Bioethics Forum Essay
To Restore Humanity in Health Care, Address Clinician Burnout
Health care in America is at a critical juncture. The number of people who need it continues to grow and costs have skyrocketed. But instead of being a beacon of healing, many health care organizations are beleaguered and overwhelmed. Burnout has become a rallying cry for nurses and doctors because it impedes their ability to uphold the foundational values of their professions and to serve in accordance with them. Clinicians struggle to balance the needs of patients with the demands of technology, documentation, and regulatory requirements, and mounting pressure to do more with less. Many clinicians lament that they no longer have the time to know their patients as people. These realities have eroded the fundamental humanity of health care.
A recent consensus study report by the National Academy of Medicine, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, highlights the problem. Between 35% and 54% of nurses and doctors experience at least one symptom of burnout, such as emotional exhaustion, being cynical or calloused toward those they serve, or feeling ineffective in their professional role. The consequences range from impairments in a clinician’s physical, emotional, and spiritual well-being to degradation of health care quality, safety, and institutional reputation.
The committee that produced the report, on which I served as a member, identified several contributing factors: individual (e.g., moral distress, degraded clinician/patient relationships), organizational (e.g., excessive workload, inadequate staffing), and systemic (e.g., administrative burden, inadequate technology usability). The report calls for sweeping reforms of the health care system and health professions’ learning environments. The recommendations include actions to reduce administrative burden, provide systemic support for clinician well-being, and engage in research to better understand the causes and remedies for burnout and the interventions that foster well-being.
The current reality will not be changed quickly or easily. The enormity of the task is overwhelming. Restoring humanity in health care will require a fundamental commitment at all levels and a sustained and multipronged approach. We can begin this process by making it a priority to improve human connections in our day-to-day interactions. This will require that we intentionally shift our mindsets from despair, disengagement, and cynicism to hope, collaboration, and possibility. A starting point is to challenge our assumptions about what appears inevitable to what else may be possible. In their recent book, Riane Eisler and Douglas P. Fry assert, we can create a world “where our human capacities for creativity, caring and consciousness are allowed to develop and flourish” by nurturing equality and partnership rather than patterns of power and domination. For clinicians and leaders alike, this means committing to pause, listen, and respond in alignment with their core values, and to be accountable for how they leave the person at the end of each encounter. Greeting each person with authenticity, curiosity, and kindness begins the shift toward restoring humanity in health care. These seemingly simple practices have the power to create the seeds of change as a new paradigm for moral community in health care takes hold.
The time is now—our beleaguered health care system is unsustainable without a healthy workforce and restored humanity. The well-being of clinicians is central to their ability to carry out their professional roles. The organizations where they work have the responsibility to help preserve and protect their well-being by creating systems that foster it. No longer is it ethically justified to disregard the very real consequences of a system in crisis. The recognition of burnout among doctors and nurses is an urgent call for action. Clinicians care for some of the most vulnerable among us—we must invest in them so that they are able to bring their gifts and talents to the people who need them most.
Cynda Hylton Rushton PhD, RN, FAAN, is the Anne & George Bunting Professor of Clinical Ethics at the Berman Institute of Bioethics and the Schools of Nursing and Medicine at Johns Hopkins University. She is a Hastings Center Fellow. The views expressed by the author are her own; they do not reflect the official position of the NAM or the consensus of the NAM Committee. @CyndaEthx.