Physicians Need Healthy Work Environments Too

By Rose O. Sherman, EdD, RN, FAAN

For well over a decade, nursing organizations such as the American Association of Critical Care Nurses (AACN), the American Organization of Nurse Executives and many others have committed to the creation of healthy work environments. In their now widely used work, AACN identified 6 standards for establishing and sustaining healthy work environments. These include: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership. We have learned from our nursing research about the positive impact of healthy work environments on staff satisfaction, retention, improved patient outcomes and organizational performance. But the need for a healthy work environment is not unique to nursing as illustrated by a very troubling article in this week’s Time magazine by Mandy Oaklander titled Life Support: Inside the Movement to Save the Mental Health of America’s Doctors.

The article focuses on the some of long-held practices that are part of medical residency programs in the United States. Practices which are characterized as creating such toxic work environments that 46% of all interns meet the criteria for depression at some point during this first year. This is not surprising when you consider that many work an 80 hour workweek in academic medicine cultures that demand that these young physicians tolerate bullying comments and constant criticism of their work. Most of these young doctors are of the Generation Y cohort who were carefully nurtured and admired by Baby Boomer parents and as a consequence when they enter challenging environments – they have a high fear of failure. Their vulnerability is not welcome in the culture of medicine.

They exist medical school with huge debt, earn very little as interns and, often move to geographic areas where they have no friends and no time to form social connections. There is more to know today, more technology to learn to use and more paperwork to fill out. Sleep deprivation has long been a rite of passage in residency programs but we now know that ultimately it is the patient who suffers when their doctor is burned out. Some might argue that is not as bad as it was before 2003 when there no limits on the workweek but physician researchers have found no difference in quality of life since implementation of those rules. With a looming shortage of 90,000 doctors by 2025 – there is reason for concern. The author also points out that 400 physicians commit suicide each year, many of them in the early stages of their career.

So What Can Be Done

There are a few initiatives out there such as Stanford University’s reflective rounds where interns can freely talk about what they are experiencing and a Balanced Life program. The ACMGE, the residency governing body, is looking to integrate such initiatives into accreditation guidelines. But as we know from nursing, old habits die hard and establishing a no-bullying, healthy work life environment takes great leadership intention and commitment.

I do believe that nurse leaders can and should advocate for these young interns within their own settings. I remember a Chief Nurse telling me when I assumed my first management role in an academic environment that my unit was my home to run. Our residents, she observed, were visitors and needed to obey the rules of the environment. I was accountable and responsible to enforce them. It was an important metaphor that I never forgot. So when I established a no-bullying environment, that meant it applied to everyone working on the unit. It was in this first leadership role that I saw the vulnerability of our interns – many of whom told me that they hated their lives. I did have some difficult conversations with some residents who were bullies. Our nurses often saw interns struggling and stepped in to help them develop skills that they were assumed to have but did not. These are things that we can and should promote as nurse leaders. A healthy work environment should be one that all members of our interprofessional teams experience – the winner will be the patient.

Read to Lead

Oaklander, M. (September 7th, 2015). Life support: Inside the movement to save the mental health of America’s doctors. p. 42-51.