The persistent issues in emergency medicine include burnout, staffing shortages and administrator responsibility. While we have wait times and patient volume that will at times press us to our limits, we have long shifts bringing in varying volumes of patients over time which leads to constant fatigue not to mention high turnover which leads to less continuity. I have seen clinicians no longer be able to maintain that patience and empathy after repeated exposure to high volumes of patients. The required documentation of patient care just adds to the already stressful nature of the practice and contributes to x time spent on patient care. Change needs to be systematic, and I'm not referring to the systemic changes, I'm talking about provider and patient centered changes. To be specific, it should be standard to have protected time for breaks, desired staffing ratios, and appropriate mental health support. Efficient electronic record keeping would save providers hours spent documenting the same assessment and plan over and over. Providers should be compensated for the billable workload, and while that is often enough for providing for basic needs, it is often not enough to compensate for the wellbeing of the physician. If teams had consistent scheduling, reliable administrative staff available to work closely with the medical team, and adequate counseling resources, burnout is lessened and patient outcomes remain stable.
- The major issues are systemic. The syndrome cannot be alleviated by isolated interventions; it is the cumulative effects of sustained high demands, long working hours, and the centrality in the occupation to which they are subjected. The loss of top-notch personnel over time is due to the fact that the system that exists currently does not stand the test of time. It is crucial to move beyond lip service around wellness and take steps to implement the processes that help make this possible for our teams. At Air Ambulance 1, we undertook a strategic change towards a team-based rostering model that places emphasis on stability and supportiveness: this has yielded a significant increase in morale and a corresponding decrease in burnout. The goal of this type of approach is to transform the workplace into an environment where people are valued and looked after, not as exchangeable bodies of labor but as persons.
Although the healthcare workers themselves talk about the meaningfulness of their job, the burden of systemic issues cannot be disregarded. The three challenges at RGV Direct Care that we see as the most urgent are those that can be heard across the US by emergency medicine personnel: too much administration, too little predictability, and too little mental health support. Clinicians get into the profession with the aim to offer care, but too frequently they end up spending hours on documentation or balancing policy that can eat up time needed to attend to patients. The result of that imbalance is frustration and burnout. The unstable recovery periods also are another issue that complicates retention. Prolonged working hours with little resting cause cumulative exhaustion which cannot be compensated by any level of job satisfaction. The other urgent problem is communication lapses between the top management and lower level employees whereby employees complain that they are not listened to when they complain on workload or lack of resources. To resolve these areas, it is more than merely an incremental solution it will demand the intentional process of changing the staffing patterns to more favorable and sustainable ones, reducing administrative pressure, and providing the workers with easy access to mental health services which will enable them to remain in the profession without compromising their personal wellbeing.
Clinical Director, Licensed Clinical Social Worker & Counselor at Victory Bay
Answered 4 months ago
Mental health providers also experience burnout same as emergency medicine as a result of: secondary trauma exposure; type of structural issues that lead to moral distress; poor-aviation compensation and inadequate staffing. This burden of trauma is difficult to process and has resulted in PTSD, depression, and compassion fatigue among clinicians who are reluctant to seek treatment because of the stigma associated with it. Moral injury occurs when systemic issues impede proper care — insurance denials, abandoned therapies, high numbers of early discharges — and skilled clinicians eventually opt out. What we need is true dedication to health and working conditions instead of just band-aid measures. Some effective strategies involve individual therapy for staff, peer consultation groups, real caps on caseloads, competitive wages and protected administrative time. We need a culture of psychological safety, that supports open conversations on mistakes and emotional condition. Continual supervision that focuses upon the worker's well-being, rotating high risk clients and celebrating small successes can promote job satisfaction and hope.
Emergency medicine practitioners always report that work is significant, but the system surrounding them puts unrealistic pressure. The greatest problems that continue to exist are structural instead of clinical. Patient workloads, electronic record work, and administration of medication result in less physician and nurse time at the bedside. Overnight coverage and shift work are disruptive of sleep cycles and add to stress, causing chronic fatigue. Moreover, the workload of the remaining staff increases due to a shortage of workers, which also increases burnout. In the context of Health Rising DPC, the problems are a bigger trend in the healthcare field where quality is sacrificed to quantity. Although the emergency departments are unable to slow down, the care delivery model can change and offer improved support. Increased access to primary care and preventive services due to models such as DPC would assist in the reduction of unnecessary emergency visits, which would relieve emergency teams. The job satisfaction experienced by clinicians when attending to patients will languish as long as the system is not changed to ensure workload, workflow, and provision of mental health support.
One essential factor here is that emergency medical work is unpredictable. Generally, better staffing levels lead to lower burnout in medicine, but in emergency work, you don't know if you're getting two patients or twenty in a shift, and you don't know if you'll be dealing with cuts and scrapes or horrific traumas. All of this means that even when emergency medical workers are well-staffed, well-paid, and well-managed, they can still encounter stressful situations that push them into burnout. Providing sufficient opportunities to recover from these kinds of encounters, including strong mental health support and adjustable scheduling, is essential.
1) What are the biggest issues remaining? The biggest issues that remain are the lack of protected decompression time and length of shifts that often exceed 12 hours. Emergency workers are expected to switch from high-trauma situations to routine care immediately; there is no recovery period and therefore the mental resets that occur to accomplish this task are energy consuming at a rate faster than the workload itself. Under these circumstances the fatigue is rapidly compounded and is made worse when schedules are unpredictable and the strain is felt mentally, even when patient flow is perceived to be manageable. 2) How might these best be addressed in order to improve working conditions? The best solutions are structural and not cosmetic. Reducing shifts to 10 hours and requiring 20 minutes decompression periods every 3 hours has reduced fatigue by approximately 25 percent, according to some reports. Retention is also enhanced when compensation schemes are tied to recovery days rather than reward for just overtime hours because this focuses on sustainable health rather than productivity in the short term. Protecting recovery time to ensure sharper decision-making, steadier morale, and safer patient outcomes that, ultimately, strengthens the workforce and the quality of care delivered.
I believe the biggest issue is stacking shifts. I have observed people being sent when there are less than 10 hours between long shifts, and when they walk in the door they are already spent. I have seen teams be pushed beyond their limits, one hospital even lost almost a quarter of its emergency department staff in a year. It is not only fatigue but unpredictability that makes it worse. Some days there are 25 expected patients, they arrive to double that with no advanced notice. That roller coaster of extreme volume causes fatigue as much as the emergencies do. I personally believe the solution starts with building rosters using patient volume data and historical staffing patterns. One facility I worked with, decreased their unplanned absence by 18% in six months when they changed their schedules this way. They also made small changes like improved rest areas and made workstations more ergonomic. These small changes allowed staff to recover a bit and feel a little more comfortable and have been helpful in retention.