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NHS staff are physically and emotionally exhausted. The Covid-19 pandemic has exposed a system plagued by staff shortages and underfunding – a system that for years has relied on goodwill.
The psychological burden of the pandemic on healthcare workers was predictable. The detrimental impact of other pandemics, such as Sars, on the mental health of healthcare workers is well documented, with increased rates of depression, burnout, post-traumatic stress disorder (PTSD) and d ‘anxiety.
Combine that with pre-existing high rates of stress-related psychiatric illnesses among UK doctors and higher suicide rates than many other professions, and we have a perfect storm. There have been early warning calls, with data released on the impact of Covid-19 on the mental health of healthcare workers in China and Singapore. We were simply ill prepared.
With the increase in cases, limited resources and staff shortages, healthcare workers are being pushed to their limits. A senior nurse at a busy emergency department in London said: “We were seven little ones this morning. Some are sick with Covid, some are isolating themselves and some have been on leave for weeks for mental health reasons.
“Every day, we rely on the goodwill of our colleagues to work extra shifts,” she continued. “The extra support we had in the first wave, with free food, transportation, and extra pay for extra teams, has been removed. Many of us are not from the UK, feel isolated and exhausted, and have not seen our families for eight or nine months. I have never seen so many nurses cry during shifts. Every shift is a struggle.
Some healthcare workers have been forced to take extended sick leave for mental health reasons or have even quit. “I have been gone for a long time for mental health reasons and got so sick that I tried to kill myself,” said another nurse. “When I return, I am driven to be redeployed. I was told that I had a job to do and to do. Many of us felt like slaughter lambs.
A study of 2,707 healthcare workers identified several factors associated with staff burnout during the Covid-19 pandemic. These included: 1 – feeling pushed beyond training 2 – exposure to Covid-19 patients and 3 – priority decision making for life.
As the current wave intensifies, many staff have been redeployed to areas such as intensive care, with limited experience and training, with increased exposure to Covid-19 patients, and senior managers need to more and more people are making priority decisions, such as whether someone is fit to be admitted to intensive care and to go on a ventilator. The staff do this day after day for months. It’s not hard to see why our workforce is running out.
A senior nurse said, “I apologize for some of the junior staff. I remember I had to teach someone over the phone how to do non-invasive ventilation because we didn’t have enough staff and I just couldn’t leave.
“When junior nurses ask for help and feel overwhelmed, sometimes they are left on their own because there just isn’t enough support. After months I was forced to take a period of sick leave as I couldn’t cope anymore and felt so guilty.
The pandemic has also had a major impact on the training of doctors. Postgraduate career-defining exams have been canceled or postponed, as have some specialty recruiting interviews, which interns have spent months preparing for. Uncertainty, unpredictability and prejudice to their career path have also contributed to psychological distress and burnout.
“I spent months reviewing this exam, but I’m not even sure it will go,” said a medical trainee. “The uncertainty has caused me so much anxiety and stress; I don’t know what’s going to happen.
The support given to staff in the first wave, such as free parking, food, accommodation, access to psychologists and wellness centers, is no longer in place in most trusts, to a when staff need it most. Our group’s ongoing research found that 37 percent of healthcare workers in the UK reported drinking more during the pandemic as a coping mechanism. Additionally, many of the staff who work in some of the highest risk areas of the hospital, such as the ICU and A&E, have still not received immunization slots.
Unable to access psychological support / therapy on his own, an anesthesiologist had to organize therapy sessions in private. “In April of last year, morale was good. But no one thought we would be facing this again and quite frankly everyone is somewhat reluctant and exhausted. I see the redeployed doctors are just plain discouraged, ”she said.
“Two beds are basically crammed into one bed space, a nurse takes care of three or four ventilated patients and there is no team spirit. The conditions are horrible. Shifts are tough, everyone is exhausted and the erratic day / night schedule means there is little continuity with co-workers. The camaraderie is dead.
“Really difficult decisions are made because of limited resources. I remember an elderly patient who should have been intubated and transferred to the ICU, but my consultant told me he was not suitable for the ICU. Unfortunately, he subsequently passed away. I have suffered from insomnia and cannot stop after work shifts. I also had flashbacks on patients ”.
The goodwill of the staff, on which the NHS has worked for many years, is running out. The Covid outbreak is expected to continue in the weeks and months to come. Government, key policy makers and local / national stakeholders must ensure that the mental health of staff is not overlooked in the face of increasing Covid admissions and deaths, and that adequate support is provided. in place to stem a looming mental health epidemic in the UK. – the consequences of which may see many staff members go on long-term sick leave or resign altogether.
Dr Ankur Khajuria is an NHS surgeon and principal investigator of the Royal College of Surgeons study on the impact of Covid-19 on mental health
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