Appreciating and Supporting Health Care Employees as We Look to the Future

When life returns to normal, there may be a tendency to put the days of sheltering in place behind us and run with abandon into the workplace or outdoors, embracing the people and job functions that, perhaps, we once took for granted. But before all that, a national pause, contemplation, and sincere homage-paying is needed – to all essential workers who kept going under dire stress, but particularly health care employees. Concentra® practices and recommends thoughtful expressions of thanks, as well as long-term compassion and support for health care employees, some of whom experience, not just physical and emotional suffering of great proportions, but also, moral injury, as will be discussed in this article. Concentra is a national leader in occupational health care, with a unique approach to patient engagement and assistance in moving past the experience of very palpable pain through functional recovery and return to work and life. We are here for our nation’s heroic health care employees.

Remembering our essential infrastructure employees

In the early phase of the national response to COVID-19, 16 sectors of critical infrastructure and essential employees were identified in a Cybersecurity and Infrastructure Security Agency (CISA) memo. The critical infrastructure industries were:

Employees in these industries were acknowledged as essential to “protect their communities, while ensuring continuity of functions critical to public health and safety, as well as economic and national security.”¹

In health care, essential employees required to continue operations to protect the nation’s health and safety included, but was not limited to, the following, Concentra President and CEO Keith Newton noted of the CISA memorandum:

• Caregivers, such as physicians and nurses
• Pharmacists
• Physical and occupational therapists
• Hospital and laboratory employees
• Managers of health IT, health plans, and billing
• Cybersecurity employees
• Emergency operations employees
• And others

In mid-March, Newton said, “Concentra and our team members will be a pivotal part of the solution during this crisis. We are all committed to providing safe and effective care to America’s workforce,” and he applauded the medical professionals in Concentra’s nationwide medical centers for their “professional commitment and their role in overseeing and providing medical care” every day and particularly at this critical time.

After a crisis, how much can feelings be managed?

In very practical terms, a return to pre-COVID-19 times may not occur. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has said a recurrence of the virus could happen next year, and that’s why the push for a vaccine and clinical trials for therapeutic approaches are so important.² This outlook can feel ominous, particularly to health care employees or to anyone who experienced excessive, unwelcome change because of the pandemic. It can be helpful to understand how our actions and our feelings feed on each other in such times and when it may be possible for us to exert control over them.

The Centers for Disease Control and Prevention (CDC) reminds us that, while all of us endure the same crisis, everyone reacts differently to stress based on background, community, and any number of factors that make one person different from the next.³ Health care employees are among the individuals who may have the strongest acute reaction and longer chronic bouts of COVID-19-related stress, says the CDC. But, before looking at extreme stress on health care employees and how to support them, let’s consider some basic guidance that can help anyone cope with stress and move forward.

“When someone tells us to let go (of a bad experience or stress) and move on, that’s easier said than done,” says Maja Jurisic, MD, who is board-certified in emergency medicine and occupational medicine. Dr. Jurisic currently serves as vice president and medical director of strategic accounts at Concentra. She has shared guidance with Concentra’s medical professionals that is based on the work of Fred Luskin, PhD, director, Stanford University Forgiveness Project and the Associate Professor at the Institute of Transpersonal Psychology.

Experiencing anxiety and anger about loss and stress is normal. But when we mentally replay negative feelings – “giving them too much ‘real estate’ in our minds and extending a toxic brew of stress hormones plus anger, this is corrosive to our wellbeing,” Dr. Jurisic said. “We must choose a different way of thinking about our situation.”

How much can feelings be managed to regain a sense of normalcy? Dr. Jurisic offered these five steps to Concentra clinicians:

1. Choose to spend as little of life as possible in the discomfort of the toxic stew caused by anger, hurt, and disappointment.
2. Realize that life comes with both positive and unpleasant experiences. Hope for the good and make peace with the fact there will be some bad.
3. Realize that life holds challenges, and that we can either choose to do our best with them (the heroic response) or we can go through life as victims.
4. Recognize that life is filled with beauty, love, and incredible marvels. You miss out on these things if you’re mired in thinking mainly about your disappointments and hold on to grievances.
5. Realize that people do the best they can. Even though we might not agree with their actions, we can offer our understanding. No one is perfect.

“Dwelling in a painful situation gives it power over you, and when you do that, you make the situation worse,” Dr. Jurisic says.

Health care employees especially can try to look back on the pandemic as a time when they engaged in heroic acts and displayed selfless hearts, focus on healing, and tireless resolve.

When service is above and beyond – dealing with moral injury

During the crisis response, health care employees endured multiple stresses, some of which were similar to other essential employees, including working long shifts, little or no restorative sleep and being separated from their families. But health care employees also carried a stress incomparable to anyone else, and it is referred to as “moral Injury.”

Moral injury has been defined as “a trauma wrapped up in guilt” or the emotional burden of being forced to make decisions, such as who gets the available medical equipment. The range of human experiences faced by health care employees in the pandemic response can leave a broad range of scars, socially, psychologically, biologically and spiritually – and their suffering may continue months after everyone else has resumed normal activity. It’s not inevitable that they will be affected in this way. Everyone reacts differently. But they need compassion support and reassurance they made the best possible decisions in difficult circumstances.⁴

The Moral Injury Project at Syracuse University says one of the best ways for society to help health care employees who feel suffering to the extent of moral injury is simply to acknowledge their pain with compassion, the same as we might acknowledge the physical and mental suffering experienced in wartime and other dangerous situations. Elevating awareness of their burden and showing interest in sharing it can go a long way to help “break the silence that so often surrounds moral injury.”⁵

Health care employees’ unparalleled heroism

As a leading national provider of occupational injury care, Concentra knows there are many aspects of recovery, including the support of others who interact with the injured employee and the psychosocial status and wellbeing of the individual. When we all express appreciation to the medical community, each time we interact with one of its members, we may contribute to the healing of the healers who served us in our time of national need. This kind of support was expressed in readers’ letters to the New York Times, with a few excerpts below.⁶

“To all the health care workers out there – doctors, nurses, technicians, medical staff, administrators, food service workers, pharmacists, security guards, our military deployed to set up hospitals and deliver aid – our nation owes you our thanks and our lives.”

“The nurses never say no, they are always there, eight, 12, sometimes 15 hours a day, and then they do it again the next day and the next. They are the front line.”

“Physicians and all medical professionals are taking an enormous personal risk, for themselves and their families, in caring for the sick right now.”

Concentra deeply appreciates the sacrifice and service of our own clinicians and the entire health care community nationwide, and we hope you will allow us to support your occupational health needs as we progress through the COVID-19 response and aftermath.

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NOTES

1 “Memorandum Identification of Essential Critical Infrastructure Workers During COVID-19 Response,” U.S. Department of Homeland Security, Cybersecurity & Infrastructure Security Agency, March 19, 2020. 
2 “Fauci says world may never return back to normal after coronavirus outbreak,” Fox News, April 7, 2020.
3 “Stress and Coping,” Coronavirus Disease 2019, Centers for Disease Control and Prevention. Accessed April 7, 2020.  
4 “Coronavirus: Why healthcare workers are at risk of moral injury,” BBC News, April 6, 2020. 
5 “What is Moral Injury?” The Moral Injury Project, Syracuse University. Accessed April 7, 2020.
6 “The Heroism of Health Workers in the Coronavirus Crisis,” New York Times, March 26, 2020.