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“Survival mode”: Stress in the time of corona

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In a profession predisposed to problems of burnout and compassion fatigue, the extra stress involved in seeing patients during a pandemic can be dangerous.

Last week, NEWStat took an informal sampling of AAHA-accredited practices for a story on what their caseloads look like at this point in the pandemic. Their consensus? Slammed.

And while most AAHA-accredited hospitals are grateful to be busy, they acknowledge that the pandemic is taking a toll on staff.

Michele Forbes, DVM, co-owner of Compassionate Care Animal Hospital in Ann Arbor, Michigan, shared these thoughts from her blog: “Our days have devolved from greeting clients in our lobby, hugging our patients, and helping over 40 patients per day to working with skeleton crews, practicing medicine with virtual visits, wearing full PPE, and locking our doors. The days are long, the work is exhausting, and the victories are small.”

“Our team is the star of our pandemic story,” Forbes told NEWStat in a follow-up interview. “They’re phenomenal. Their jobs changed overnight—and not for the better! We have our team in full PPE as they do what is already a difficult job. Our days are even more complex than ever. Receptionists are overwhelmed with phone calls and juggling so much. And the backdrop to all this is the ever-present concern of getting infected.”

Forbes believes that the first months of the pandemic were a cakewalk compared to what’s coming.

“As we face our state reopening, there’s now a real concern about becoming infected,” Forbes says. “As we have contact with more patients and perform more surgeries, we wonder what our true exposure is.”

Despite all these unknowns, Forbes says her team comes to work every day ready to do their best and help pets, even as they face their own stressors. “Each team member has different anxiety about exposure and finances,” but, she adds, “everyone has come together and is working as a team to swim rather than sink. In the first few weeks . . . we cheered when we earned enough to cover costs, and all took turns loving on the few pets who actually came into the clinic. We suddenly realized how much we benefit from simply handling our patients. They give us so much and get us through the long days.”

Forbes says they reduced everyone’s hours and increased their pay to make sure they had more downtime. “We buy them lunch. We purchased everyone virtual yoga and Zumba classes. We meet daily and say thank you for all the amazing work they’re doing. We have also created remote jobs for some employees who were too anxious to be in the hospital.”

As for resources, Forbes fervently wishes there was more information. “There’s been no benchmark, no road map, and no [one] single source of information,” she says. “I wish we had a better system for communication between veterinarians. I wish we had a better system for organizing our policies and plans so we could share and/or compare our ideas.”

Amy Knights, RVT, at Airpark Animal Hospital in Westminster, Maryland, says they’re just as busy as they were prepandemic, if not busier. “This morning I had 12 lines on hold at one point.” They have nine doctors, with a tenth starting in August. And even so, she says, they’re stretched pretty thin. “We see new patients every day.”

Crystal Davis, LVT, at Armistead Ave Veterinary Hospital in Hampton, Virginia, said her hospital is “Unbelievably crazy busy! I feel like we can’t even catch our breath!” Armistead is a walk-in-only practice (except for surgeries), and Davis says they were working to capacity even before the pandemic—and she didn’t believe they could get any busier.

She was wrong: “We are telling people two- or three-hour wait times, and they actually wait! It’s mind-boggling!”

Scott Driever, DVM, owner of Animal Hospital Highway 6 in Sugar Land, Texas, says they’ve been both busy and short-staffed, “so we’re noticing a little more friction between team members where there’s usually very little. Tempers are shorter than normal, and our edges are beginning to fray for sure.”

Driever says management’s been bringing in food and snacks from time to time and clients have been sending treats, which helps. “And we’ve been taking the time to check in with team members individually to see how they’re holding up and if there is anything they need at home or work to make things better.”

Mostly, he says, everyone’s trying hard to stay positive.

“We’re hearing a lot of deep breaths from many team members that are typically followed by a quietly spoken ‘OK.’ It’s as if everyone is taking a moment to breathe and mentally regroup before going on to the next task.”

He says the hospital will close early this Friday for a pizza-and-tomahawk-throwing party, calling it a time for fellowship, and a time to re-center.

“Staff is less affected by concerns about the virus, and more concerned about providing our same high level of care that we’re used to providing before we went curbside,” Driever says. “It’s the effort of keeping up the same high standard of care while doing curbside that’s exhausting, not fear of the virus.” And as far as mental health resources go, Driever says that even if they had access to them, “we wouldn’t have time or the mental bandwidth to effectively utilize them right now. All efforts are focused on getting through each day as it comes. Ironically, we’ve had fewer people call in sick during the pandemic than ever before.”

“Crazy. Freaking. Busy,” says Maureen Ward, DVM, owner of Harrisonburg Animal Hospital in Harrisonburg, Virginia. While Ward acknowledges her profound gratitude for being as busy as they are, she concedes that stress is part of that package: “The frustrations we feel are the demands of the client to keep up the same pace, maintain the same availability, and possibly even increase flow since clients are home and wanting to be seen ASAP. . . . Some of our clients are unforgiving [of] having to push back wellness appointments or preventive surgeries, despite our team reviewing the limitations with COVID.”

Particularly frustrating for Ward: “I see a lot of people reaching out to their hairdressers and expressing flexibility in getting an appointment as they try to make up for lost time,” she says. “Unfortunately, there seems to be a disconnect in that same understanding for veterinarians.”

Chantel Steele, RVT, at Martensville Veterinary Hospital in Martensville, Saskatchewan, Canada, wrote on the AAHA Accredited Members Facebook page that “We’re in this sinking boat together,” as a message of solidarity to her AAHA colleagues. When NEWStat asked her to expand on that, she said, “We’re doing curbside appointments with minimal restriction on appointment type. We’re inundated with sick exams. There is no time to breathe between appointments. Every day brings new challenges, and every time we think we have things figured out, our ship springs a new leak.”

Steele says her hospital’s staff isn’t really dealing with the stress: “There’s no time. We’re in survival mode. We’re just trying to get through each day with our sanity intact.”

Yet Steele remained upbeat even as she amended her ship metaphor: “Our motor has seized and the navigation is broken,” she says, “[but] we’re staying afloat.”

And Steele, along with many of her colleagues, are doing it pretty well, according to one mental health professional.

“I observe [most hospital staff] doing better than they thought they could do,” Sandra Brackenridge, MS, LCSW, told NEWStat.

Brackenridge is a licensed clinical social worker and former associate professor of social work at Texas Woman’s University in Denton, Texas. Her specialty is helping veterinary professionals maintain emotional and mental health, and she supervises a veterinary social work internship program at the Center for Veterinary Specialty + Emergency Care in Lewisville, Texas, in addition to working as a consultant for other hospitals.

Brackenridge says everything about the pandemic has been “quite a challenge” to veterinary staff everywhere, and on many levels.

Even under ordinary circumstances, veterinary professionals are “a highly anxious population,” she says; the high rates of burnout, depression, and compassion fatigue in the field are well documented. “The interesting thing to me is that I’ve heard several people—veterinarians, technicians, nurses—comment that if they were a highly anxious population anyway, now they feel like they’re in the same boat as everyone else, Brackenridge says, coincidentally echoing Steele’s boat metaphor.

Brackenridge counsels veterinary staff to remember that life goes on for everybody during the pandemic: “Babies still get born to staff members. Parents still have problems. Illness is an issue.” Illness is a source of particular stress for hospital staff, she says, because “when they have symptoms, whether it’s a headache, fever, or sore throat, they worry they’re going to have to take time off to wait for test results [to come back negative]. There’s always the fear that you’re letting your team down [by taking time off].”

“Most private hospitals don’t have a social worker embedded in the hospital,” Brackenridge says, but management can still organize stress-relieving activities. As a consultant, she says she’s seen great success with activities such as TikTok challenges, during which staff vie to see who can produce the most entertaining 60-second video, with a gift card going to the winner. She says treasure hunts are good, too. Now that it’s June, she suggests doing “something that normalizes June, like a hot dog cookoff.”

But her favorite stressbuster: a poop-pinata party.

“For veterinarians professionals, poop is their nemesis,” Brackenridge laughs. So she has hospitals get a bunch of candy-filled pinatas in the shape of poop (yes, they’re a thing), and take turns whacking them with a stick. And while a poop-pinata party might be wonderfully therapeutic, almost any group activity will do: “Anything that’s just silly, fun, and maybe competitive.”

The group part is important (while keeping social distancing in mind).

“Some people have wondered if suicidal ideation has increased during [the pandemic],” Brackenridge says, but adds that, personally, “I have not seen an increase.”

She has her theories about that: “Isolation contributes to suicidal ideation, but the veterinary profession has kept going.” Most staff at hospitals are working in some capacity, and “Work de-isolates people.”

So while the work itself may be more stressful than usual, Brackenridge says the sense of community it provides can help reduce that stress.

For helpful resources, check out the “Wellbeing and self-care” section on our COVID-19 updates page.

Photo credit: © iStock/wilpunt