The intense care required for Covid-19 patients has exhausted nurses and other health care staff. (Oregon Health & Science University photo)
The pandemic’s been tough on nurses in Oregon.
They picked up extra shifts, worked overtime and endured relentless tragedy.
Most are mentally exhausted, and many are considering leaving the profession, surveys show.
But help is likely on the way.
A lawmaker and a group of medical professionals are working to include nurses in a mental health program that provides free therapy sessions.
The Oregon Wellness Program, created three years ago, is now offered to medical doctors, doctors of osteopathy, podiatrists, physician assistants, nurse practitioners and dentists. But Rep. Rachel Prusak, D-Tualatin/West Linn, nurse practitioner and chair of the House Interim Committee on Health Care, wants the service extended to registered nurses.
“Our nurses are at their breaking point,” Prusak said. “They have endured so much trauma since the pandemic hit. We need to be there for them in this most challenging time.”
The program offers eight one-hour therapy sessions a year to professionals who don’t have to do anything other than to book the appointment and show up, these days on video. They can choose among 18 therapists, who include psychiatrists, psychologists and master’s level social workers.
“All of them are carefully vetted,” said Dr. Don Girard, chair of the program’s executive committee. “They are selected primarily by people within the community because of their reputation, stature and because they all are experienced with providing care for health care professionals.”
Girard is a longtime supporter of mental health programs for medical professionals. In 2003, when he was associate dean of the medical school at Oregon Health & Science University, he created a similar support system after two suicides among medical residents. That post-graduate training period for newly minted doctors can last three to seven years, depending on the specialty.
Those years are difficult, with long hours and high demands, Girard said.
“I decided that we should start a program to try to help residents when they were feeling down,” Girard said.
Later, as chair of the Oregon Medical Board, he set the wheels in motion for the creation of the wellness program. Though most medical practitioners are covered by insurance, and many have access to mental health help through employee assistance programs, the wellness program guarantees something that those other programs don’t: confidentiality.
“Every hospital in the country is required to have an EAP to provide counseling for employees,” Girard said. “But those programs are not well used by physicians because they’re concerned that if they have a mental health issue, that will be leaked to the credentialing committee or the medical board and that could influence their license status.”
The wellness program is independent of any employer. Clients are given a unique and confidential identifier, and only the therapist knows they were seen, said Diane Solomon, a psychiatric nurse practitioner and a member of the program’s executive committee.
Appointments are guaranteed within 72 hours.
“That’s unbelievable in the current climate,” Solomon said. “Even when you have insurance, your copay is going to be $20 to $75, depending on your insurance, and it’s almost impossible to get in to see anyone.”
The program has given more than 2,000 sessions over the past three years. Those that have used it – about 260 professionals – only account for 1% of those who qualify but Girard said that’s still high.
“We don’t advertise,” Girard said. “We’ve doubled, tripled in size every year.”
In a survey two years ago, 90% of those who used the program supported it.
“It was stunningly positive,” Girard said. “They found the program helpful in making them feel better as practitioners and to make them more resilient.”
The sessions also helped clients adjust to the demands of the pandemic, Girard said.
Nurses, too, have faced stepped-up demands during the pandemic, something that Matt Calzia, a consultant for the Oregon Nurses Association, saw this summer when he took a leave of absence and worked as a registered nurse in an intensive care unit.
“Every shift is so much to endure that you have this compassion fatigue,” Calzia said. “Before the pandemic, one shift out of a handful of shifts was really bad. Now when you’re coming in, you know that every shift will be rough.”
A recent survey of 1,000 nurses at OHSU quantified the toll nurses have faced treating severely ill Covid-19 patients.
More than 90% said they were mentally exhausted, more than 80% reported being burned out and 60% said they were thinking of leaving their profession. Another 85% reported being unable to take a vacation or mental health day.
In recent months, the Oregon Nurses Association and the Oregon Nurses Foundation created a mental health program with Lines for Life, a nonprofit focused on preventing suicide, that offers free online support sessions with peers for those struggling with mental issues. The nurses association supports expanding the wellness program to all registered nurses, giving them even more robust help.
“You have to treat health care workers first so that they can treat the community,” Calzia said.
The main barrier is money.
The program is now open to about 26,000 professionals and costs the Oregon Medical Board and hospitals a total of $250,000 a year to run.
There are more than 70,000 registered nurses in Oregon, and expanding the service to them could cost $700,000. Much of that money would be for providers, who are paid $200 per session. Right now clients average about three sessions each, with younger practitioners accounting for the largest share of clients.
Solomon said the Oregon Nursing Board is likely to contribute. The rest of the funding is not yet arranged, but the executive committee is hopeful that that program will be expanded to nurses early next year.
“If there is any silver lining to this pandemic, it is that hopefully we are paying more attention to what nurses need,” Solomon said.
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