The Health Worker Crisis Is Real and How We Can Act Now to Avoid a Health Care Catastrophe

Shauna Hill, LICSW, Cofounder and CEO of mental health media and education company, StateChange, is a Vermont-based neuroscience educator and trauma psychotherapist with decades of experience in family, community, and behavioral health. Shauna joined the “Finding Joy” podcast to discuss strategies for addressing health worker stress and burnout. Shauna offers her decades-long earned insights into the healthcare worker crisis in “The Health Worker Crisis Is Real and We Must Act Now to Avoid Health Care Catastrophe”. She describes the kind of support with which healthcare leaders are in need and that of the health worker staff as well. From “finding a spark” to providing open discussions, Shauna believes, with immediate action, the health worker crisis can be overcome.

“Finding Joy: The Health Care Professional’s Journey to Well-being" is a podcast resource developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting well-being among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.

The Interprofessional Education Research team wishes to thank the following individuals for their invaluable contributions to this project:

• Dr. Barb Richardson, nurse, educator, and interprofessional champion;

• Cameron Cupp, creator of the “Finding Joy” musical score and current enrollee at WSU Elson S. Floyd College of Medicine;

• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and

• Claire Martin-Tellis, Executive Producer, and Solen Aref, student intern, who developed the first five episodes of the “Finding Joy” podcast.

This episode of “Finding Joy” was produced by Doug Nadvornick, Program Director, Spokane Public Radio.

If you would like to reach out, please contact our team by sending an email to: medicine.ipoc@wsu.edu We also encourage you to visit our podcast blog as well as our team's website at: https://opioideducation.wsu.edu/about/.

Transcript

This is “Finding Joy: The Health Care Professional’s Journey to Well-being.” It’s a podcast developed by a team of interprofessional education researchers from Washington State University Health Sciences Spokane. They’re promoting well-being among students, faculty, and healthcare professionals during challenging times. Funding is provided by the Health Resources and Services Administration.    

[theme music] 

I’m Doug Nadvornick. In this podcast we receive advice with healthcare professionals about how they’ve dealt with pandemic-related stresses. Often, we put that at the end of the show. This time we’re flipping the script and starting with a little advice from Shauna Hill, a Vermont-based neuroscience educator and trauma psychotherapist. 

Shauna Hill: “I always coach folks to add something,  if there's anything right now that people need. It's like something that just feels good. So it's a hobby, it's picking up an instrument, hanging out with your dog more, going to the beach, finding that thing that's positive,  et cetera. People, when they're tired, cut that stuff out. And I'm encouraging folks, find one thing you can add that just feels like you and is about you and has nothing to do with these other roles and responsibilities. And when people start to do that, it sparks something in them that upends the burnout and the collapse in the stuck place and really shifts us towards some more energy.” 

Shauna Hill’s career arc has gone like this: clinical social worker and child and family therapist for about 20 years with a  focus on community mental health and behavioral health practice. She has worked  as an executive within healthcare systems. Now she’s a consultant and the co-founder and CEO of StateChange, which Hill calls a mental health media and education company.  

Shauna Hill: “Fifteen years ago, folks in the allied behavioral health professions were being trained in all kinds of talk therapy, different theory and models, many of them well researched and developed. There was sort of two branches of mental health where one is emphasizing sort of relational work and process and another is sort of behavior management, right? How do we change behavior? I was trained in behavioral work and what you learn pretty quickly about behavioral work is that carrot/stick or behavioral systems and incentives don't shift the way that people behave, they just shift it in the moment when that system is there and you take it away, it doesn't create any change. The other thing is that it can sometimes dysregulate people, right? So when you do behavior management, say, with kids in schools, for some kids, they behave better and we feel successful. I could see that behaving better didn't necessarily mean those kids were learning or feeling better, they just weren't behaving badly. The other thing is, for some kids, those systems would actually produce more disruption, more dysregulation, and so I think a lot of professionals in a variety of health fields could see that this idea of behavior change, whether you're talking about weight loss, quitting smoking, any type of behavior change, that the behavioral models and methods were missing something because people couldn't really make very good use of them.” 

Shauna Hill: “I came to neuroscience the way a lot of practitioners and professionals do, which is that we're unsatisfied with the tools we have and we can see that they're not very effective or that they're only effective sometimes for certain kinds of folks or in very specific situations you can't re-create. There's been a lot of limitations in mental health because of that. The most powerful concept that I think folks need to understand is to think of our brains and bodies as a dynamic interconnected system that is run not just by the brain, but the whole nervous system, and that idea that the brain is the boss and the body is separate, was a problem. This is one dynamic system changing and reorganizing all day long, every day, in response to many variables and it's complicated, but there is a science to it, and so you can teach even some basic concepts of that part, for example, calm versus dysregulated and call people's attention to that and that it becomes easier then to think about something like behavior change. If people don't feel safe, aren't regulated, have trauma, et cetera, and chaos in their lives, then their thinking brain would never be available for behavioral strategies because the system is doing something else. And that liberated a ton of health professionals once we learned that, from trying to do things we kind of knew didn't work because now we had a path to look for something that would be more relevant to learning what will help this person in front of me at this time.” 

You’re listening to the Finding Joy podcast. Our guest is Shauna Hill, a Vermont-based neuroscience educator and trauma psychotherapist. She’s also the co-founder and CEO of StateChange, a mental health media and education company. 

Doug: “I hear a lot of hospital leaders in our state talking about, one, they can't find healthcare workers right now. Healthcare workers are bleeding from the system. They're trying to figure out what's the best way for us to make it a healthier place for them. What advice, if you sat down with them in a conversation like this, what is the advice that you would give to them?” 

Shauna Hill: “I’m so glad you asked this question because it's such a big question mark for those managers and leaders and I deeply understand that. I think there are structural realities to healthcare that cannot accommodate the needs and the challenges we have right now and they all sort of know that. I think maybe they need a therapist like me to sit in a room with them and give them language and validate that it is terrifying to be this ski  lled and experienced, to have this much responsibility in your profession and to be in charge of a giant hospital system and to think that you have no idea how to solve these people challenges. Just like in a regular therapy context, sometimes naming the problem is really helpful. Just saying, yes, this is an entrenched complicated problem that we haven't had to solve or even think about really before. So let's name that it's that and not situate those leaders to feel like they're supposed to just invent these solutions out of thin air by themselves without support or integration from, frankly, those of us out here who do the people work and who are the people scientists. I think we need to lean into the healthcare system and they're not used to anyone doing that, nor is it built really for that. It's built to sort of operate in its own silo. Structural challenges, simply put, are really around the financial and care models a nd that's a conversation I would love to really map out with those folks, which is if the put through levels and the scheduling and the billable care planning and the financial models are such that there isn't space, people can't take time off, they can't take breaks or sabbaticals, they are overworking, covering each other's shifts and covering vacancies for years on end, which is where we've come, then there is no expected outcome except exactly what's happening. It's not like there's one tweak and people won't leave. I think we need to name that this just is happening. That's the challenge, which is how do we create more space for there to be more buffer, a little bit more give, a little bit less crisis? And that is going to take pretty complex strategies and it's going to take talking about the care models and the money and there's no way around that. But in the short term, the solution is a little easier, which is getting in authentic relationship with your workforce, with your managers, with your HR execs, your teams, with your boards, all the stakeholders in the healthcare system, and saying out loud that until we can solve some of these larger longitudinal systemic challenges, we have to find language that's wholehearted and authentic to say to our existing remaining intact workforce, we are here, we see you.”    

Shauna Hill: “The deep family therapy history in me, the family therapist, wants to say we need language and we need some authenticity that starts with the naming all of this because it creates a trust repair and trust repair in your nurse who's covering three extra shifts and just burned out and hates this job right now, when she hears her CEO or her manager say, ‘My god, this last two months has just been unmanageable. I am so sorry for the impact of that. We recognize we don't have solutions to this right now and our old solutions aren't working and here's what we're doing to try to bring in some new ideas.’ Right? Like, you say that and that nurse comes back for that next shift. She takes the one more coverage shift and we have to stop thinking about that as a way to squeeze another shift out of someone and think about it more about how to be in trust with our workforce, because my biggest concern when I look at those numbers, and I look at the data all the time, you're talking about the folks who are planning on leaving within two years, nurses, doctors, clinicians and looking at the care waits, especially in rural communities, this is a nightmare. What I see is that the urgent focus must be on connecting with the remaining workforce, right this minute, in the next year, in a human way where everyone feels in trust, like we're having the same conversation and they don't want to hear promises and they don't want to hear jargon and they don't care actually at all about the data. They just want to hear that a human being up there hears that this work feels this way, sees the burnout, sees the moral injury, sees the patient care changing in a way that none of us want and is in that same conversation with us. People will show up, work hard and start coming up with their own ideas, actually, and really lean into their jobs when they feel in trust with their leaders and I just think healthcare hasn't been forced, maybe, in the same way some kinds of other fields. Like, mental health, we have to do this all the time. But they haven't maybe been forced before to have to develop those relational skills and really think in terms of organizational trust as the starting point for retaining staff, because these staff also know that their only choices are to leave this job and take another healthcare job that could be just as bad or worse, or to leave the field. Healthcare workers never want to leave their field, like we're really the least likely to leave what we do. We put a lot into it, we have a license, we're here, we're skilled, we want to do this. So, remembering that this is people work, that relational approach and the language and the trust matters because then everyone stays still and gets creative and starts to work together. My concern is that, if we miss that moment in the healthcare system, that we see this looks worse in a year and it's a catastrophe in two years.” 

Our guest is Shauna Hill, a Vermont-based neuroscience educator and trauma psychotherapist. She’s also the co-founder and CEO of StateChange, what Hill calls a mental health media and education company. 

Doug: “So you've had this consult with the hospital administrator. Now you're going to have the consult with the burned out nurse and she's asking you, what should I do? So what do you say to her?” 

Shauna Hill: “I have a lot of those folks on my caseload, burned out healthcare workers, and the first thing I do is I take a little bit of assessment of what state they're in. If this person has told me they haven't been sleeping in three months, they're losing weight, they're losing hair, I can see they're in a real health crisis. The advice for those folks who are truly in a crisis is that they need to cut back. If that means quitting, unfortunately, sometimes it does, but it can also mean cutting back hours or asking for an extended leave or a sabbatical. And so systems that can create some flexibility there, even though it doesn't make the numbers look good, are going to retain staff. So that's one thing. But if someone is not in physiological crisis yet, then I usually coach folks to think about two things, which is, if you took yourself out of this job and you, like, blank canvas this and you imagine what would a balanced version of this job, where you didn't feel this way, look like? And sometimes they'll say, well, two years ago it felt that way. They know what it looks like and sometimes they don't know. We have to paint that picture and then talk about, is there any agency in your job where it can look more like that? Could you switch departments or is there something you could ask for from your team or your manager, or a schedule change? And often in burnout, we're not thinking creatively. We don't have that ability, but someone else helping folks sort and map like, ‘Oh, so I can't maybe get from A to Z, but I might be able to get from A to B to C,’ if I know what that roadmap is. Sometimes that's about hours and sometimes that's about maybe I've been doing this particular kind of nursing so long, maybe I can't be in the NICU anymore. Maybe I need to be in a pediatrician’s office or maybe I need to be, I don't know, in a dermatology office. Somewhere else. Thinking about this as a relay and not a marathon or a sprint, but a team relay. The healthcare, we can move, we can rotate, we can be creative and that requires some shift around that cowboy mentality of ‘I will just sit here and work and do this job with no complaints.’ I think that's what ends up with people leaving is their belief that there is no way to create shift nor would anyone care. But if they believed that someone cared and there was some room for problem solving, even if we don't have the solution, that creates engagement and it's engagement you want. You can't please everybody, but we can try to keep them them better bought in and in the conversation and engaged versus resigning and leaving that role.” 

Doug: “What would your assessment be as you look ahead? You're going to be in this consulting work for a while. Where do you think the healthcare system is headed?” 

Shauna Hill: “I'm most pessimistic about whether or not the systems of care and the complex financial models will change fast enough to create some more of the space that's needed in this system. I think that will determine what happens to the American healthcare system. I think Covid revealed problems that we all know, if we worked in that system, have been there a long time. It just exacerbated them and sort of put them out on the table in front of everybody in a new way. But we never had an exodus of professionals like we've seen now and we're also in a kind of a moment. There's inflation. We're in sort of a moment of a lot of complex stressors on that system. And in my mind, it's our ability to get back in engagement and trust with the remaining workforce and to involve them relationally in this system, in the story of where we can create some of this human-centered work life and give them some more agency and, frankly, just stop dragging them through this way of working that's so depleting. That stabilizes us where we are versus it getting catastrophic. But then we have a second problem, which is, does anyone want to go to medical school or nursing school anymore and come into this system, because we're also hearing a lot of data about young folks coming out of nursing school and Covid and lasting a year and then going and doing something else and that's devastating. Thinking about that is devastating. We need more people in healthcare and mental healthcare. It doesn't matter if these models worked before, they don't work now and these younger folks aren't willing to work the way…I’m Gen X, like I was willing to work like crazy when I worked in a hospital and I did. But they're not and they have options and they have choices and it doesn't feel like a desirable profession to them when they see this and they're correct about that. So we have to think of ourselves as stewards of healthcare in general, for the duration, in our communities, that the only way we repair what's already happened in healthcare is by creating a system and ways of working with young professionals and students where they feel excited to come in and they will not feel that if we're asking them to do 80-hour weeks, we're not properly attending to them. They just won't enter the system. They'll go do something else. And I know that some leaders understand that, but again, I think what paralyzes folks is that no one knows what the roadmap away from that is, and my suggestion is, let's be more creative with who's in these conversations and bring human being experts, people experts, relational thinkers, organizational thinkers into healthcare and not ask healthcare to sit in its own space and solve this structural issue by itself, because it will have to solve for its own financial picture. That's the only thing it can do. So I think, looking at it as a community level problem instead of an individual organizational problem is probably the big picture, like strategic vision. It's a hard thing to get a giant system and a giant infrastructure to see itself in a larger context or to work collaboratively in a new way with folks when there are so many urgent needs. It's a big ask.” 

Shauna Hill is a Vermont-based neuroscience educator and trauma psychotherapist. She’s  the co-founder and CEO of StateChange, a mental health media and education company. We thank her for joining us. 

[theme music] 

We also thank the following individuals for their contributions to the Finding Joy podcast series: 

• Dr. Barb Richardson, nurse, educator, and interprofessional champion; 

• Cameron Cupp, creator of the “Finding Joy” musical score and a current student at WSU Elson S. Floyd College of Medicine;  

• Washington State University staff from Marketing and Communications, Financial Services, and the Collaboration for Interprofessional Health Education Research and Scholarship; and 

• Claire Martin-Tellis, the original executive producer of the podcast, and student intern Solen Aref. They developed the first five episodes of “Finding Joy.” 

This episode was produced by Doug Nadvornick. 

If you are interested in sharing your perspective about well-being as a healthcare professional or would like to reach out, you can contact our team by sending an email to: medicine.ipoc@wsu.edu. We encourage you to visit our website at: https://opioideducation.wsu.edu/about/.