damaging toll, both physically and psychologically, that the COVID-19 outbreak is having on healthcare workers.

As staff have been at the frontline of the pandemic, they have been exposed to multiple different occupational hazards and put at risk. These include exposure to SARS-CoV-2 and other pathogens, violence, harassment, stigma, discrimination, unimaginably heavy workloads and prolonged use of PPE.[2]

The International Council of Nurses (ICN) estimated in June that at least 450,000 healthcare workers had been infected with COVID-19.[4] It is therefore clearly important that healthcare institutions provide safe work environments for staff to perform their essential duties.[4] Much focus has been placed on vaccinations, enhanced safety protocols and PPE to protect the physical health of clinicians and staff.[5]

The scale of the COVID pandemic has caused mass psychological trauma among the world’s nurses. Moreover, difficulty in providing end-of-life support to patients and their families because of visiting restrictions has been a specific stressor for all staff.[7]

Under these trying conditions, healthcare workers are likely to experience anxiety, depression, trauma, burnout and other mental health issues.[5] Reports from the US show that 93% of healthcare workers were experiencing stress at the height of the pandemic, with 76% reporting exhaustion and burnout.[6] A UK study reported that nearly half of ICU staff in England had symptoms of PTSD, severe depression, or anxiety.[7] For physicians, burnout was linked to a four-fold increase in suicidal thoughts.[5] Healthcare organisations ought to recognise the impact that emotional distress has on both patient safety and staff retention during and after the pandemic.[5]

There is strong evidence that poor mental health is associated with functional impairment which increases the risk of patient safety incidents.[7]

Therefore, equally as important as physical protection are resources to protect staff mental wellbeing.

Action steps taken by an organisation before, during and after a crisis will reduce psychosocial trauma and increase the likelihood that staff will cope.[8] For example, hospitals could appoint a Chief Wellness Officer (CWO) and establish a professional wellbeing programme for their staff. It is critical for hospitals and health systems to address burnout from a system-wide level to better care for their staff and to become resilient organisations.[5] Healthcare workers who feel well-supported are less likely to leave their job or reduce their hours worked.[7]

Research has highlighted the vital importance of fostering a supportive workplace culture, and the need to provide universal access to high quality wellbeing support and occupational health services.[7]

Furthermore, a study has shown that people who engaged with receptive arts activities (such as drawing or painting) on a frequent basis had a 31% lower risk of dying,[9] which highlights the significance of fostering a work-life balance that actively supports mental and physical health.

The safety of staff in the workplace is crucial, as is their wellbeing. The COVID-19 crisis has had a destructive impact on staff mental health, as shown in multiple studies worldwide, which cannot be overlooked. The massive elective backlog caused by the focus on COVID means that there is unlikely to be an easing of the strain on healthcare professionals for months if not years to come. It is therefore critical that both the physical and psychological safety of healthcare workers is supported and upheld by healthcare organisations in order to maintain a productive workforce who are better able to serve their patients.

Becky Tatum

Further reading

• Why is staff safety a patient safety issue?
• "I know this is burnout. I didn’t want it to be. But it is."
• Rethinking doctors’ mental health and the impact on patient safety: A blog by Ehi Iden
• Safety Incident Supporting Our Staff (SISOS): A second victim support initiative at Chase Farm Hospital
• Understanding moral injury: a short film (HEE and NHSE&I)
• Hidden Wounds
   

References

1. ‘Health Care Worker Safety Checklists: Protecting Those Who Serve’, Joint Commission International, 2019. [online] Available at: https://store.jointcommissioninternational.org/health-care-worker-safety-checklists-protecting-those-who-serve/?_ga=2.32377150.1488641257.1624913835-465240.1624122412
2. ‘COVID-19: Occupational health and safety for health workers’, World Health Organisation, 2021. [online] Available at: https://www.who.int/publications/i/item/WHO-2019-nCoV-HCW_advice-2021.1
3. ‘Burnout Prevention and Treatment’, HelpGuide, 2021. [online] Available at: https://www.helpguide.org/articles/stress/burnout-prevention-and-recovery.htm#
4. Blasi, A., Nunner, K. ‘Ethical principles in health care prove critical to protecting health care workers in pandemic’, Medical Economics, 2020. [online] Available at: https://www.medicaleconomics.com/view/ethical-principles-health-care-prove-critical-protecting-health-care-workers-pandemic
5. ‘WELL-BEING PLAYBOOK 2.0. A COVID-19 Resource for Hospital and Health System Leaders’, American Hospital Association, 2021. [online] Available at: https://www.ihf-fih.org/wordpress/wp-content/uploads/2021/02/caring-for-health-care-workers-covid-19.pdf
6. ‘The COVID-19 Effect: World’s nurses facing mass trauma, an immediate danger to the profession and future of our health systems’, International Council of Nurses, 2021. [online] Available at: https://www.icn.ch/news/covid-19-effect-worlds-nurses-facing-mass-trauma-immediate-danger-profession-and-future-our
7. Mahase, E. ‘Covid-19: Many ICU staff in England report symptoms of PTSD, severe depression, or anxiety, study reports’, BMJ, 2021; 372. [online] Available at: https://www.bmj.com/content/372/bmj.n108
8. ‘Creating a resilient organization’, American Medical Association, 2020. [online] Available at: https://www.ihf-fih.org/wordpress/wp-content/uploads/2021/02/caring-for-health-care-workers-covid-19.pdf
9. Fancourt, D. ‘The art of life and death: 14 year follow-up analyses of associations between arts engagement and mortality in the English Longitudinal Study of Ageing’, BMJ, 2019; 367. [online] Available at: https://www.bmj.com/content/367/bmj.l6377

About the Author

I am a volunteer for Patient Safety Learning who loves to blog about health and care.