Health Care Professionals

Sometimes it’s easy to recognize the signs that you need to talk to someone about how you’re doing. But as you continue to care for patients, fill extra shifts and manage all the usual stressors day after day, it can become routine to ignore the effects of stress and trauma. You can miss the signs that you need support, so it’s essential to check in with yourself frequently. Reach out for support if you are experiencing any of these warning signs.

Feeling irritable or angry. You may have a lack of patience for things that never used to bother you. You may feel irritated or even angry a lot more than usual.

Feeling anxious, depressed, lonely or constantly sad. You may feel happy much less frequently. The bad days seem to far outweigh the good days.

Reliving traumatic events. You may want nothing more than to forget the distressing things you’ve experienced, or the losses and suffering you’ve seen, but those memories keep reappearing, often unexpectedly.

Isolating yourself and lack of trust in others. You may feel alone, yet you also prefer to be alone. You don’t want to talk or socialize, and have lost interest in usual activities. You may question whether anyone cares, including your leadership at work, and maybe even people who are normally close to you.

Experiencing compassion fatigue, burnout or moral injury. You may find it difficult to empathize with others and are bothered by decisions and situations that feel wrong. The cost of caring may have stretched you thin, and you struggle to get through each shift.

Struggling to sleep or oversleeping. You may be negatively impacted by shiftwork and have little recovery time. You never seem to feel rested — if you can sleep at all. Or you may want to sleep far more than usual.

New or increased substance use. You, and perhaps others, have noticed an increase in how much you are drinking or using other substances.

Experiencing physical issues that impact you in unexpected ways: This could include:

• Digestive and/or appetite problems
• Increased aches and pain
• Sexual and/or reproductive issues
• Executive function and memory problems

The COVID-19 pandemic has created some unusual circumstances and as a result, you may find that you’ve taken on additional roles that create a range of emotions. These feelings and experiences are normal, but they can take a significant toll on your well-being.

It doesn’t mean that you are destined to have a long-term mental health condition because you’re experiencing this, but addressing signs and symptoms is vital to ensuring lifelong mental health and wellness.

Taking care of yourself is essential — and NAMI can help.

You have been focused on taking care of others, now it’s time to let others help take care of you. Sometimes just having someone to listen helps. Other times, having professional mental health support is essential. Just because you aren’t able to speak with someone face-to-face doesn’t mean you can’t access support.

There are several free, confidential and virtual support services available for frontline health care professionals. Find the one that is right for you.

• Project Parachute provides pro-bono therapy for frontline health care professionals, including individual and group support.
• The Emotional PPE Project connects health care professionals with licensed mental health professionals who can help. This service is free and does not require insurance.
• COVID Mental Health Support from the Pandemic Crisis Services Response Coalition offers free mental health support, searchable by area.
• The Battle Within provides free therapy to medical personnel, first responders and veterans. Private therapists are available to work with individuals in crisis, or who are experiencing grief, anxiety, stress or trauma.
• 911 At Ease International provides access to free trauma-informed counseling for frontline responders and families, including police, fire, paramedics, emergency medical personnel and other essential agencies.

You can also contact the NAMI HelpLine between 10am and 6pm ET at 800-950-6264 to access confidential, professional support. For immediate assistance, text “SCRUBS” to 741741 at any time.

A trained peer — someone who also wears scrubs and knows exactly what you’re going through — can be an invaluable resource. They understand the challenges and frustrations of the profession and are able to lend support in tough times. Peer support offers you a shared perspective with a skilled response.

You are not alone; your peers are ready to stand with you.

• PeerRxMed is a free peer-to-peer program for physicians and other health care professionals. PeerRxMed offers support, connection, encouragement, resources and skill building for optimal well-being.
• Physician Support Line helps physicians and medical students navigate personal and professional challenges through a volunteer network of psychiatrists.
• American Academy of Experts in Traumatic Stress offers online support groups for emergency responders and health care workers.
• Nurse Groups is a free and confidential videoconference group service for nurses to connect and process issues related to COVID-19.
• Disaster Response Assets Network offers free online peer support groups for frontline responders and health care professionals.

As a frontline health care professional, you are already accustomed to stress. But for most, these last months of working during a pandemic have been more difficult than usual. The added stress of treating patients with especially difficult illnesses and injuries can cause stress to accumulate. It can be easy to ignore the minor impact — until you realize that the impact is no longer minor.

You may also find that your usual methods of coping are harder to access due to the COVID-19 pandemic. Those who have met up in groups to decompress, or used the gym or fitness classes to alleviate stress, may be wondering what is left to try when something as simple as hugging one another may be risky.

Whether you are building your resilience as a preventative measure, or are seeking to add to your resiliency skills in new ways, you do have options. Health care professionals already know and understand the importance of their physical health, so you need more than the usual list of coping skills. Before getting into specific strategies, start with these essential steps.

• First and foremost, have compassion for yourself. Your work is demanding and difficult, and it’s normal to be negatively affected by stress and trauma. It’s especially normal that these feelings are magnified by the pandemic.
• Identify your emotions: shock, sadness, anger, guilt, fear, relief, etc. These are expected emotional responses, and it is okay to feel them, in any combination. Calling them what they are helps you gain perspective, and focus on your approach for feeling better.
• Identify the symptoms that are bothering you, as well as how they impact you daily. Then talk to someone about it, whether through professional channels or peer support.
• Explore resources and keep track of go-to coping strategies. Every step you take to manage stress and trauma puts you in a powerful position to improve and protect your mental health.

Resiliency Skills and Tools

You can improve your stress response and build strength to reduce the harmful effects of stress and trauma. Like any skillset, resiliency should be strengthened, and adding tools like social support and access to resources helps counteract cumulative stress.

Explore resources for yourself and share them with others, keep track of go-to coping strategies, and continue to look after your own physical health. It’s also a good idea to check in with your colleagues sometimes. Here are a few suggestions.

• Write down your readily available sources of strength, such as family, friends, pets, music, faith, hobbies or time in nature. Think about the things that bring you joy and find ways to connect with those sources.
• Purposefully reframe your thoughts. Can you change the problem that is troubling you? If so, how? If not, how can you accept it? Choose how your experiences shape your outlook.
• Envision positive outcomes. As you think through potentially stressful situations, imagine in detail the steps you will take to reach a successful outcome. Fostering optimism can improve your overall outlook.
• Express gratitude. Each day identify something you are thankful for — and why.
• Did you hear the one about the nurse who....used humor to cope? You understand humor as a coping mechanism, but you should also know that it has healthy short and long-term benefits. Rediscover the things that make you laugh, because after all, laughter is the best medicine.
• Set the tone for each day. Take charge of the day from the outset with a healthy and positive habit. It can be five minutes of mindful meditation or prayer, ten minutes of stretching, or even just a few minutes to focus on your goals for the day.
• Limit your media exposure and the amount of time spent on social media to maintain a positive outlook. Continual review of negative stories and outcomes on what you work with daily can increase your stress and create a sense of helplessness.
• Create a list of tips and resources that you’ve tried and categorize them — what worked well, what you’re willing to try, what didn’t work for you, etc. Experiment with new approaches.
• Create a list of strategies for taking care of yourself throughout your shift. You don’t have to be off-duty to utilize stress management skills. Often, even the simplest thing such as box breathing, or stepping outside for a quick mindfulness break, can make the day less stressful.

Wellness Resources

As a health care professional, you already know the importance of eating healthy, exercising and doing your best to get quality sleep — no small feat given the negative impacts of shiftwork. Keep up the good work and don’t forget to add resources regularly.

• Tips for healthy habits when working shifts.
• Healthy nutrition for shift workers.
• Keep up with your diet and exercise and track nutrition needs.
• Many people carry tension and pain in their shoulders and neck. Simple stretches can help with that.
• Sleep can be elusive, but it is essential. Prioritizing sleep and creating a restful environment are still possible with these sleep tips.
• The Sleep Matters Initiative at Brigham Health offers a wealth of education and tools for sleep hygiene.
• Harvard’s Division of Sleep Medicine discusses how to improve shift and sleep schedules.  
• There are a variety of apps to help track sleep, improve relaxation and help with circadian rhythm.

Being a family member of a health care professional can be exceptionally challenging. You worry about their health and safety, as well as how their challenging career impacts your family. With the added concern of COVID-19, the worry can feel overwhelming. It is important to have resources and support.

You may find it rewarding to begin a social support network for families of health care professionals in your area, or even sharing resources and support with others on social media. If you have no-cost resources you would like others to know about, please send them to frontlineresources@nami.org.

• The All Clear Foundation is a comprehensive resource database dedicated to improving the life expectancy and well-being of frontline responders and their families.
• Married to Doctors Podcast discusses the challenges faced by the spouses and families of physicians.
• The Center for the Study of Traumatic Stress offers advice for families of health care professionals.

Having information to use and share with others is important. Resources can be useful in different ways for everyone, so we encourage each individual to explore options and build a resource toolkit of your own.

Other resources to consider:

• American Medical Association offers information on managing mental health during COVID-19.
• The National Academy of Medicine has resources to support health care professionals.
• The Schwartz Center offers information, tips, resources and weekly webinars for health care professionals.
• Covid Calm is available for all health professionals, offering free, mini-workshops on stress management by experienced trainers and therapists.
• Massachusetts General Hospital offers a guide to COVID-19 Mental Health Resources for Health Care Providers.
• Road to Resilience Podcast is a presentation series on resilience, from the Icahn School of Medicine at Mount Sinai.
• Heroes Health is a free mobile app from the UNC School of Medicine. It helps health care professionals and first responders monitor their mental health and gain access to mental health resources.
• CrewCare is a resilience focused app for first responders and health care professionals.
• American Foundation for Suicide Prevention offers interactive screening programs for suicide prevention, tailored for medical schools, hospitals and health systems.
• The American Nurses Foundation Well-Being Initiative offers tools and resources to support the mental health and resilience of all nurses.

If you have no-cost resources you would like others to know about, please send them to frontlineresources@nami.org.