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In recent years, burnout in the healthcare sector has contributed to a national health human resources crisis. The situation is putting significant pressures on emergency departments across Canada: 868 emergency departments closed in 2023 due to staff shortages. Other studies indicate that healthcare workers are more likely to experience burnout than the national average – potentially leading to mental health challenges such as depression, suicidal ideation and symptoms related to post-traumatic stress disorder.
Research shows burnout in emergency medicine is related to factors such as severe overcrowding, staffing shortages, workflow inefficiencies, administrative burden, limited access to family doctors and nurse practitioners, and financial challenges across the healthcare sector. The COVID-19 pandemic worsened these circumstances.
Many emergency staff also work around the clock and see a high volume of tragic, unpredictable and at times dangerous patient situations. This can include unexpected patient deaths, trauma, and struggles with homelessness and substance use which can result in moral injury.
At times, emergency staff are also victims of aggressive and violent behaviour from patients and their families. Studies reveal over half of ED nurses are physically or verbally abused in any given week and, between 2007 and 2017, the number of violence-related lost-time claims for frontline healthcare workers increased by almost 66% – three times the rate of increase for police and correctional service officers combined.
“Many emergency staff are shift workers who deal with a lot of stress, trauma and, at times, emotional and physical abuse. There can be hard situations to process, and no one really teaches you how to deal with them. Oftentimes, it can also feel like you’re alone,” says Dr. Muneesh Jha, Emergency Physician at MGH.
“We see a lot in our line of work that can make the day-to-day very tough,” adds Linda Phillips, Registered Nurse in the MGH ED. “Sometimes, when something traumatic happens, we don’t have time to process it or take a break or take care of ourselves. We have to move on to providing care for the next patient because, in the ED, our doors are always open. That can take a toll on you.”
It’s a crisis that MGH’s Stavro Emergency Department (ED) is working to combat with the support of the MGH ED Wellness Committee, a group of emergency staff dedicated to addressing stress and burnout while building a healthy, positive and enjoyable work environment among all providers in MGH’s ED, including doctors, nurses, clerks and personal support workers.
“The stress and burnout we feel in the ED can lead to mental health crises or cause providers to leave healthcare altogether. It’s not uncommon to see very high turnover rates among emergency staff,” Dr. Jha says. “With our wellness program in the ED – which is created by healthcare providers for healthcare providers – we’re trying to mitigate that.”
Since being formed in 2020 during the height of the COVID-19 pandemic, the MGH ED Wellness Committee has implemented various initiatives designed to support, recharge and inspire emergency staff in the ED.
These include a peer-support program that pairs new emergency physicians at MGH with veteran ones, so new doctors have someone to turn to if they have questions or need help; regular social outings, such as picnics, group runs and visits to the Art Gallery of Ontario; a “cool-down space” where emergency staff can access coffee, quiet and snacks so they can rest, recharge and process traumatic events that may have taken place during the day; and supporting Schwartz Rounds, an internationally recognized program that offers healthcare providers regularly scheduled time during their workdays to openly and honestly discuss social and emotional issues they face in caring for patients and families.
In addition, the committee has implemented critical incident debriefing, a program that aims to support emergency staff who have had a difficult day or situation with a patient. Under this initiative, Drs. Jha and Cameron reach out to other emergency staff at MGH who have experienced or been involved in a traumatic event at work to provide support or just be a shoulder to cry or lean on.
This can take the form of a text message, phone call or another method of communication that lets their colleagues know they're here to listen and help. Where needed, they also offer to connect their colleagues with mental health resources, like psychotherapy.
“Even something as small as being able to connect with a colleague makes a huge difference. It helps create a safe space and a more collegial environment,” says Dr. Jha, who co-leads the MGH ED Wellness Committee alongside Dr. Cameron, Linda and Jack Annett, Registered Nurse in MGH’s ED.
“Talking to each other helps because we understand what we go through and have experienced some traumas together,” adds Linda, who is helping the committee plan a trip to the Toronto Zoo this summer where ED team members can hang out with one another and their families.
Linda also talks to her colleagues to ensure they have the mental health resources they need. “Being together outside the emergency department environment helps remind us that we’re human, too, and we need to take care of ourselves.”
The initiatives may seem simple but, in an environment where healthcare providers continuously face an increasingly demanding workload, they’ve received overwhelmingly positive feedback from the team and gone a long way in promoting staff satisfaction and retention in MGH’s ED. The initiatives are co-funded by the physicians, staff and hospital.
The committee’s work has been so successful it's caught the attention of other emergency staff in Toronto, including those who are part of the University of Toronto Emergency Medicine Academic Wellness Collaborative, a group of local emergency doctors who meet regularly to share wellness-related learnings and provide support for one another.
Drs. Jha and Cameron say several other hospitals have adapted the MGH ED’s wellness initiatives to support emergency staff at their own organizations. “If we’re able to keep ourselves well, it will only improve the care we provide for our communities,” Dr. Cameron says.
Dr. Kyle Vojdani, Chief and Medical Director of the ED at MGH, says the ED Wellness Committee has done an incredible job at ensuring staff and physician wellness is built into the department’s culture.
“I know many of our team members have been deeply and positively impacted by our wellness program and we are thankful to our incredible Physician and Nurse Co-Leads for their dedication and support of these important initiatives,” he says. “They help us take care of each other so we can be at our best for our patients.”
Research indicates the health and wellness of emergency staff is crucial to the success and effectiveness of healthcare systems. If not addressed, burnout affects providers’ ability to perform and show up at work, which compromises the safety and quality of patient care.
“Our initiatives are evidence-based and rooted in Stanford University’s model of professional fulfillment, which is a framework that shows well-being is driven by personal resilience, as well as an organization's dedication to fostering a culture of wellness and efficiency of practice,” says Dr. Cameron, who has conducted significant research related to emergency staff burnout and is part of the Canadian Association of Emergency Physicians’ Wellness Committee Executive.
“As part of this work, we’ve had to reconceptualize what wellness means and represents to us.”
Dr. Cameron, Dr. Jha and Linda say they were motivated to contribute to the MGH ED Wellness Committee because of their own interests in health, well-being and supporting their colleagues.
As part of their co-lead roles, they aim to gather feedback from their teams so they can identify opportunities to improve existing wellness initiatives and find new ways to help those in need.
“We work with amazing people so anything we can do to support them, we do,” Linda says.
“The nature of our work entails some difficult outcomes,” Dr. Jha adds, “so the more we can support each other, the better.”
