“Gloom, despair and agony on me. Deep dark depression, excessive misery.” The renowned refrain from the old Hee Haw television series exemplifies the mood of many as they assess the status of their hospital’s emergency department. It’s bad enough to have to hear the wails and weeping coming from these patients and to see their traumatic, sometimes gruesome, injuries. It’s bad enough to have to live in that chaotic world for an 8- to 12-hour shift; but to additionally endure staff shortages and limited resources and/or pay is more than some can bear.

Brewing Beneath the Surface

We’ve all heard the news of hospitals around the country having to shut down certain services over the last couple of years, including—in some cases—their emergency rooms. Atlanta Medical Center announced just a few days ago the closure of its emergency department weeks ahead of the facility’s full closure next month.

But it’s not just pressure-cooker cases and periodic closures that some ER workers are having to endure. In some instances, the emergency department is simply overloaded to the point that they can take no more patients. A September article at an Upstate New York news outlet asked the question: “Why are large emergency rooms going on ‘diversion’ more often?” The article went on to quote Dr. Keith Grams, chair of Emergency Medicine for Rochester Regional Health at Rochester General Hospital:

Diversion status is basically our communication to emergency medical services or the ambulance corps that we are currently in volume-overload in the emergency department. Unfortunately, in 2020 and 2021 and the beginning of 2022 we’ve seen that happen a few times.

The article goes on to report that, with shortages in the healthcare industry, diversion status is to be expected on occasion. For Rochester General, Grams estimates that the hospital has entered diversion around a half dozen times in the last two years.

Perhaps the most disturbing trend in America’s emergency departments involves the mental health of its workers. We have outlined above some of the contributing factors to this quite serious development, which all boil down to increased stress among ER workers. The situation has gotten so bad in some locations that some observers are seeing an uptick in suicide among the emergency department staff. One study stated, “nurses and staff from the emergency room have a higher risk of experiencing suicidal ideation due to the nature of cases they consult daily.”

Addressing the Stress

According to the American Hospital Association (AMA), “Healthcare workers can experience situations on the job that are stressful, emotionally draining and uncertain. This can contribute to feelings of psychological distress that, when not addressed, can be detrimental to their mental well-being.” In an effort to address this growing issue, the AMA has published the following guide: suicide-prevention_evidence-informed-interventions-for-the-health-care-workforce.pdf (aha.org). The guide suggests that there are three drivers of suicide among healthcare workers: the stigma associated with mentally or emotionally debilitating illnesses, limited access to behavioral health resources and treatment, and job-related stressors. The guide goes on to offer 12 evidence-based interventions that hospitals and health systems can implement to reduce the risk of suicide among its workers, which include, in part, the following:

• Create a culture where employees feel safe to discuss behavioral health without fear
• Eliminate credentialing questions and policies that stigmatize seeking behavioral health treatment or resources
• Provide employees and medical staff with multiple options to pursue behavioral health services and screenings (on-site, off-site, and virtually)
• Employ dedicated personnel to implement processes that oversee behavioral health and wellbeing resources

The bottom line is that hospitals would do well to consider implementing these and other strategies that might mitigate the risk of suicide and the tensions that could lead to it.

A Ray of Light

In the midst of this dour discussion, it may be helpful to hear a story that might provide a picture of hope. Recently, an emergency department RN, who provides leadership in a youth program, broke his pinky finger while playing football with some of the teens. It was a bad break causing the skin to burst out due to the bone displacement. He drove himself to his own hospital’s emergency unit. He received quick attention, and the break was successfully reduced and the skin sutured. What was heartwarming about the ordeal was a family photo that emerged showing the patient lying in his bed surrounded by several of his ER colleagues, as well as the attending doctor, all holding up their pinkie finger in a show of solidarity for their fellow worker. Demonstrations of caring and unity, as seen in this story, can make the workplace more tolerable and may just lead to more hope for those who labor therein.