Emotional Exhaustion Among US Health Care Workers Before and During the COVID-19 Pandemic, 2019-2021

Abstract

ImportanceExtraordinary strain from COVID-19 has negatively impacted health care worker (HCW) well-being.ObjectiveTo determine whether HCW emotional exhaustion has increased during the pandemic, for which roles, and at what point.Design, Setting, and ParticipantsThis survey study was conducted in 3 waves, with an electronic survey administered in September 2019, September 2020, and September 2021 through January 2022. Participants included hospital-based HCWs in clinical and nonclinical (eg, administrative support) roles at 76 community hospitals within 2 large health care systems in the US.ExposuresSafety, Communication, Organizational Reliability, Physician, and Employee Burnout and Engagement (SCORE) survey domains of emotional exhaustion and emotional exhaustion climate.Main Outcomes and MeasuresThe percentage of respondents reporting emotional exhaustion (%EE) in themselves and a climate of emotional exhaustion (%EEclim) in their colleagues. Survey items were answered on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree); neutral or higher scores were counted as “percent concerning” for exhaustion.ResultsElectronic surveys were returned by 37 187 (of 49 936) HCWs in 2019, 38 460 (of 45 268) in 2020, and 31 475 (of 41 224) in 2021 to 2022 for overall response rates of 74.5%, 85.0%, and 76.4%, respectively. The overall sample comprised 107 122 completed surveys. Nursing was the most frequently reported role (n = 43 918 [40.9%]). A total of 17 786 respondents (16.9%) reported less than 1 year at their facility, 59 226 (56.2%) reported 1 to 10 years, and 28 337 (26.9%) reported 11 years or more. From September 2019 to September 2021 through January 2022, overall %EE increased from 31.8% (95% CI, 30.0%-33.7%) to 40.4% (95% CI, 38.1%-42.8%), with a proportional increase in %EE of 26.9% (95% CI, 22.2%-31.8%). Physicians had a decrease in %EE from 31.8% (95% CI, 29.3%-34.5%) in 2019 to 28.3% (95% CI, 25.9%-31.0%) in 2020 but an increase during the second year of the pandemic to 37.8% (95% CI, 34.7%-41.3%). Nurses had an increase in %EE during the pandemic’s first year, from 40.6% (95% CI, 38.4%-42.9%) in 2019 to 46.5% (95% CI, 44.0%-49.1%) in 2020 and increasing again during the second year of the pandemic to 49.2% (95% CI, 46.5%-51.9%). All other roles showed a similar pattern to nurses but at lower levels. Intraclass correlation coefficients revealed clustering of exhaustion within work settings across the 3 years, with coefficients of 0.15 to 0.17 for emotional exhaustion and 0.22 to 0.24 for emotional exhaustion climate, higher than the .10 coefficient typical of organizational climate (a medium effect for shared variance), suggestive of a social contagion effect of HCW exhaustion.Conclusions and RelevanceThis large-scale survey study of HCWs spanning 3 years offers substantial evidence that emotional exhaustion trajectories varied by role but have increased overall and among most HCW roles since the onset of the pandemic. These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions.

Large increase in bloodstream infections with carbapenem-resistant Acinetobacter species during the first 2 years of the COVID-19 pandemic, EU/EEA, 2020 and 2021

“…In 2020–2021, there were larger numbers of severely ill patients, many with severe pulmonary infection. High occupancy rates necessitated increased provision of ICU beds, often with staff who were overworked or less experienced [ 13 , 14 ]. Inappropriate application of contact precautions for COVID-19 patients, in particular suboptimal hand hygiene, as well as contamination and insufficient cleaning of the hospital environment, probably contributed to direct or indirect between-patient Acinetobacter spp.…”

A Peripandemic Examination of Health Care Worker Burnout and Implications for Clinical Practice, Education, and Research

“…Now, almost 3 years later, and in light of the current pandemic, the US Surgeon General published an advisory on addressing HCW burnout, further underscoring that conducting investigations and supporting HCW well-being must be a national priority. 3 In this present study, Sexton and colleagues 4 Sexton and colleagues 4 suggest potential contributors to EE in HCWs, including some that may have been uniquely exacerbated during the COVID-19 pandemic. They point to the overt politicization of public health during the pandemic and state that HCWs have had to contend with an intensification of incivility directed at them for following COVID-19 protocols.…”

“…These studies would be useful to help interpret survey responses, such as the data collected in this present study. As Sexton et al noted, 4 burnout is a unique construct that is highly dependent on a multitude of personal and professional factors. Not all latent constructs can be validly assessed using empirical tools (eg, scales, questionnaires) across various populations.…”

“…Sexton et al, 4 as well as others, 6 also point to the role of clerical tasks, such as electronic health record (EHR) documentation burden, as a contributor to EE. They suggest that the temporary flexibility and decrease in EHR requirements during the pandemic (eg, due to gubernatorial executive orders that provided temporary relief of standard documentation mandates) may have accounted for the decline in EE reported by physicians in 2020.…”

Developing a behavioral health workforce for team based care.

“…Studying the Factors That Relate to Recruitment, Retention, and Sustainability of the Workforce While work is underway to grow the behavioral health and primary care workforce, attention must also be paid to workforce retention. COVID-19 has placed incredible strain on the health workforce, increasing burnout and intent to leave (Sexton et al, 2022). However, health worker burnout was a rising issue even before the pandemic (National Academy of Medicine, 2019).…”