Care for Health-Care Workers

A long-time nurse reaches out to other health professionals to foster an open dialogue about stigma around mental health

Busy periods are common in any profession. Think of the morning rush in a local coffee shop, tight project deadlines, and new product launches – they all create stressors and excitement for employees.

However, the constellation of challenges is taken to a whole other level when we talk about the health-care system in Canada. Overcrowded emergency rooms have been pushed to the limit as the effects of COVID-19 continue to put pressure on our already fragile systems. In the face of such pressures, doctors, nurses, and administrative staff have worked hard to maintain service levels despite limited resources. Many still see no end in sight.

A study completed prior to the pandemic brought to light the toll workplace stress has had on the mental well-being of Canada’s nursing workforce — and the results were staggering. One in three nurses screened positive for major depressive disorder, one in four for generalized anxiety disorder, and clinical burnout. But most concerning of all was that 33 per cent reported having suicidal thoughts, and eight per cent said they had attempted suicide at least once in their lifetime.

How did we get here? And how much worse has the situation gotten since the pandemic?

Debbie Phillips, a registered nurse for over 30 years, with most of that time spent in the emergency department as a psychiatric nurse, has witnessed the increasing pressure placed on hospital staff first-hand.

“Because of cuts in funding to the health-care system, we were constantly tasked with doing more work while being given fewer resources. When I first started my career in the emergency department, if a patient needed to be admitted, we had beds available for them. By the end of my career, I was calling hospitals province-wide to find appropriate spaces for our patients to receive care, often waiting five days until beds became available.”

Unfortunately, her experience is not unique. According to The World Bank, the seven hospital beds per 1,000 patients seen in the 1970s and ‘80s now average less than three and is steadily declining. This regression has had a severe impact on the physical and mental well-being of hospital staff and the people they provide care for.

Giving but not receiving
While under their care, health-care professionals are responsible for our safety and well-being when we are most vulnerable. Over 700,000 of them fill these selfless and often thankless roles to make sure our physical and mental health needs are addressed.

Yet, with such a prolonged strain on our systems, the question of who is there to support their health needs can be overlooked.

One might think health-care workers have an acute sense of their physical and mental well-being, given their daily role in providing treatment for others. But that is not the case, Phillips says.

“Nurses often overlook warning signs of their own mental decline,” she notes. “We have the mindset that we know better, and we wouldn’t let ourselves get to that point.”

For those who do recognize these signs, resources can be scarce. Limited staffing means that sick leave requires proof of a physical ailment. There are no days off for feeling burnt out.

This limitation increases the stigma health-care workers face when it comes to their mental health. “You can’t just take a day off and rest,” says Phillips. “When you’re away from work, you feel guilty that you’re not there because you know your team won’t have additional resources to fill your spot. You know that people will be waiting for care, and that weighs on you. It adds more stress to the situation.”

Some are unaware of the stress they are placing on themselves, and others are too stigmatized to seek support, Phillips says. So where do we go from here? What resources are available to help those in need?

Resources for change
According to a paper in Nurse Leader from April 2022, 76 per cent of nurses in the U.S. who experienced workplace burnout did not seek mental health support. And just 42 per cent of health-care employees felt that their workplace valued their mental health.

Based on this and other evidence, the article calls for the transformation of “nurses’ perceptions and the cultural context that serves as a barrier to nurses caring for their well-being and accessing mental health care.”

Making investments to address stigma, it adds, “could also have a secondary benefit of improving nurses’ perceptions about mental health needs and care in their patient population.”

In Phillips’s experience, such investments in workplace mental health-related programs have been inconsistent. Since the funding grants that are periodically available are for one-off programs, she says, they fail to make a lasting impact on her team.

To address this gap, training must both adequately address employee needs and effectively reduce workplace stigma. One program specifically designed for those purposes is The Working Mind Healthcare, an adaptation of The Working Mind from the Mental Health Commission of Canada.

This evidence-based course is designed to shift the way employees think, act, and feel about mental health in the workplace. It aims to reduce the stigma around mental health and foster open dialogue between co-workers. As a facilitator for The Working Mind, Phillips has seen its impact on participants as they took the training.

“You could literally see lightbulbs coming on for people. Whether it was looking at the mental health continuum or the Big 4 coping strategies, you could see the expressions change on peoples’ faces as they were learning. You could tell they were having their eyes opened.”

Having a background in the health-care sector allows Phillips to connect with those she trains on a deeper level. It helps create an environment that promotes dialogue, knowing that everyone in the room has shared similar experiences.

The most frequent feedback she hears after her sessions is participants’ wish that they had taken the course sooner. “I think it should be part of orientation for everyone going to work in a health-care setting,” she says. “Why not set up the next generation for success as soon as they get in?”

Since tackling the stigma around mental health in health-care settings is a long-term challenge, it’s important that we all do our part to be mindful of the stress these workers are under when we encounter them.