Behind the scenes, these jobs can be extremely stressful and demanding for a multitude of reasons. I will focus on just a a few of them here…..First off, lets talk brass tax. Unfortunately, a dirty little secret (or maybe not such a secret) is that our healthcare system is strongly economically driven, where “do more with less” is the rule. In many of the healthcare systems in which I have worked, we were chronically under staffed, particularly with respect to nursing. Our nurses are often the unsung heroes, behind the scenes, working closely with patients and balancing the need of their patients against administrative demands and restrictions….
They are planted firmly between the needs of their patients and demands of the job, orders from superiors/physicians/admin. Increasingly large healthcare conglomerates with their attention on the bottom line, cut staff and force healthcare workers work longer and longer hours. In my years working in the nations healthcare system, we were short staffed every year by, not a few, but hundreds of nurses within the state. Worse yet, is that state and national administration was well aware of this shortage and did nothing. I shouldn’t say nothing. They issued hiring freezes and fuloughed workers, due to strained budgets. You see, everything was reduced to and seen in terms of “productivity units”, and profit over patient care. This stress this can cause is immense for the folks who got into the field to help others. A colleague of mine who works in primary care, within a large healthcare group in Northeastern Pennsylvania, is forced to see patients every 10 minutes, per quota systems set up by hospitals and bonus systems set up based on productivity. He typically leaves the house at 6am and returns at 7pm and then performs his charting until 11 or 12 midnight…Because God knows there’s no time to chart, consult with other docs or research better methods to intervene when patients can be seen and insurances billed.
If the pressure at work are not enough, many of our nations healthcare providers belong to a group we may call the “sandwich generation,” caught between caring for their families and children and their elderly parents simultaneously, while trying desperately trying to acknowledge and tend to their health and wellbeing. However, when we are burning the candle at both ends, we tend to cut corners….and that starts with ourselves.
There is an inherent pressure that comes with being part of the healthcare profession, as they are held to a higher standard than many other professions. Given that they belong to a group that helps others there is pressure to set a high standard and be an example, therefore these individuals often feel like that can’t feel depressed, anxious, or have struggles like other people. Our medical clinicians due to some of the stressors discussed above as well as others can be particularly vulnerable to stress, depression, anxiety, compassion fatigue, and even substance abuse. In fact, research indicates healthcare providers are at higher risk for developing these conditions. Yet, there is often a zero tolerance policy and reluctance to come forward when/if one is struggling. Many of these professionals are high achievers with and equate such struggles with weakness, so they are less likely to take time off work or for self-care activities.
The culture, built early in their training is to take on more clients, work longer hours and try to help the most difficult of patients as this is often
as a badge of honor. In education and training programs, there is a “eat the young” mentality where we look for vulnerability and weakness in trainees under the guise of “protecting” the filed from individuals otherwise unable to perform, when in fact we all feel, we all have bad days….
The difference may be in those willing to express and share what’s going on, which might make them more likely to reach out for help….rather then keep pushing through, the “never let them see you bleed” ethos…
Healthcare professionals in general do not like to come forward and self-report or reach out as they do not feel safe to do so. Many are reported by peers, colleagues or administrators and by that time they have likely been struggling for some time…
However, once reported they find themselves stuck in a frightening and uncertain world, scared that they will loose all they worked for and unsure how to handle it all. While there is much talk of a rehabilitation and help being available and posters hung about many facilities, it is much more punitive in nature, particularly once this comes to the attention of the professional boards.
In PA for example the impaired professionals are placed into a one size fits all program, which mandates self-help group attendance and has random drug screening. While on the surface this might seem reasonable, particularly when it comes to safeguarding the public; however, this approach is not necessarily consistent with the research and science in treating substance use disorders. A simple failure to disclose an over the counter medication can lead to a false positive and revocation of licensure. Or say a professional has been working many hours is suddenly exhibiting “strange behavior”, simply because they have been pushing past their necessary accommodations for Chronic Fatigue Syndrome so that can stay on top[ of their work. He or she might find themselves under investigation, and subject to an order for an “assessment” by the prosecuting attorney for the department of state. Now the individual who will be conducting this exam, is not an unbiased independent evaluator, they work for the state and have their interests in mind. This is not a pleasant experience, these evaluators are often aggressive, over bearing and accusations and look to trip you up, more like a trial attorney than an mental health evaluator concerned for any one’s wellbeing.
The strange thing here as that the very boards that developed such programs are also very aware of the research and science on addiction, and know the best modalities and treatment options, they simply choose not draw on those references….quite hypocritical in my opinion. We need to provide more resources to our healthcare clinicians on the front lines, change the culture so one feels comfortable to come forward and reach out for help. Maybe one of these people has treated you. Maybe they were struggling, and now they are the ones in need of help?
The current system is archaic and is in desperate need of reform, lets help care for our caregivers …the people who risk all to keep us healthy and happy.
Dr. SDr. S is a licensed psychologist in both New Jersey & Pennsylvania. Additionally, he is Board Certified by the American Board of Professional Psychology (ABPP) in Clinical Psychology and Behavioral and Cognitive Psychology and is a fellow of the American Academy of Clinical Psychology.
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