Pandemic Burnout Survey Uncovers Work-Life Stressors Among Cardiology Staff

A look back at how cardiology healthcare workers felt during the height of the COVID-19 pandemic reveals that burnout was running high among many of them, with up to 45% of nurses reporting their intention to the leave the field.

Prior research on work stress in cardiology has tended to focus primarily on physicians, including an eye-opening survey published in 2017 that found that more than one in four cardiologists reported feeling burnout. Earlier this year, a survey of US physicians found that burnout, often defined as a feeling of emotional exhaustion, was less likely for those who took at least 3 weeks of vacation per year, although most of them weren’t able to manage anywhere near that many days off.

The Coping With COVID survey, published last week in the Journal of the American Heart Association, assessed work conditions, burnout, and intent to leave among not only physicians, but also nurses, advanced practice providers (APPs), and other essential clinical cardiology staff members.

“It not only gave us a better understanding of what role types were most affected, but also the key factors that mediated or contributed to burnout,” said lead author Sanjoyita Mallick, DO (Hennepin Healthcare, Minneapolis, MN). “There were differences among role types, and the advantage of this is in terms of interventions we are able to provide and how this can and should be individualized.”

A prevailing theme in the survey was the impact that feeling undervalued on the job had across all cardiology roles. Mallick and colleagues report that nurses in particular voiced feeling “expendable” during the pandemic and felt that they were not appreciated by leadership despite putting their own lives in danger to do their jobs.

In an accompanying editorial, Laxmi S. Mehta, MD (The Ohio State University Wexner Medical Center, Columbus), and colleagues note that among the many harms of burnout is that it is associated with decreased productivity, more medical errors and absenteeism, and higher turnover rates, all of which can have “a rippling effect” across healthcare teams and units.

They suggest that organizations “need to invest in foundational programs that include wellness-centered leadership development programs, safety net resources for employees in distress, programs to provide employees the opportunity to identify ‘pebbles in the shoe’ irritants at work, programs that promote belonging and community at work, self-care offerings, and resources for employees during major life transitions.”

Overworked and Undervalued

Mallick et al surveyed 1,199 cardiology healthcare workers from 23 US states from April to December 2020. The survey was anonymous and taken online, consisting mostly of multiple-choice items scored from low to high.

Nurses accounted for 43% of those surveyed, followed by physicians at 29.5%, APPs at 15.5%, and other clinical staff at 10.5%. Among physicians the majority were men, while women comprised the majority in the other groups. Roughly 30% to more than 40% of physicians, APPs, and nurses had been in practice for more than 20 years. Geographically, 54% of respondents were from the Western United States, 24% from the Northwest, 13% from the South, and 9% from the Midwest.

Among all groups, nurses had the highest reported rate of burnout, at 59%, compared with 57% for other clinical staff, 46% for APPs, and 40% for physicians (P < 0.0001 for differences among roles). Intention to leave their profession was more frequently reported by nurses than the other groups, at 45%, versus 35% for APPs, 32% for other clinical staff, and 23% for physicians (P < 0.001).

Nurses also reported more anxiety/depression, work overload, and fear compared with the other groups, while APPs appeared to have the most childcare stress of any group.

Work overload was an independent predictor of burnout for all groups, while emotional health issues like depression and anxiety were a predictor for physicians, nurses, and APPs. All three of those groups also reported that feeling valued was associated with a lesser risk of burnout. Similarly, intention to leave was reported less often by both physicians and APPs who felt valued.

In the portion of the survey that allowed open-ended comments, physicians made such statements as “there was no consistent plan to keep caregivers safe,” administrators were “out of touch,” and there was a sense of “constant scrutiny” on top of inadequate compensation.

Nurses reported a lack of financial incentives to work more, feeling like “a cog in the machine, and a disposable one at that,” being stressed and out of their comfort zones by mandates to redeploy from their standard duties to ICU care, and having no control over work schedules, breaks, and time off.

Primary Prevention of Burnout

To TCTMD, Mallick said the findings, while new, are not surprising.

“The high rate of stress and burnout among all role types, highest among nurses and other clinical staff in cardiology, has not to our knowledge been studied,” she said in an email. “The importance of feeling valued as a mediator of favorable outcomes for most roles offers a new strategy for organizations to lift up their workers in cardiology by offering them the support they need to do their jobs well, and find lower burnout as a result.”

According to Mallick and colleagues, other research has shown that six specific themes are associated with feeling valued versus not valued at work: safety, compensation due to pandemic-related financial challenges, transparent communication, teamwork, empathy in leaders, and support by the organization for their daily work.

The survey results add to these by identifying protective and exacerbating factors that are specific to individual healthcare worker roles. Mallick and colleagues say interventions based on their data “will hopefully lead to higher retention, improved physical/mental health, and better morale/performance among cardiology team members.”

In their editorial, Mehta and colleagues note that once burnout has happened “the well-being of the unit has already deteriorated, and actions to reverse course end up being reactionary.” They liken it to stages of CVD.

“While efforts targeted toward secondary prevention to avoid recurrent burnout are necessary, concerted efforts are also needed to focus on primary prevention to reduce burdensome workplace stress and primordial prevention as an upstream method to maintain professional well-being,” they write.

At the same time, Mehta and colleagues emphasize the importance of fostering professional fulfillment. While not easy to do, it is key to promoting more than simple job satisfaction and will go a long way toward carrying employees through difficult situations because they feel valued, supported, and that they have a say in decision-making. Among the “foundational programs” they recommend are things like wellness-centered leadership training, mentorship and coaching programs, streamlining administrative tasks, crisis intervention and peer support programs, flexible scheduling, and resilience training.