Long Island health systems put post-pandemic focus on staff mental health

At the height of the COVID-19 pandemic, the seemingly endless number of people critically ill or killed by the disease had cast many Long Island healthcare professionals on the front lines into emotional despair and anguish.

It had become clear to the leaders of health systems, including Northwell Health and Mount Sinai South Nassau Hospital in Oceanside, that many physicians, nurses and other medical staff needed to get a handle on their mental health amid a medical crisis like none they'd seen before.

"That was a big, a huge stress moment for healthcare workers, where they really had to question why they're in healthcare, because you go into healthcare to really help people and save lives, said Renee Sanchez, director of patient care at Long Island Jewish Valley Stream. "During COVID, it was trying times for us, very hard, trying times where we did see a lot of death. We felt like we weren't giving our best, because every day we were trying to save lives, and then you come back the next day and the patients have passed because of COVID."

Burnout risk

The burnout rate among physicians and nurses — already at the crisis stage before the pandemic began in 2020 — has continued to spike in the years since, putting a strain on patient care, staffing levels and health systems' bottom lines. As an antidote, Northwell has prioritized managing mental health and has trained more than 37,000 staff members in its Stress First Aid program, which monitors workers' well-being and stress levels while offering daily mediation, peer support and access to therapy. At Mount Sinai South Nassau, meditation and yoga are part of a similar treatment plan for staff mental health.

Catholic Health was also recently recognized by the American Medical with the Joy in Medicine award to promote wellness and reduce burnout. The health system employs 18,000 employs at more than a dozen facilities on Long Island, including five hospitals.

Catholic Health offers peer support groups, burnout assessments and training for doctors and healthcare workers to recognize and promote wellbeing.

Northwell’s Center for Traumatic Stress Resilience and Recovery focuses preventive and clinical treatment for post-traumatic stress disorder, trauma and grief of front line workers, said lead clinical psychologist Amy Nadel.

Healthcare officials said they are working to address the difficulties physicians and nurses face, with an eye to preventing burnout. The key, Nadel said: making mental health and wellness services more accessible while getting past the resistance of physicians, nurses and other medical workers to reaching out.

'A fair amount of stigma'

"What we find often is that our healthcare providers and workers often don't feel comfortable seeking help and support. There is a fair amount of stigma in the culture of medicine," Nadel said. "I think most people that are driven to this cause end up finding tremendous meaning in the work and value in it. Over time there's this repeated exposure over and over again to significantly traumatic events or simple things that they've witnessed."

About half of nurses and physicians nationwide reported burnout before the pandemic, in what the National Academy of Medicine described at a "crisis level." Up to 60% of medical students and residents also reported burnout, according to a U.S. surgeon general’s report last year. Burnout rates have increased by about 15% since the pandemic, the report said.

Burnout and other mental stress, including fatigue, can lead to diminished patient care or staffing shortages by healthcare providers. The surgeon general’s report estimated burnout turnover costs health systems $9 billion to cover work lost by nurses and between $3 billion and $6 billion annually for physicians.

"We know that burnout, and for providers that are experiencing symptoms of burnout, that they have higher risk of things like medical errors," Nadel said. "So it can have not just an impact on their emotional health and well-being, but also then trickles down directly to the impact on patient care, and so that is a real concern."

Other health effects can include anxiety, depression and questioning the ability to do the job after a near mistake, errors or unexpected outcomes, Nadel said.

Self-care and wellness

Northwell has tried to combat burnout and stress by using a peer-support and self-care model developed by the U.S. Navy. The program includes team coaching and wellness checks. A color-coded chart asks staff to analyze their stress levels so they can work to manage their well-being.

At Mount Sinai South Nassau in Oceanside, the hospital has worked to reduce burnout and retain staff with debriefings and programs through its "recharge room." The hospital offers tai chi, yoga, meditation and breathing exercises.

The stress and trauma on healthcare workers can be constant and unpredictable, said Dr. Salvatore Pardo, the emergency department chair at Northwell LIJ in Valley Stream.

"I think we see patients at their worst every day," Pardo told Newsday. "So, I think to be a an effective clinician, you have to be able to manage that not only for the patient, but then afterward, for yourself, it's an important part of recovery."

He said it’s important for healthcare workers to take care of themselves, and find a way to release the stress and trauma of the day.

Like Nadel, the Northwell clinical psychologist, Pardo said breaking down barriers is key to helping healthcare workers in need.

"I think professionally that you have to put up a wall. You have to have that ability to respond in a level and clear-headed way," Pardo said. "I think where the difficulty comes is, what do you do with that every day as you leave the hospital, many people will bring it home and bottle it up, but I think there has to be a release of those feelings as well."

South Nassau’s interim president, Dr. Joshua Kugler, said hospital staff have dealt with mental health challenges brought on by outside forces before the pandemic. Superstorm Sandy, Kugler said, meant some medical staff reporting to work while their homes were underwater.

"Knowing they’re not alone, our staff knows it’s a priority for a reason," Kugler said. "I think they know they’re in a trusted environment if they feel vulnerable."

Kugler said many employees were still seeing effects of the pandemic years later and may still be treated for PTSD.

"To put your life on the line when you don’t know the outcome is on another level," Kugler said. "We didn’t recognize enough how deeply impactful COVID would be. It lasted well beyond the pandemic, and we didn’t recognize the effects soon enough."