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Why It's Hard To Gauge How Workers' Burnout Is Affecting Patient Care


A lot of doctors and nurses are exhausted and overwhelmed. Like many of us, they thought COVID vaccines would get us closer to life as normal. That hasn't happened. What has happened is burnout in the medical profession. Here's NPR's Yuki Noguchi.

YUKI NOGUCHI, BYLINE: The desperate and frantic pace of work at the epicenter of the pandemic in New York City was more chaotic than anything intensive care nurse Matthew Crecelius had seen.

MATTHEW CRECELIUS: It was like watching a bomb go off in slow motion.

NOGUCHI: He was caring for double the usual number of patients. Extra ventilation made the sound deafening.

CRECELIUS: Giant fans that you see, like, in construction zones that are loud. It's got plastic tubing, and it's flapping really loud, so you can't hear anything.

NOGUCHI: He couldn't always see his patients, either. COVID protocols required large wooden doors to separate patients.

CRECELIUS: You shout out to somebody, hey, can you check on my other people? Like, I can't even see a monitor. I don't know how they're doing.

NOGUCHI: Then, behind one door, a patient with COVID ripped off his oxygen mask, triggering a heart attack. Alarms blared.

CRECELIUS: Because he was heading for respiratory arrest.

NOGUCHI: Crecelius ran, swathing himself in a new gown. He got to work trying to revive him.

CRECELIUS: And we suctioned out his airway...

NOGUCHI: Other nurses raced in to help. But the man died clutching a photo of his daughter.

CRECELIUS: Now all the other patients are out there. You hope to God it doesn't happen to someone else. And there were times it did.

NOGUCHI: Crecelius has worked as a contract nurse in a dozen hospitals over the last year. And he can recall numerous moments like this one, even just recently, when the crush of work and burnout among health care staff had a direct impact on patient care.

CRECELIUS: And that plays out again and again, day by day, at many hospitals. And I think - in my opinion, I think it's getting worse.

NOGUCHI: Burnout is a common term many associate with sheer exhaustion. But the World Health Organization says it's also characterized by greater cynicism and reduced effectiveness at work. Ernest Grant is president of the American Nurses Association.

ERNEST GRANT: It's not good for their mental health. It's not good for the work environment. There's increased chance for mistakes, medication errors.

NOGUCHI: But just how much burnout affects patient care is very hard to gauge. Multiple studies link burnout to lower quality of care. But many of them rely mostly on subjective measures, like patient surveys and self-reporting by doctors and nurses. So drawing a direct line between a burnt out health care worker and a bad patient outcome isn't easy. What happened to Carolyn Dewa illustrates why. In April, Dewa's father was hospitalized with cancer. She had a hard time reaching his doctors. COVID had restricted visiting hours. Over capacity left staff no time to talk to family. His doctors halted his anti-stroke pills, thinking he couldn't swallow.

CAROLYN DEWA: No one asked me. I'm trying to tell them he can swallow it.

NOGUCHI: A short time later, her father died of a stroke. The painful irony is that Dewa studies burnout's effects on medical care. She's a professor at the University of California, Davis. Personally, she feels burnout cost months of her beloved dad's life. Yet, it's hard to pinpoint how.

DEWA: Medicine - it's a team sport. So can you attribute it to one clinician? How many clinicians need to be experiencing burnout until we see an effect in quality?

NOGUCHI: Clearly, one huge problem is a shrinking field of seasoned professionals. Since the pandemic, retirement rates among doctors and nurses have accelerated. Nurse Matthew Crecelius says that, too, comes at patients' expense. At the small Michigan hospital where he works now, he discovered a nurse on a previous shift put a heart attack patient on the wrong medication.

CRECELIUS: She's a newer nurse and, you know, doesn't know that this is completely inappropriate. Had someone more experienced been here, we would have been able to catch that.

NOGUCHI: He used to think of such incidents as teaching moments. These days, Crecelius has no time or energy to mentor. He just complains.

CRECELIUS: Dude, this is [expletive]. Like, we should have never been in this situation in the first place.

NOGUCHI: The shortness of time, staff and fuses causes still more burnout. Lindsay Moore-Ostby sees this play out in Indianapolis. She's a family doctor and member of Physicians for Patient Protection, a patient advocacy group.

LINDSAY MOORE-OSTBY: A lot of times when you hear that there's no beds available, it may not be that there's no physical bed in the hospital you could lay in. It's that there's not a staffing situation where they can take care of you.

NOGUCHI: She says one doctor recently tried to transfer a patient.

MOORE-OSTBY: And she wrote a list of - I think it was 42 hospitals, if I recalled - that she had personally been calling, trying desperately to find a bed for a patient who needed ICU care.

NOGUCHI: She hears this every day.

MOORE-OSTBY: Now I'm spending time trying to make this transfer happen. So what if I can't provide the care I need to the other patient who needs me? It's really a game of dominoes, where the doctor is just emotionally devastated because they can't fix it.

NOGUCHI: Worst of all, says Moore-Ostby, that leaves no time to talk to patients.

MOORE-OSTBY: That little bit of time connecting with the patients - that's what they like. That's what they need and deserve. And it's what I love about medicine.

NOGUCHI: Time and again, I heard health care workers lament how burnout over the past year has robbed them of their sense of purpose - caring for others. That's new for Matthew Crecelius. He harbored a lifelong desire to run toward disaster, where help's most needed.

CRECELIUS: Last year at this time, I had a greater sense of, like, this is kind of my duty, right? Like, I'm able. I'm young. We can make a difference. Let's go and see if we can put this fire out.

NOGUCHI: He muscled through. Then, on a road trip this summer, it all caught up with him. He stood in line with his groceries, looked up and saw a cover story about the pandemic on a tabloid.

CRECELIUS: And it said, you know, this was an avoidable thing. And it had a picture of someone loading zipped-up bodies into a truck. And I lost it.

NOGUCHI: He trembled, thinking of families he'd helped say goodbye over the phone, how he'd volunteered to load bodies at the morgue.

CRECELIUS: You're doing it to just - anything you can do to, like, give a little bit of dignity back or kind of help out.

NOGUCHI: But the work feels different to him now. Crecelius, a fifth-generation nurse, is looking to switch careers.

CRECELIUS: Now that there is a vaccine and people aren't getting it, my sense of duty - it's changed for me. Like, no. I'm not interested anymore.

NOGUCHI: Yuki Noguchi, NPR News.

(SOUNDBITE OF GUILTY GHOSTS' "WAILING WALL") Transcript provided by NPR, Copyright NPR.

Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.