After the Pandemic: Clinicians Must Prioritize Self-Care

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For MedPage Today‘s “After the Pandemic” series, we asked our editorial board members to discuss what significant and lasting effects the COVID-19 pandemic will have on medicine and the delivery of healthcare.

Here, we interview Bernadette Melnyk, PhD, RN, vice president for Health Promotion, university chief wellness officer, and professor and dean of the College of Nursing at The Ohio State University (OSU) in Columbus.

Check out some of our other articles in the series here.

This interview has been lightly edited for clarity and brevity.

The media has constantly referred to healthcare professionals as “heroes” throughout the pandemic. As dean of the College of Nursing at OSU, do you worry that this creates an expectation that clinicians put everyone else first?

Healthcare workers didn’t enter the field to be heroes. They entered because they were really passionate about caring for other people. Most clinicians do a great job of caring for everybody else, but they don’t tend to prioritize good self-care.

There are a lot of providers out there who think it’s selfish to prioritize our own self-care, but as I remind our clinicians all the time, we cannot pour from an empty cup. If we don’t practice good self-care, not only are we going to suffer, but the quality of the care we provide and the safety is going to suffer as well.

I published a paper in May in the American Journal of Critical Care, and the findings for critical care nurses are very disheartening. My research has shown the poorer their physical and mental health, the more medical errors they make.

They don’t want to make errors. They’re so committed to doing a good job, but if people are in poor mental or physical health, they can’t fully engage the way they would if their health and well-being were better.

Are you seeing anxiety, depression, and substance use increase among nurses during the pandemic?

I’ve done research not only of faculty and staff at The Ohio State University, but also with clinicians, which has shown that people are using unhealthy coping mechanisms to cope with COVID. We are seeing increases in alcohol use, and increases in unhealthy, emotional eating, but also a decrease in physical activity.

So what we’re going to see downstream from this is not only a rise in mental health issues — because right now, one out of three Americans has clinical anxiety or depression — but 3 years from now, we’re going to see even more diabetes and high blood pressure as a result of how people have tried to cope with all the stressors of this pandemic.

As the chief wellness officer for OSU, what have been the most common challenges that students and faculty have shared with you?

I coordinate a survey that we’ve administered three times — once in August, December, and April — because we wanted to get a handle on where our faculty, staff, and students were with the pandemic, with their mental health outcomes and their needs. The bottom line is we have seen an escalation in stress, anxiety and depression as a result of the pandemic, but we are no different than every other institution out there that has also seen pretty big increases in stress, anxiety and depression.

As the pandemic hit, we increased our wellness offerings exponentially. For example, I started a “Wellness Wednesdays” series of lectures with skills-building exercises. By the end of each part of the series — part four is currently underway — our surveys showed nice drops in stress, anxiety and depression.

Can resilience really be taught during a pandemic?

A lot of people have a misperception that you’re either born with resilience or not, and that couldn’t be further from the truth.

I’m not saying there’s not some genetic component to that, but we absolutely know through research that resiliency can be built, and we also know people with higher resiliency have less mental and physical health problems. At the Ohio State, we are very focused on building these resiliency skills — cognitive behavioral skills; building mindfulness.

One thing that is so easy to do is the daily practice of gratitude. During the last few months, I launched an initiative called “Mask on, Mood up.” So, what I’m doing is encouraging everybody, when you put on your mask, to do three brief evidence-based tactics that we know work.

One, take three abdominal deep breaths using the 5-7-8 method (inhale for a count of five, hold for a count of seven, exhale for a count of eight). Two, be kind to yourself. Make a positive self-affirmation statement. “I’m too blessed to be stressed” is one of my favorites. Say it out loud. And then lastly, take that dose of Vitamin G (gratitude). Think about a person you’re grateful for and let him or her know through a card or text or an email.

If we can get everybody doing these things, they ought to have less stress and their mood will improve. It’s simple but it’s not easy because it’s a behavior change.

What do you see as the most urgently needed fix to help address clinicians’ mental health?

We’ve got to get mental health screening in place for our clinicians. There are wonderful, anonymous tools, including one from the American Foundation for Suicide Prevention. It allows clinicians to be screened and then anonymously referred and connected to a mental health provider.

Because there is still a lot of stigma, clinicians often think ‘I shouldn’t need that help.’ And there are still licensing boards that ask questions about whether you’ve been treated for a mental health disorder. Those questions need to be changed because we can’t have a punitive system for people who do have mental health problems. We’ve got to have a helping system. I also think offering evidence-based programs, employee assistance, and mental health counseling is critical.

I developed a cognitive behavioral therapy-based program over the last 28 years that has been really successful in decreasing depression, anxiety, stress and suicidal ideation. We just adapted that for clinicians and we did a randomized controlled trial with it, with great outcomes.

To what degree should healthcare professionals hold health systems and hospitals responsible for their emotional and mental well-being?

I think that we have to give voice to our clinicians to the point that the C-suite does listen to them. And my research again has shown if clinicians perceive their work site is supportive of their wellness, they have much better mental and physical health outcomes. So that support, that wellness culture, is critical in terms of the clinician population’s health and well-being.

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    Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She is also a member of the site’s Enterprise & Investigative Reporting team. Follow

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