Well-being of medical workers comes into focus

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Even before the pandemic, wellness in the health care workforce was identified as important, but then the pandemic ratcheted up the pressures and stresses of the job in ways that maybe weren't anticipated.

Today I'm talking about staff wellness with a social worker who recently joined Upstate. Her name is Lauren Angelone, and a big part of her job is caring for the caregivers. Welcome to "The Informed Patient," Ms. Angelone.

Lauren Angelone: Thank you for having me.

Host Amber Smith: Now, when we talk about wellness, what does that really mean?

Lauren Angelone: Wellness is an interaction between your personal needs and your environment at any given time.

It's intersectional. Wellness will vary depending on the person, their circumstances, their culture, their belief system, politics, morals, values, religion. So wellness is not just about any one dimension, it's a combination of actions in multiple dimensions. It's not just how you feel, think or say you're doing. It's about all of that and more.

And furthermore, when we look closely at the relationship between the individual and the workplace environment, we know it's not only intersectional, but it's also reciprocal, almost on a continuous loop. The work environment affects the individual and their well-being, and then the individual's well-being can affect productivity and organizational performance, and people feel anxious or depressed. Quality, pace and performance of their work tends to decline.

But truly, there are several domains of wellness, emotional, physical, social, financial, spiritual, environmental and professional. They're interdependent and influence each other. And when one dimension is out of balance, then the other dimensions are affected.

Host Amber Smith: It sounds like wellness is going to be different for each individual, though, because all of the things you listed matter to people to different degrees.

Lauren Angelone: Absolutely.

Host Amber Smith: So there are certain stressors that are unique to health care. I'm thinking about dealing with life/death situations, working odd hours or around the clock.

But people who are entering the profession, they already know that, and there's not really any way to change those things because that's medicine. That's the way it is.

So how do you, as a social worker, focus on staff wellness and deal with situations that create stress but are inherent?

Lauren Angelone: We focus on what is within the locus of control, and my priorities are creating a culture of wellness, normalizing and reducing the stigma that's associated with mental health. Building a team of support and promoting awareness of that support system. Allowing space to feel and share truths and really looking at policy and how that truly informs and impacts practice, not just in theory, but in reality.

A common vision and mission statement is a wonderful place to start, but where the rubber meets the road is what truly drives wellness.

Host Amber Smith: There's so many different jobs in health care. Is that going to be different depending on whether you are a surgeon or a lab technician or a nurse or a food service worker?

There's different aspects that you might have control of in those different jobs, right?

Lauren Angelone: Certainly, you know, each role carries varying job demands. And then, there may be nuances within those roles that could predispose an individual to a greater level of stress.

Research has noted that if there's a lack of job autonomy, employees are seemingly trapped by job demands or employees who work on extremely repetitive tasks are likely to experience high levels of stress. Research has also shown that role ambiguity, like lack of clarity, certainty or predictability one expects from a job, conflict and overload, they're all closely related to high intensity of individual stress and low work contentment, low trust and low self-worth.

Workplace stress is the harmful physical and emotional responses that can happen when there's a conflict between job demands on an employee and the amount of control that that employee has over meeting those demands. But when we understand stress as an intersection between environmental variables and how they're interpreted by the individual, you realize that stress is not just inherently based on the role itself, but also the perception of that stress. So, wellness is not just different for different jobs, it's different for individual perceptions.

Host Amber Smith: So the majority of the people that I know that are in health care, they got into the field because they genuinely want to help others.

Do you find, though, that a lot of those people have trouble helping themselves dealing with being able to manage stress?

Lauren Angelone: Well, personal wellness is something that we're all challenged by, but when I speak of that stigma, of mental health, how that plays out in the medical field is unique.

We take oaths to put patients first, and I think it creates this norm and value of setting aside yourself and your own personal wellness. And not only that, there's this culture in the medical world of relentless perseverance, often a desensitization of humanity, because how else can we cope with the volume of demand?

We can't fall apart because we're needed to do our jobs in the very next moment in the room down the hall. So, a challenge that I'm faced with: breaking down those barriers and normalizing the priority of taking care of yourself. It's kind of like when you're on an airplane and they're orienting you to take off and what happens in the event of an emergency, and you're instructed to put on your own (oxygen) mask before you're able to put on the mask of someone else.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Lauren Angelone.. She's a social worker at Upstate, and her focus is on staff wellness.

Can you talk about some of the initiatives that hospitals and health care organizations have tried in recent years to help promote well-being and resilience in health care workers? Which have worked well?

Lauren Angelone: There seem to be some common themes, and I think we actually do a lot of it right here at Upstate. These practices include improving input, engaging front-line health care professionals to identify system issues and empowering them to develop and implement solutions. Here at Upstate, we call that "shared governance."

Also by increasing recognition, appreciating and rewarding employees for heroic or above-and-beyond acts that they do on a daily basis as part of their jobs. Here we have the Daisy Awards and Stars Recognition. Cultivating a sense of community, having peer support and mentorship. Here, we do that through the nurse residency program, where we take new nurses and support them, for the first year of their career.

We have a clinician peer-support program. We have Schwartz rounds (a seminar on the personal by offering robust professional development opportunities, offering training and education in mental health literacy, self-help, mindfulness skills. We have such a variety of things that increase resiliency that way. We have the Pathway to Wellness, which offers weekly and monthly events and activities.

We did a series of "writing for wellness" workshops. We have pet therapy (such as visits by dogs) for staff and patients. Mindful Tuesdays. We have The Well-being Index, which is a tool that helps you rate and monitor your own personal wellness level that you can take every month, and it connects you to appropriate resources based on your results.

And we're currently, building a hotline for staff to call with any wellness concerns. And from there we will triage staff and provide them with appropriate resources.

Host Amber Smith: So it sounds like there's a huge variety, and they all sound kind of different, from rewards to just a range of things. So maybe what works for one person might not be helpful for another, but then there's something else that would help that person.

Lauren Angelone: Absolutely. It kind of goes back to that interdimensional framework of wellness. it's an individual path, but it connects with the environment. And so it's not a "one size fits all" approach. Different things work for different people.

Host Amber Smith: Does research show a correlation between salary and benefits, and job satisfaction?

In other words, would a pay increase make the job stress more bearable? And if it did, would it last?

Lauren Angelone: Certainly, higher-income earners across the board are more satisfied with their jobs, find more meaning in their work, and they're less likely to consider quitting than those in lower-income brackets. An effort/reward imbalance -- meaning combining high efforts at work and low rewards in terms of wages, promotion prospects, job security -- is associated with an increased risk of depressive disorders, but fair and competitive wages, although they're an essential component to wellness, it's just one factor that influences workers' job satisfaction. The relationship between income and career is complex and certainly raises increase work happiness, but it's only temporary, rather than creating a permanent sense of being valued at work.

Host Amber Smith: Now, during the pandemic, not just at Upstate, but across the country and the world, health care workers dealt with a lot of fear, especially in the early days, which really lasted for months. What techniques do you think worked best for getting workers through the worst of the pandemic?

Lauren Angelone: Well, certainly having positive outlets helped all of us get through those darkest times: Journal writing, exercise, counseling, connections, FaceTime.

But what I would say after speaking with people, what I would say helped our health care workers was transparency, support, flexibility from leadership, communication through daily briefings from our director, having adequate supplies, feeling supported by the community, feeling as though the community was rallying behind them, feeling valued and recognized.

Host Amber Smith: I'm curious whether social workers and others who are focused on staff wellness learned anything from the pandemic in terms of how to look at wellness or how to ensure a health care workforce that's happy and healthy.

Lauren Angelone: That's where we began to look at, look more closely at, wellness as being multidimensional and intersectional.

It's not just a personal crusade, one that you deal with on your own time, perhaps with a therapist, and then you check your baggage at the door. We've realized that the professional is personal and there is a mutual relationship, cost and benefit to establishing a culture of wellness. We realize that the stigma associated with health care workers acknowledging mental health struggles and the need to break that stigma.

And we also realized that we simply don't have the resources to support staff entirely, which is essentially what led to the creation of my position.

Host Amber Smith: The U.S. surgeon general said the pandemic brought the relationship between work and well-being into clearer focus, not just for health care workers, but for workers in all jobs.

And he produced a workplace and mental health and well-being report, which I know you've reviewed. I wonder, do you take anything from that report for your role in caring for the caregivers?

Lauren Angelone: Absolutely. I took a lot from that report. It's saying that organizational leaders have to prioritize mental health in the workplace by addressing structural barriers to seeking help and decreasing that stigma around accessing mental health support in the workplace, encourages organizations to invest in workplace well-being, as well as local organizations and community development. And the suggestion that that can turn into the development of a happier and healthier, more productive workforce and contribute to the success and economic well-being of an organization.

But something in particular stood out to me. They conducted a national survey, and 84 of the respondents said that their workplace conditions had contributed to at least one mental health challenge, and that 81% of workers would be looking for workplaces that support mental health in the future.

So what I took from that report is that I'm not only needed, but I'm wanted.

Host Amber Smith: It sounds like this is important to workers. Well, thank you so much for making time for this interview, Ms. Angelone.

Lauren Angelone: Thank you again for having me, Amber. I appreciate it.

Host Amber Smith: My guest has been social worker Lauren Angelone from Upstate Medical University.

"The informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.