Health Care Workers Risk Burn Out. How Will They Get the Care They Need? | Opinion

It's been a long plague year. COVID-19 hospitalization rates are declining, but the stress level of health care workers remains sky-high. We're in the pandemic's third wave, and only a few weeks away from peak hospitalizations in early January. New, more contagious strains of the virus could increase the burden on hospitals yet again.

After an already superhuman effort over the last year, working through successive surges in caseloads and the end not yet in sight, three quarters of frontline health care workers report feeling overwhelmed.

A recent survey found 93 percent of health care workers are stressed, 86 percent experience anxiety, 82 percent felt emotionally exhausted, 70 percent had trouble sleeping and 76 percent reported burnout. Who will care for caregivers, so they can continue to care for others?

They're getting vaccinated, which ought to help allay their anxieties about bringing COVID-19 home. But their work exposes them to another kind of contagion, putting them at risk for secondary or "vicarious trauma," where they internalize the emotional distress of patients and their families.

It's a well-known phenomenon among humanitarian aid workers, human rights defenders and social workers, causing chronic stress and emotional impacts similar to what their clients experience. Caregivers in the pandemic also find themselves feeling the same overwhelming emotions as the people they care for.

CDC guidelines for caregivers on stress and resilience acknowledge the risk of vicarious traumatization and PTSD among health care workers. No vaccine can inoculate them against that, but building resilience can.

Resilience is the ability to respond flexibly to challenging situations, and to bounce back from the stress they cause. Acute and chronic stress can cause psychological and physiological damage, which building psychological and physiological resilience skills can buffer. Resilient people aren't just lucky accidents. Research shows resilience isn't an innate trait; it can be learned and strengthened, and contemplative practices can help.

But there is very little infrastructure in place to teach such skills to health care workers on the front lines of the pandemic. We lionize and applaud them, call them heroes and Starbucks offers them free coffee, but that kind of high-fiving doesn't give them the emotional support they need to cope with chronic stress and build resilience.

Some hospitals have resources dedicated to the emotional wellbeing of their workers, like the in-house mindfulness program at Middlesex Hospital, or Mount Sinai's Center for Stress, Resilience, and Personal Growth, which offers referrals to mental health care providers. But health care workers are often reluctant to seek such help, and in general the capacity of mental health resources for health care workers is still small compared to the vast need.

Peer-to-peer mental health networks, such as Helping Healers Heal, have sprung up to help fill the unmet need. But for many health care workers, support networks remain few and thin, leaving them with two options: toughing it out or trying to care for themselves. The CDC guidelines recommend self-care techniques like taking breaks, getting enough sleep and meditating.

COVID-19 nurse
A registered nurse cares for COVID-19 patients in a makeshift ICU at Harbor-UCLA Medical Center on January 21, 2021, in Torrance, California. Mario Tama/Getty Images

Easier said than done. A nurse working a double shift, sacrificing her break to stay at the bedside of a dying patient, can hardly follow such advice consistently. What she needs is a self-care resource she can use in short increments when she gets a spare minute, which can be scaled up until it's available to millions of health care workers like her.

That's a perfect job for meditation apps. Demand for them exploded during the pandemic, and meditation apps designed specifically for health care workers are emerging.

To help fill the need, we built a free Care for Caregivers app combining secular mindfulness meditation with yoga and other mindful movement techniques proven to reduce stress and help balance mental and emotional wellbeing. It draws on a body of previous work called Contemplative-Based Resilience (CBR), where similar trainings helped social workers, shelter workers and humanitarian aid and relief workers.

The gist of the training is a healthy understanding of empathy and how it's distinct from compassion. Though often used interchangeably, they're different.

Frontline workers' deep empathy can cause them to overidentify with and internalize the suffering they witness. But compassion operates in a separate part of the brain from empathy. It recognizes others' suffering, feels it along with them and seeks to relieve it, while also understanding that it is not one's own suffering.

Empathy without compassion tends to make health care workers burn out. But empathy with compassion builds resilience, helping caregivers extend compassionate care to themselves as well as their clients, so they can serve others abundantly without losing themselves.

This kind of resilience is a cognitive and quasi-physical skill that can be learned, practiced and honed experientially, including through meditation and movement.

Apps could help health care workers learn how to be resilient. They aren't a substitute for professional mental health care. But they can extend the limited reach of mental health resources for caregivers, teaching them the skills they need to practice effective self-care instead of just admonishing them to do it.

Diana Calthorpe Rose is founding president emerita of the Garrison Institute, which applies contemplative practices to social and environmental issues.

Sharon Salzberg is a leading meditation teacher, co-founder of The Insight Meditation Society and a New York Times bestselling author.

The views expressed in this article are the writers' own.