The global COVID-19 crisis has inadvertently brought mental health to the forefront of the public eye. Emotional wellbeing is being talked about more openly than ever. Nevertheless, society still holds a stigma regarding mental health despite these conditions being increasingly prevalent (Mental Health Foundation, 2015). As a result, many health professionals delay asking for support, and this delay could explain health professionals having a 23% increased rate of suicide, compared to the general population (Kinman et al, 2020).
Recent movements have been spreading awareness about mental health: ‘it's okay to not be okay’; #bekind, ‘clap for carers’. Healthcare workers are starting to be acknowledged for the endless care they provide, and it's becoming more understood how underfunded and under appreciated the NHS is. Burnout has been reported at a dangerous, all-time high amongst frontline staff, seeing more nurses than ever leaving their jobs and 44% of healthcare workers feeling ill due to their mental health (Gillett and Wright, 2021). This could be as a result of lengthy shifts with little rest time in between, resulting in no work-life balance. This can impact our physical and mental health, as well as our productivity at work (Kinman et al, 2020).
If we can't take care of ourselves, how can we provide high quality care for our patients? Burnout and fatigue appear to be leading human factors, causing potentially catastrophic consequences.
This can be due to the failure to identify critical issues in a timely manner (Draper et al, 2017). Studies have shown that being more emotionally aware, therefore preventing burnout, may reduce the rates of stress-related mistakes, inferring this could improve patient outcomes (Masiero et al, 2018). Adams et al (2018) reported that a lack of self-care, pre-existing mental health conditions and unapproachable superiors all can lead to an increased chance of burnout.
If we can't take care of ourselves, how can we provide high quality care for our patients?
Maternity claims represent 50% of the total NHS new litigation costs (NHS Resolution, 2021). The weight this holds for a midwife's accountability is monumental. However, juggling this alongside caring for vulnerable, frightened women and their families during a pandemic has been an unprecedented challenge, especially for newly qualified midwives. A total of 83% of midwives suffer from burnout and Hunter et al (2019) reported that up to 38% of midwives participating reported having anxiety, depression and work-related stress. Some major contributing factors included being junior, younger and working in a variety of areas (either rotational or integrated settings). This is something I have experienced and witnessed firsthand as a newly qualified midwife through the pandemic. There is a culture where burnout can be deemed trivial and is accepted within healthcare settings—a study amongst newly qualified midwives experiencing burnout felt this impacted their ability to practice safely, suggesting concerns about the influences on patient outcomes (Donovan et al, 2020).
Practicing self-care often can increase emotional awareness/wellbeing and consequentially could make us safer practitioners (Nightingale et al, 2018). Promoting the self-care initiative could look like normalising mental health difficulties within the workplace by ‘checking-in’ regularly with trusted colleagues eg Schwartz Rounds (Barker et al, 2016). This could begin to improve communication regarding maternity staff 's wellbeing in the workplace on a daily basis. Similar findings are reflected within other projects which promote kindness and reflective practice (Civility Saves Lives, 2017). Self-care could also resemble being kind to yourself, asserting boundaries by taking mental health days and prioritising your needs, ensuring annual leave is consistently booked.
One important modality of self-care is practicing mindfulness regularly. My personal go-to is the evidence-based Headspace mindfulness app. Headspace have kindly offered a free membership to NHS employees as a way to support our emotional wellbeing (NHS England, 2021). Self-care has been shown to be an essential skill for every midwife to have in their resilience ‘first-aid kit’ and time needs to be prioritised to maintain this (Kinman et al, 2020). This ‘first-aid kit’ can be personalised to whatever activity the individual finds relaxing or pleasurable eg exercise. Studies have linked being more active and exercising regularly can decrease the rates of being ‘off-sick’ for prolonged periods of time (López-Bueno et al, 2020).
Similarly, research shows that self-care needs to be done regularly to be effective (Kinman et al, 2020). Self-care practices should be encouraged from the start, and maintenance as promoted by ‘A-EQUIP’ through Professional Midwifery Advocate supervision (Rouse, 2019). If self-care is practiced earlier in the career process, even pre-registration, the chances of working through a longer, more fulfilling, sustainable career are higher.
However, a culture of wearing burnout as a ‘badge of honour’ within healthcare has been observed (ECRI, 2018). This is something I have witnessed over the years and this culture appears to be counter-intuitive. The issue of burnout needs to be discussed and we can combat it together. This could be done by spreading awareness of mental wellbeing in the workplace, and reducing the stigma of diagnoses/pursuing treatments during employment. Therefore, improving work-life balance and practicing self-care could help healthcare professionals become more emotionally intelligent and prioritise their health-both physically and mentally. If this became a reality, we could see a drop in qualified midwives leaving the profession due to burnout/stress-related conditions.
Research highlights the importance of health professionals being emotionally aware, and acting accordingly if their mental health/burnout begins to affect the relationship with their patients eg being friendly and approachable (English et al, 2021). Inferring that patients/colleagues are less likely to disclose domestic violence or mental health concerns to a midwife who is ‘burnt out’ and preoccupied. Furthermore, more studies need to be done but this could be detrimental for patient outcomes and disclosure rates. In the meantime, it's crucial we are aware of how we come across. This may ensure the safety of the families we care for and reduce the chances of these potentially harmful incidents going unreported. Equally, if we are emotionally aware and well-rested, this could lead to more disclosures and increased patient safety and patient experiences (rapport).
Burnout amongst midwives is overwhelmingly common. Newly qualified midwives may be higher risk of suffering from poor mental health and consequently burnout may occur if not adequately supported. Self-care and self-compassion should be a priority in these turbulent times in an effort to maintain the safety of our patients and ourselves. We are only human. Be kind, protect the NHS, save lives.