Stressful Situation

Meditation apps might relieve mental stress and promote wellness, but Dr. Kaushik believes national and institutional leadership and policymakers need to make a comprehensive action plan that addresses burnout from a global perspective. He envisions peer-to-peer coaching, access to psychological health support, prioritizing the mental well-being of all healthcare workers, culture changes that promote resilience, and the development of wellness committees within individual healthcare institutions and wellness champions within individual departments. “Nothing will change if national healthcare leaders don’t acknowledge and address the issue,” says Dr. Kaushik. “It’s important for leadership to understand the difference between being tired and being burned out, and develop an action plan to solve burnout.”

Jane Lodato, chief of wellness for the department of surgery at Mount Sinai Health System in New York City, has helped launch the Stress Intervention Tools (SIT) program to help surgical professionals work through their emotions, reduce their anxiety and manage crises.

SIT is a holistic initiative designed to give surgical professionals the tools they need to build resilience and increase their sense of calmness  — while finding positivity and joy in their work. “The goal is to not only help team members manage their daily stress, but thrive in spite of it,” says Ms. Lodato.

The program includes Surgeon’s Six classes, a series of one-hour sessions occurring over six consecutive weeks that include interactive discussions and mindfulness practices that can be incorporated into daily life. “The series is like basic training,” says Ms. Lodato. “It provides tools and practices to reduce stress, burnout and feelings of being overwhelmed. Participants gain insight into their own habits to free themselves from patterns of reactivity and behaviors that make a day more difficult.” 

SIT also involves private one-on-one sessions, recurring small group peer meetings, guest speakers and grand round presentations — all focusing on stress-reduction tools, mindfulness practices and coaching. Ms. Lodato says several members of the surgical department — faculty surgeons, residents and administrators — have been participating in weekly private sessions for several years.

“Some groups choose to continue to meet monthly or bimonthly after the end of the series for practice, support and peer sharing,” says Ms. Lodato. “From what we have seen, having a group evolve and bond in this way is beneficial. It becomes an ongoing way of life and source of support for the members.”

SIT is designed to reduce burnout, provide personalized support, promote resilience, and increase wellness, contentment and joy. Ms. Lodato wants surgical professionals to find acceptance in dealing with the many challenging situations that are inherent to the profession.

She says the approach is unique in that a chief of wellness is embedded within the surgical department, an arrangement that provides ease of access and personal support to every staff member, with mental health and wellness advocacy coming from peers and the top down.

“Although many surgical departments provide invaluable mindfulness programs, we believe that SIT takes a unique integrated approach to stress management that is proactive and personalized,” says Ms. Lodato. “By offering one-on-one consultations on demand, we’re able to give providers specific practices that can be used to manage most situations as they unfold without missing a beat.”

Mindfulness has become a buzzword used to market a burgeoning wellness industry, but the practice is based on neuroscience and significant amounts of scientific research conducted over the past 25 years. “The research proves how these practices actually create change in one’s brain, reduce stress, overwhelmed feelings and anger,” says Ms. Lodato. “It increases focus, a feeling of calm, happiness and resilience. Through mindfulness, we give ourselves a choice about what’s going to happen next in our lives.”

Conversations, interactions and circumstances that we can’t predict or control can cause us to react in ways that create excessive frustration, says Ms. Lodato. “We judge ourselves and others, and feel overwhelmed when we’re reactive,” she says. “That’s how our brain is wired.”

Perfectionism combined with intense pressure can cause individuals to question their behaviors or self-worth, which contributes to a lot of their stress and fatigue. It’s a vicious cycle.

By utilizing mindfulness and self-awareness, you learn how to pause by tuning into your own reactive patterns. You’re able to respond to events rather than react. “The pause is an intervention with one’s own reactivity, and lets us choose an outcome that is most beneficial,” says Ms. Lodato.

She partnered with Michael L. Marin, MD, the Jacobson Professor of Surgery at the Icahn School of Medicine at Mount Sinai and surgeon-in-chief of the Mount Sinai Health System. Dr. Marin is a big proponent of mindfulness training and has been proactive in improving the mental well-being of his staff with a comprehensive strategy. He brought Ms. Lodato onboard as a fulltime mindfulness trainer who could equip the staff with the tools they need to address internal struggles and prevent burnout from occurring.

Ms. Lodato says the more providers use awareness tools, the more they rewire their neural pathways to become less encumbered by the situations they face each day. “The goal is to equip people with practices to avoid the patterns that bring about burnout, and to restore balance in work and life,” she adds.

Mindfulness might feel like one more task to add to an already lengthy to-do list. Ms. Lodato has created bite-sized practices that can be done throughout the day — walking down the hall, at the scrub sink, during morning or evening commutes — to serve as an entry point to mindfulness. As providers learn how to incorporate the practices into their daily routines, and begin to see the benefits, they will become more of a way of life.

“Mindfulness works, and the rewards are real,” says Ms. Lodato. “Our minds are often racing ahead to the future and relentlessly rehashing the past. The goal is to bring the mind and body to the same place at the same time, to become self-aware and embodied. If you retrain your brain and increase self-awareness, you’ll gain vitality, energy and perspective. The payoffs far outweigh the demand of what’s required.”

She’s a former Silicon Valley executive and single working mother who didn’t have time to meditate for hours at a time. The mindfulness practices she shares with surgical professionals can be accomplished in 10 minutes each day.

“Although we cannot change what happens to us at any given time, we can choose how we want to respond or relate to what happens,” says Ms. Lodato. “The key to emotional, mental and physical freedom is in that choice.”

Nurses who are asked to stay late to cover cases that stretch into the evening often do so without hesitation because of the inner nature that led them to surgery in the first place and a constant willingness to put the well-being of patients above their own — even to the point of burning themselves out.

Burnout leads to staff turnover, which places more of a burden on clinical leaders to train new hires. Established staff members must also work that much harder to fill the gaps that inevitably occur until new hires get up to speed, which could take several months to a year. The harder staff work, the more likely they are to burn out and leave the profession. It’s a vicious circle that’s driving highly skilled and highly trained providers — including those in leadership positions — away from the profession they love.

“I’ve been working in surgery for close to 20 years and I’ve never seen anything like the current level of burnout,” says Andrea Dyer, MSN, RN, CNOR, president of her local AORN chapter in Maine and a travel nurse who in recent years has worked at Boston Children’s Hospital and Children’s Hospital Colorado.

Mindfullness works, and the rewards are real.
— Jane Lodato

As Ms. Dyer moves from assignment to assignment, staff at each stop always ask her the same question: What are other facilities doing to retain staff? She doesn’t have a great answer. “I’m really worried about the current situation,” says Ms. Dyer. “We don’t want to leave our jobs because we’re obsessed with working in surgery, but how much more can we take?”

Staffing shortages negatively impact the current workforce in subtle ways. Ms. Dyer recalls poking her head outside an OR door to ask a colleague to grab a needed instrument. There was no one there to help, when in the past the hallway would be full of available team members. Ms. Dyer says she’s forced to do more with less, and feels the burdens of the job more than in any point during her career. Some days she logs 15,000 steps on her pedometer.

Efforts must be made to ease the mental and physical strain in the short term and address long-term staff retention, according to Ms. Dyer. She believes a meaningful first step would involve administrators including frontline staff members in decisions that impact workplace policies and conditions. “The only way to keep staff is to listen to their needs and ideas — perhaps assign a liaison or advocate who can communicate their concerns to administration,” she says.

When surgical errors occur or equipment breaks down mid-procedure, surgical teams conduct a mandatory debrief to discuss solutions to the issues that occurred during the case. Shouldn’t the mental health of healthcare workers trigger the same transparent sharing of ideas? “I’d find an open dialogue so helpful,” says Ms. Dyer. “It makes you feel appreciated and needed. I don’t think surgical professionals feel that right now, and that needs to change.” OSM