Healthcare workers continue to face record-high burnout rates worldwide, causing staffing shortages and reduced quality of care. But after working with providers in Ukraine, this psychiatrist believes it’s possible to turn this trend around, even under the hardest circumstances.
After Russia invaded Ukraine in February 2022, about 5.1 million Ukrainians have been displaced as of 2023 and 6.2 million have fled the country. The United Nations Human Rights Council estimates that 17.6 million people are in need of humanitarian aid due to the conflict. Meanwhile, just in 2022, there were over 700 attacks on healthcare facilities in Ukraine and 86 attacks targeting healthcare workers, killing 62 people and injuring 52 others. Ultimately, one in three Ukrainians have lost access to medical care, according to the Ukrainian Healthcare Center.
That’s just a snapshot of what healthcare workers in the country are facing, and the circumstances Dr. Maya Bizri, psychiatrist and founding director of psycho-oncology at the American University of Beirut Medical Center, found herself in this past March. Partnering with MedGlobal, a nonprofit dedicated to helping frontline healthcare workers improve their mental health, Dr. Bizri spent six months developing training modules on burnout and forms of traumatic stress. She then took her work to Lviv, in western Ukraine, to educate — and hopefully help — healthcare workers at a pediatric oncology hospital.
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“Burnout isn’t a specific mental health diagnosis, and yet it’s associated with a risk of mental health challenges like anxiety and depression, and poor coping skills like increased substance use,” says Dr. Bizri. “But most people tend to wait until it develops into something that is far more alarming to intervene, whereas it should be the other way.”
While Dr. Bizri believes this to be true for healthcare workers around the world, the point is only further driven home in a war setting, where burnout is compounded with conditions like secondary traumatic stress. With similar symptoms to post-traumatic stress disorder, secondary trauma is the result of an individual hearing about another’s firsthand trauma. As she trained hospital leaders and staff on four modules centered around improving employee benefits and increasing mental health awareness among workers, she witnessed secondary trauma and other forms of distress common in crisis environments.
“We would hear air sirens going off from time to time, but we were not in an active combat area, and these healthcare workers hadn’t necessarily lost someone in their family,” she says. “But they heard patients recount their experiences from being in combat settings.”
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Another common challenge many Ukrainian healthcare workers experienced was moral distress, where they had to put aside their own morals to treat a patient. For example, Dr. Bizri saw healthcare workers treat an old lady who made it clear she blamed the western Ukrainians for starting the war and displacing people.
“As a healthcare worker in a war zone, you obviously take a side, but the patient you’re treating may not be on your side and say something like, ‘I don’t pity the boys dying in western Ukraine,'” says Dr. Bizri. “This can create moral stress for the worker because they don’t want to help these patients. But they’re healers, and to not help goes against the value system they live by.”
When healthcare workers practice in a world that doesn’t align with their moral standards, it can lead to moral injury, feeling as if they violated their own conscience, explains Dr. Bizri. This only worsens feelings of burnout, depression and anxiety, among other mental health conditions. These same conditions were evident among U.S. healthcare workers during the pandemic, too, Dr. Bizri says.
“It doesn’t look much different in Ukraine than it would look in the U.S. or it would look in Beirut — it’s a global phenomenon,” she says. “And it’s very costly to the healthcare system as more and more people quit.”
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In the U.S., it’s estimated that more than 6.5 million healthcare professionals will leave their positions by 2026 and only 1.9 million will be able to replace them, according to a Mercer report. Dr. Bizri underlines that hospitals can no longer afford to ignore burnout or write it off as an expected occupational hazard. Her work in Ukraine made it clear there are solutions, starting with her first module: training hospital leaders and executives on how to reduce the systematic causes of burnout.
“Look at burnout as a problem with the system,” says Dr. Bizri. “While you want to address burnout at an individual level, it must be distinguished as a workplace phenomenon that primarily calls for organization-level solutions.”
These solutions aren’t revolutionary for most industries — hospitals can start by providing better benefits. From required PTO and child care assistance, to increased mental health coverage and telehealth options for those struggling with depression, anxiety, PTSD as well as substance abuse, Dr. Bizri is asking healthcare employers to catch up to other industries within the professional world.
She further advises employers to reduce the administrative burden on healthcare workers by improving things like team delegation planning and leaning more on automated technology. Employers should also screen workers periodically for burnout, using the Maslach Burnout Inventory, which is the first official test for burnout. It may prove harder to identify secondary trauma or moral distress, but employers can at least provide education on both conditions.
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Dr. Bizri also stresses that healthcare workers are deserving of care and treatment themselves — her training modules focus on the healthcare worker’s personal experiences, and help them see themselves as patients too. Dr. Bizri asked workers to stop buying into the resilience narrative, where healthcare workers are expected to endure their hardships without complaint or else seem like they are not “resilient enough” for the job. Lastly, providers should be trained on how to work with patients who experience trauma, helping them identify how their patients’ stories may affect them and the resources available to them.
While Dr. Bizri received positive feedback from Ukrainian healthcare workers on her training, she plans to revise the modules and expand to more providers in crisis situations. However, she believes even without pandemics and war, hospitals should take her advice and invest in the health of their workers before it’s too late.
“Whether in the U.S. or a disaster setting, burnout is a natural reaction in healthcare systems working at capacity,” says Dr. Bizri. “That’s why it’s important to recognize the early signs and treat them.”