Prescribing Care: How Risk Management Can Support Health Care Workers

Stressed out, overworked, understaffed, burnt out: It almost reads like a prescription side-effects list. But for a good portion of health care workers, these labels are more than that.

They’re the lived experience of physicians, nurses and staff who hold lives in their hands every day.

Health care workers’ wellbeing cannot be ignored.

“We are in a profession where our role — 100% of our job — is to put other people in front of ourselves,” said Dawn Moore, RN, senior director, case management services, Genex Services.

Noble: yes; and in a world where modern medicine has the capability to cure diseases and remove ailments, the health care profession is a vital part of our society. But if its workers’ needs are not placed at the fore, like they do their patients’, that could lead to misdiagnoses, malpractice suits, worker injury and worse.

Luckily, risk management and insurance is on the case.

Understanding Health Care Workers Stressors

To fully grasp the severity of the situation requires a review of where the stressors are coming from — and why.

Moore placed stressors in three buckets: work, personal and the balance between the two.

“Global Qualitative Nursing Research said about 49% of health care worker stressors are at work, 32% comes from personal life stressors, and then about 19% of that intersects between the two,” she shared.

At work, providers are under pressure to get things right. Each patient has their own care needs, as well as their own personalities, for personnel to navigate. Health care workers must adhere to facility policies, administer appropriate dosages of medications, have exemplary bedside manners, all while working odd hours and even up to 80-hour work weeks.

Scarily, many are taking on these responsibilities understaffed.

“There is a shortage in health care staffing. And it can become this cycle where, if you’re understaffed, that creates stress. As workers become more stressed, eventually, in some cases, they’ll leave the field, or they’ll go to a different, less stressful part of the field, which then perpetuates the shortage of workers,” said John Livatino, senior vice president, head of health care liability, QBE North America.

The Duquesne University School of Nursing reported that by as early as next year — 2025 — there will be a shortage of more than 400,000 home health aides and 29,400 nurse practitioners. The Association of American Medical Colleges forecasts a 124,000-physician shortage in the next decade.

Less physicians and other health care personnel in the field could lead to longer wait times for patients, which can also exacerbate stress for the health care workers who have to act as the face of health care to those disgruntled patients.

And disgruntled patients are leading to another scary stressor for health care workers: “We’ve seen a significant increase in workplace violence in the health care field,” said Dennis Cook, president of Liberty Mutual health care and Ironshore health care. “We’ve seen it from patients, we’ve seen it from families, and we’ve actually even seen it from coworkers at times.”

Workplace violence made the top five causes of health care worker injury, according to Liberty Mutual’s 2023 review of the sector. In total, 6.8% of health care workplace injuries were a result of intentional injury by another person.

“Within the health care industry, this is one [risk] that is trending upward,” Cook explained.

“Health care workers are dealing with stress, through patients who are dealing with life-and-death situations … we’ve seen patient-on-staff violence increase, but we’ve also seen staff-on-staff violence increase. While there’s no one reason why there’s an increase, we can likely link it to the stress of their jobs compounded with mental health issues.”

Another way patients and their families can add stress is through the threat of malpractice suits. For health care workers, even a minor mistake on the job can cost someone their life, and so the pressure to perform can add up. Accidents, misdiagnosis, unintentional medical errors and delays in treatment can be serious professional liability issues that health care facilities can face.

Not to mention that just the perception of mishandled care can lead to a suit.

An average of 20,000 malpractice lawsuits are filed in the U.S. every year against doctors. The American Medical Association reported that one in three physicians face the possibility of being sued at some point within their career, even if the claim results in no finding of negligence or error.

“From an insurance perspective, there’s the social inflation that’s related to this,” Livatino said. “A very aggressive plaintiff’s attorney will go after these health care workers, using what’s called the Reptilian Theory, which plays off human instinct to spot dangerous situations. The attorneys will use health care incidents as a warning bell or example for the jury.”

From there, the plaintiff’s attorney can play on the jury’s sense of justice, cultivating larger and larger verdicts bordering on billions of dollars each.

Outside patient care, hospital and health care facility affairs can layer more stressors onto these professionals.

“There’s a lot of merger and acquisition activity going on,” Cook said.

This is not a new stressor, but rather an ongoing one that a Reuters survey says is likely to amp up in 2024.

“Whomever might be your employer today may not be your employer tomorrow, which means health care workers may be looking at changing processes, procedures, technologies to keep on top of,” in addition to their regular responsibilities, Cook said.

A Pandemic’s Trail by Fire

Suffice to say, burnout in health care is very, very real. It would be remiss if we did not mention the giant, COVID-sized elephant in the room and how that, too, has changed the game for the profession.

Before the pandemic, “we had a health care community that wasn’t really doing a good job of taking care of themselves,” Moore said. “And then all of a sudden, bam, there’s this pandemic. Workloads are higher, burnout is higher, the work is harder.

“I had some really good friends in the clinical setting who had to fully gear up with PPE every single day when the pandemic started,” she shared. “It wasn’t just showing up for work; it was actually showing up early, gearing up, changing. Some nurses couldn’t even see their families due to some situations of mandatory isolation, which made family-work-life balance a struggle. The pandemic definitely compounded the burnout situation for health care providers when we were already struggling.”

“The pandemic has been a real stress on the whole of the health care system,” Cook added. “There was a short period of time where everyone rallied around these workers and really tried to support them. But that didn’t last as long as it probably should have.”

With over a million deaths in the U.S. alone, COVID placed health care workers on the frontline during an extreme time of uncertainty. It’s hard to remember a time before the vaccine, but in March 2020 through the early months of 2021, many health care providers were being asked to put their lives on the line for a disease that had no precedent.

Procedures changed daily. Protocol adapted to information coming in from all sources. Work-from-home was an option for many professions, but not health care.

Many stuck it out and came through the other side. A lot of professionals left the field entirely. (Over 230,000, according to a Definitive Healthcare report.)

Hope Is Not Lost

The sheer number of health care worker stressors paints a bleak picture, but not the whole picture.

Risk management and insurance is already playing a role in combatting health care worker burnout. It starts with awareness and acknowledgement of the burdens these professionals face and ends with practical tools, like new technologies or better benefits, to show that steps are actively being taken to help.

“Several third-party risk management companies are already providing hotlines, publishing content, doing assessments and surveys … in an effort to provide support and content that’s answering questions for this industry,” Livatino said.

Employee surveys around mental health and wellbeing go a long way in getting a baseline assessment of workers’ attitudes toward their jobs, if they feel underappreciated, and if addressing mental health is important for them.

“Prior to the pandemic, a negative stigma already existed around being able to speak freely about mental wellness. The pandemic gave our profession an opportunity to have more viable discussions around the topic,” Moore said.

She added that since 2020, as someone who oversees nurse case managers, she has done more to talk about and address worker mental wellness.

“In the last three years, I’ve done more surveys, had more discussions, just ensuring that we have a pulse on morale, that we show that we care about what’s going on with these individuals,” she said.

Wellness programs geared toward addressing worker mental health and wellbeing is another strategy many have employed, especially after the onset of COVID-19.

“Our organizations are very aware of this topic and are trying to help mitigate the exposures through more support for their employees, whether it be wellness programs, or maybe more time off. It could be in increasing staffing ratios, working with their broker or their insurers to figure out some risk mitigation measures,” Cook said.

He noted telemedicine is just one way to lessen the workload and pressure providers face: “We’re seeing more telemedicine being used to help offload some of the burden that comes from lack of staffing.”

Insurers can also help by providing quality claim handling that works to offset stressors related to litigation. As Livatino explained, “providing quality claim handling that works to offset the aggressive stance of the plaintiffs’ bar and social inflation can be one role of insurance in decreasing the stress on our health care providers.”

“As a health care provider, I will tell you that we are the worst patients,” Moore quipped. “We are the best with telling others how to take care of themselves, how to be compliant with treatment plans, telling them what to do to be healthy. But health care providers often take issue caring for themselves.”

Knowing this is the case, the risk team should work to create an environment that nurtures wellbeing for their workers. When providing a safe space to not only talk about but also address mental health and wellbeing, leadership is inviting its health care employees to place their needs first — like they so often do for the rest of us in their care. Contact CMR Risk & Insurance Services, Inc. for additional risk management guidance and resources.

Article Published By: riskandinsurance.com

Article Written By: Autumn Demberger