Many Health Workers Harmed by Hostile Work Environments

Originally published by our sister publication Infectious Disease Special Edition

By Marie Rosenthal, MS

More than double the number of U.S. health workers reported a higher number of threats, bullying, verbal abuse and other harassment from patients and co-workers in 2022 than in 2018, according to a new CDC Vital Signs report.

“Health workers dedicate themselves to caring for us, our families and our communities, and they are pouring from an empty cup,” said L. Casey Chosewood, MD, MPH, the director of CDC’s National Institute for Occupational Safety and Health (NIOSH) office for Total Worker Health, during a briefing about the report.

Health worker burnout was at crisis levels before COVID-19, experts said, but the pandemic only made it worse, further impairing the mental health of health workers and increasing their desire to quit their jobs. And these negative feelings were occurring in all areas of healthcare from hospitals to long-term care facilities, according to Debra Hourie, MD, MPH, the CDC’s chief medical officer, during the same briefing.

“The COVID-19 pandemic only intensified many health workers’ longstanding challenges and contributed to new and worsening concerns, including compassion fatigue, depression, anxiety, substance use disorders and suicidal thoughts. Burnout among these workers has reached crisis levels,” Dr. Hourie said.

“A crisis is an understatement,” Dr. Chosewood noted. “Many of our nation’s healthcare systems are at their breaking point. Staffing crises, lack of supportive leadership, long hours of work and excessive demands, and inflexibilities and our nation’s health systems all must be addressed.” 

The Vital Signs report used the National Opinion Research Center's general social survey, specifically the quality of work life module, which included self-reported mental health assessments from U.S. adults from various occupations, including healthcare. The team reviewed the self-reported mental health symptoms of 1,443 respondents (266 health workers) from 2018 and compared them with the responses of 1,952 workers (325 health workers) from 2022. In addition, they augmented the 2022 questionnaire to delve deeper into the challenges faced by health workers, Dr. Chosewood explained.

From 2018 to 2022, health workers in this country experienced greater declines in a range of mental health outcomes than other workers, according to the report.

“The number of days U.S. health workers reported their mental health was not good in the past 30 days increased more than other workers between 2018 and 2022,” said Dr. Chosewood, who is also the associate director of Strategic Initiatives, CDC NIOSH.

Health workers were more likely to report negative changes in their working conditions during the pandemic, including being harassed at work, and they were more likely to report symptoms of anxiety, depression and burnout than health workers who did not report being harassed, according to Dr. Chosewood. 

“Specifically, the analysis showed that 46% or nearly half of all health workers reported often feeling burned out in 2022—an increase from 32% in 2018,” he said.

“Additionally, more than double the number of health workers reported harassment at work in 2022 compared with 2018. Intentions by health workers to change jobs also increased” with 44% reporting in 2022 that they intended to change jobs, Dr. Chosewood added.

In comparison, people in other occupations reported a decrease in their intention to look for other work.

Even before COVID-19, healthcare workers faced “long work hours, often with unpredictable or rotating schedules, or like what I experienced as an emergency physician working overnights and on holidays,” Dr. Hourie added. “Caring for people who are sick can also be intensely stressful and emotional. Exposure to human suffering takes an immense toll on this vital workforce.”

However, the analysis also showed areas that could improve the situation, they said. Supportive work environments had a positive impact on health workers. Positive working conditions were found to be associated with reduced feelings of anxiety, depression and burnout. These conditions may include the ability to participate in decision making, trust in management, supervisor assistance, enough time to complete work, support for productivity and lack of harassment.

These data further support the imperative given in the U.S. Surgeon General’s 2022 report, “Addressing Health Worker Burnout,” which emphasized the need for action to create a system where health workers can thrive.

“This fall, NIOSH will be launching a national campaign for hospital leaders, focusing on providing them resources to help them think differently about how to identify and remove barriers to health worker well-being,” Dr. Hourie said.

To promote worker well-being, employers can modify working conditions and change aspects of the organizational structure that are associated with poor mental health. This study suggests such changes could include allowing health workers to participate in decision making, building trust in management, providing supervisor assistance and enough time to complete work, and preventing and paying attention to reports of harassment.

“We’re calling on employers to take this information to heart and take immediate preventive actions. We know from previous research that organizational systemwide interventions are more effective than individually focused intervention approaches, or those that rely on the worker to take the initiative to address their own mental health concerns,” Dr. Chosewood said.

“We don’t just want to treat workers who are suffering; we want to prevent that harm to all workers in the first place. The ultimate goal is to build a sustainable infrastructure for future generations of health workers that optimizes the culture of healthcare settings. In accomplishing these goals, we expect to have a positive impact on multiple organizational and employee outcomes. Central among these is workforce retention, patients and our communities. Really, all of us will fare better when our health workers are thriving,” he said.

If you or someone you know needs assistance (in English or Spanish) with mental health concerns and/or substance use disorders, prevention and recovery, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357) or visit https://www.samhsa.gov/find-help.