Burnout among healthcare workers has reached a crisis level. But while many reports have focused on physicians and nurses, few have considered the impact on clinical laboratory professionals. “The laboratory is often behind the scenes supporting the patient’s clinical care,” said Melissa Allen, MS, program administrator, pathology and laboratory medicine at the University of Rochester Medical Center in Rochester, New York. "We have a supportive leadership team, but lab personnel in general tend to fly under the radar because we lack visibility."
Even if burnout among doctors and nurses does get the most attention, especially when hospitals are full of COVID-19 patients, the evidence shows that burnout in clinical laboratorians is also severe: 85.3% of respondents to a 2020 survey from the American Society for Clinical Pathology (ASCP) reported having felt burnout.
That study was conducted before COVID-19 became a pandemic, and all evidence points to the pressure on laboratorians increasing dramatically. Working in a job that has a small margin for error plus high demand for mental acuity is demanding enough without pandemic-level work. “Laboratory science has exacting technical standards and places high cognitive demands on the individual, plus there’s a societal expectation that leads to hesitancy to recognize and address fatigue and burnout,” said Kathryn Gibson, MD, medical director of health and wellness at ARUP Laboratories.
If left unchecked, burnout compounds and leads to new problems. Fatigue and burnout “lead to an increased number of errors and decreased quality, which in turn lead to higher resource utilization, decreased margins, and increased pressure on the system,” Gibson said. “At ARUP, we’re figuring out how to interrupt this cycle with a focus on changing the culture around mental health.”
The ASCP survey also found that 44.4% of respondents were considering changing careers altogether, 33.4% thought about finding a job in a related field, and 24.9% were considering retiring—ominous signs considering the already dire clinical laboratory labor shortage. What would help? Not surprisingly, 58.9% said better wages, but 27.1% also said better work-life balance.
“The fundamental culture of wellbeing has to shift,” Gibson said. “Everyone talks about putting on your oxygen mask first, but our cultural norms are so strong that even if someone knows it logically, we have a hard time engaging with that thought emotionally or behaviorally.”
PUTTING PEOPLE FIRST
Breaking this cycle isn’t going to happen by changing the nature of clinical laboratory work, Gibson said. It can’t, not if laboratorians are going to continue maintaining superb patient care. “We’re not going to change the requirements of standardization, high mental acuity, and attention to detail,” she said. “What we can do is change the hesitation to acknowledge the stress and burnout and put the structure in place for peers to support each other, and for supervisors to support their teams.”
During the first and second waves of the pandemic, Allen said that she noticed the extreme stress among technologists who were working to clear the backlog on the bench and outrun an onslaught of pending tests. She said she “tried to encourage staff to take time to step away from the workplace to go outside and take a walk in the sunshine.” She also encouraged mindfulness moments when employees did get a break.
There are no easy fixes. The University of Rochester’s employee wellness team ran webinars about burnout and, prepandemic, organized mindfulness sessions and yoga. That helped some employees, but Allen also saw that some of these initiatives caused stress itself as staff “wanted to keep the work moving, get one more patient sample through,” she said. “We tried having ice cream trucks come through, little things to lift their spirits. But often, it’s good for one group but creates stress for another group because they can’t get away and participate.”
What has helped most, she said, was expanding employee assistance and mental health resources, and making therapists available to all staff, whether they used the University of Rochester health insurance products or not. “Our organization took a big step to open mental health resources to all staff regardless of insurer, which was really helpful,” she said. “We need to increase our availability and access to things like employee assistance programs and therapy and practical resources that can help people navigate this emotional onslaught.”
In addition to making therapy more widely available, revamping employer-provided leave programs to cover not just physical but also better cover mental health is critical. Longer term, the government can help by making the Federal and Medical Leave Act (FMLA) more inclusive of mental health, she said.
“Taking a leave for physical health concerns is far more straightforward than for mental health concerns, as there’s not a well-established timeline to improved mental health,” Gibson said.
Education and awareness of burnout coming from a leadership level also makes a difference, she added. “Talking about mental wellbeing really does open the door for other people to talk about it. Psychologically, it’s a safe place to go to if your leadership engages the topic,” she said. “I know that education and awareness sound dry, but when you really think about it, what that means is awareness that you’re not alone, and awareness of how other people deal with that.”
Allen hopes that the pandemic has also opened leaders’ eyes to the key role clinical laboratory professionals play in overall patient care and they recognize that they are affected by the increased demands and stress of the current situation, too. “COVID has really brought forth a spotlight on the clinical laboratory and the part we take in treating and diagnosing our patients,” she said.
If anything good has come of this, it’s that when elective surgeries were canceled during peak COVID-19 hospitalizations, laboratories had the opportunity to cross-train staff in other areas of the lab, “which is something we don’t often get to do because of our day-to-day workload,” Allen said. That can potentially help with the staff shortage.
WELLNESS AWARENESS, FOR THE NEXT GENERATION
While the median age of a range of medical professionals continues to get older, younger professionals remain a force for change in all fields, and they are approaching potential burnout and fatigue in ways that make more sense to them. That includes wellness.
“Younger professionals are very interested in how we can maintain what, in many ways, is a satisfying and fulfilling career, without succumbing to the potential for burnout,” said Sarah Hackenmueller, PhD, technical director of rapid response laboratories at the Providence Oregon Regional Laboratory and chair of the AACC Society for Young Clinical Laboratorians Core Committee (SYCL).
Members of the SYCL Core Committee (which defines “younger’” as under 40 years old) had been informally sharing what wellness tactics worked for them. “We talked about different challenges that we were encountering and how some of us were able to overcome them even if we weren’t all susceptible to the same frustrations or same challenges,” she said. They realized that “there must be others in our professional community and within AACC who feel the same way.”
They started a new wellness initiative to share tips and tricks for making the most of time and energy. The goal is to share what peers know works for them, in the hopes that creating a database of options will help other members find something that might work for them as well.
In January 2020, the committee launched the monthly Wellness Tip community on the AACC SYCL Artery forum, with the goal of fostering an environment where wellness-related topics can be discussed in a practical and broadly applicable way, and where members can freely share what has worked for them.
“We can’t deal with anything specific in terms of staffing limitations or schedules at a particular institution, but we can provide tools that are broad and generic enough that they can be added to each person’s internal toolkit for resilience,” Hackenmueller said.
She also hopes that wellness and resiliency are included in more training programs for the next generation, so that they know that, yes, they will encounter stress, “but here are some ways you can really start to prioritize your own well-being,” she said. “It seems obvious, but people need to be told it’s OK, you can and should prioritize your own wellbeing at some point. That doesn’t mean you can disregard your job, but there needs to be more awareness and more focus on that earlier in the training process.”
Jen A. Miller is a freelance journalist who lives in Audubon, New Jersey. @byJenAMiller