Getting to the heart of travel healthcare.

A podcast hosted by Sunny & Matt

Podcast Transcript


Stephanie Levy is a licensed therapist to the first responder community. She joins Cardium Podcast to talk about mental health for healthcare workers during COVID-19.

Healthcare Workers and Mental Health: The Impact of COVID-19

June 24, 2020


Voice Over: Welcome to Cardium from Aureus Medical, the podcast that gets to the heart of travel healthcare and asks, "What's your why?' With each episode, we explore the topics and issues that impact healthcare professionals in the fields of nursing and allied health. Now, here are your hosts, Sunny and Matt.

Matt: Welcome to another episode of Cardium. If you're a subscriber, welcome back. Thank you for being part of our Cardium family. If you are a new listener, thank you for stopping by. We hope you enjoy today's podcast and we'd love for you to subscribe so you can enjoy our future podcasts. Joining me as always, my cohost, Sunny. Hi.

Sunny: Hi, how are you?

Matt: I'm good. Just enjoying these interesting times that we're living in.

Sunny: It's definitely interesting times.

Matt: Yeah. The point of our recording here, we've been doing this awhile, so there's a lot to think about, especially you and I. We talk a lot and it seems like our conversation is really centered around how are you doing? How's your head?

Sunny: Where are you at?

Matt: Yeah, yeah, yeah. Besides, where are you at, are you in your kitchen today? Are you in your living room? How's your head?

Sunny: I think I'm doing okay. There's ups and there's downs, especially since we are generally isolated for the most part in these times. There's anxious moments and then there's really, really good moments. But for the most part been really, really, really good. What about you?

Matt: I'm good. The working from home is different and I think you miss the comradery, but it's all the other things. It's the stuff on the news, and it doesn't matter where you tune in and it's the stuff in the world. Then on top of that, you're not with your immediate coworkers, so your meetings have to be planned. Even if you want to shoot the breeze with someone, it has to be a planned thing. I think that that's been a lot of our conversations with our coworkers is really, where's your head at and how are you doing? We talk a lot about morale in some of our conversations, how's the morale with your team and how's the morale with you? So I think today's topic is extremely important because we can talk about not only where we're at and we're not on the road. We're home.

Sunny: Yeah. We're lucky to be home with our families and our loved ones where we can reach out and literally have someone we can talk to. Even with our coworkers who we worry about those that maybe live alone, we're constantly able to reach out to them and maybe check in with them. We have to worry about those that are on the road, who maybe don't have someone that can literally reach out, and talk to them on daily basis.

Matt: Yeah. Combine everything else that they're dealing with as a healthcare provider. They're seeing the normal grind of the business and trying-

Sunny: Yeah, the hardships…

Matt: Yeah. Yeah. Then on top of the that, all the other things. Yeah. So extremely important and extremely pertinent information today. I think that this podcast will resonate with a lot of people and it's a little bit different than what we've done before because of the gravity of what's going on in the world around us.

Sunny: Very sombering topic, but also just give us a lot of great information on how we can move forward. So today our guest today is Stephanie Levy. Thanks for joining us.

Stephanie: Thank you.

Sunny: Just a quick bio on Stephanie. She received her master's degree in social work and is a licensed independent clinical social worker. Stephanie has been a therapist for the past 17 years. For the past seven years, focused her practice on first responders. Integrating into the first responder community and receiving specialized training has allowed her to connect with first responders and serve them better. Currently, Stephanie serves on the board of trustees for the First Responder Support Network and works as a lead clinician at their West coast post-trauma retreats. She has worked to bring the retreats to the Midwest to better serve first responders in this region. Stephanie is the director of the First Responder Support Team, which is part of the First Responder Foundation. Welcome.

Matt: Welcome, Stephanie.

Stephanie: Thank you so much for having me.

Sunny: First of all, just want to talk about your experience with first responders and tie that into health care workers and their space in our field.

Stephanie: Right now with the pandemic going on, a lot of our healthcare workers are on the front lines as first responders. They're absolutely essential, and putting themselves at risk in ways they never had to before. So the parallels between the two groups ... They've always had good working relationships. The paramedics get to know the nurses when they bring people in and they've always had just a bond in that way. But now the nurses, especially the ones working ER, working really in the front lines of COVID, there's this parallel between they are the first responders as well, and dealing with stuff that they we're not necessarily equipped to deal with because there's not a lot of knowledge about it.

Matt: You nailed it for sure, Stephanie, but since a lot of the health care workers in general are acting as first responders as you said, what's the state, the mental state, the mental wellbeing for the traditional, as we look at it, first responders from your point of view and what you're hearing?

Stephanie: In the beginning when this started, I'd say back in March, and first responders really feel like, "This is my opportunity. I'm here on the lines. This is what I've been trained for." But we've taken this acute crisis that's now turned chronic and we're three, four months into this. Everybody's just very worn out at this point. The great thing about first responders is under that pressure, they can react so well and do their job and they're excellent. It all crumbles, or they really feel the effects afterwards, but with this crisis lasting so long, people are really getting worn out from it.

Matt: Does that put an additional strain on them? Because, like you said, they step up when things get rough, but is there a point where they're seeing things that they never expected? When they raised their hand and said they want to do this job, they want this profession, but they're seeing things that they never expected. No one in training, no one in the industry told them that they were going to see these kinds of situations.

Stephanie: Absolutely. I feel that the health care workers, especially the ones that have lost people on their team to COVID, are being impacted in a way they were never trained for. Not that police or fire are trained about how to manage a loss within the department, but they know that it's a possibility and still it impacts departments for years to come. Well, now we have healthcare workers who are experiencing this and that is not what they ever thought would happen. Having to, okay, and you wake up the next day and go do it again and you're losing people on your own team. Very stressful.

Sunny: I think we have to also give maybe a visualization for those listeners that maybe are not first responders or are maybe on the administrative side or are just listeners who like to listen. So thank you. But to give them a reality of what these first responders are experiencing, because a lot of times it's not just ... When you experience going in and getting care, you envision a hospital bed and being a patient and receiving care. But just imagine you being that nurse, let's say, who is the patient's only point in contact, and maybe the person is passing away and still being that only point of contact. So you have to imagine that this person now has to wear multiple hats and it becomes such a physical and emotional response for this person. That's not a training that I would imagine anyone can prepare for it. Am I correct in that? Or can you give more of maybe a visual for our listeners on that?

Stephanie: I think you're absolutely right with the different hats that people are having to wear with the limited visitation in hospitals and nursing homes. So these nurses are having to be the connection with family, hold up FaceTime for final goodbyes, do things that just engages them more and more emotionally with the family, which then makes that loss even harder. So the more time you spend with family, the more you're facilitating those talks, the greater you're going to feel that loss. Especially for those healthcare workers that have parents may be in the same demographic or kids. The closer the age and demographic the patient is to what's going on in that nurse's life, the harder it's going to hit because the empathy goes up. Like, I can see myself in this person. I imagine that hurt because that could be me.

So nurses are having to do so much and balance this emotional piece that is harder than it ever has been before, I imagine. Normally physiologically, there's a crisis, heightened awareness, your adrenaline's going, you take care of it, and then you have that time to come down. But with this long hours, day after day, this crisis lasting, people's level of adrenaline, hypervigilance, all of that, is so elevated that they're not able to come down to their baseline in between shifts and physiologically. That can be really tough on a system.

Sunny: Yeah. I can relate to that. My dad recently was in the hospital for a heart attack and it was hard because I'm bawling, my mom's bawling, we can't go and visit him. He's scared. He's a retired military vet of 20 years and he has anxiety and depression on top of it. He's like, "Oh my gosh, I can't talk to my family member." His nurse, he was so thankful for, because she was trying to calm him down and they're treating him for his heart, but also treating him for anxiety because that was making him worse because he was just like, "Am I not going to be able to say goodbye to my family?" That was tough for all of us.

Stephanie: Oh, so scary. Then also to mention, these nurses are not able to step away and take care of themselves using their normal coping because the world's just so not normal. So I keep hearing from nurses that, "When I do get off my shift, I come home, I won't let any of my kids hug me. I have to [inaudible] scrubs off, take a shower." Or, "I can't see family I used to see," or, "I can't go to the fitness classes I used to go to." All those things that we build into our lives that would bring that adrenaline down, that would take us to our baseline, there's barriers in doing them. So that's a whole other level of, how do they take care of themselves in this pandemic now?

Matt: Yeah, it's interesting you say that about the extent of the trauma that they are dealing with. Many of the things that happen in healthcare workers lives, they're dealing with in hours. An emergency where they're dealing with mass casualty and it's hours, perhaps a couple of days, that they're dealing with the aftereffects of a mass casualty. What we're dealing with now is completely different. So you almost liken it, and I want to circle back to the situation where you're talking about PTSD. Because PTSD to me, my mental state, you hear about it in combat or war, or really terrible, terrible situations. This is terrible, so now I think that we start talking about PTSD and the effect of PTSD and how it aligns with healthcare workers in the field today. Can you talk a little bit about that with the folks that are working in the front lines?

Stephanie: Absolutely. The criteria for PTSD is witnessing or being involved in a traumatic event where you feared for your safety or someone else's safety. All of our healthcare workers right now are facing this trauma and being exposed to it. The difference between [inaudible] diagnosis or not really depends on a couple of things. I'd like to say that lack of sleep, racing thoughts, a little anxiety right now, that is a normal response to a very abnormal situation. So the fact that you're experiencing that just means you're human and this is rough. Where it starts to differentiate is the length of time. So when we're looking at three and six months past the crisis, the disrupted sleep, the anxiety, the intrusive thoughts, maybe avoidance of certain places, that's when you would really qualify for a diagnosis of PTSD if you have these symptoms and they're very disruptive to daily life.

One of the issues, we can't even begin to predict the trauma that's going to come out of this because we're still in the middle of it. People coming home from Vietnam, they were so different. Now it's however many years later, and they're still carrying that trauma. This is going to have long-term impact. The positive side, the hopeful side is nurses now, healthcare workers now, can do things to build their resiliency. Part of this whole process and trying to go about it in a healthy way is just noticing the trauma. This is trauma, this isn't normal for me. Although there's a very helpless feeling in that, there's ways you can take control. Look at what you can control versus what you can't control, because there are so many things in this that we all feel helpless with. So really making an effort proactively to take care of themselves, to connect, to talk, things of that nature.

Matt: Yeah. I'm glad you mentioned that. We've had other podcasts where we talk about sometimes healthcare workers, they put everybody else in front of themselves and they forget themselves. I don't recall which podcast, but Sunny has mentioned it speaking with, I believe it was a nurse. But it was amazing because you think that healthcare workers would be able to recognize, "Boy, I need help. I need to talk with someone. I need to find a way to deal with the stress I'm working with." But in many cases they don't, because they're so worried about their patients. They're worried about their family. They're worried about the next patients. They're worried about their family of the patients. So I'm just curious on coping mechanisms or coping skills that a healthcare professional can take a look at. Just something that you're thinking of, of dealing with this crisis.

Stephanie: They have all been trained to be caretakers and meet each other's needs. So normally they're very poor about setting those boundaries to take care of themselves. So what I always encourage people to do is utilize your day off. You get called in for overtime and you have the option to say no, put things physically on the calendar. Plan for things you'll do, write it down, be accountable for yourself. Even if you don't feel like it, you do it anyways. Because oftentimes when you hit the day off, all the first responders, healthcare workers included, they're exhausted. They just want to collapse in their chair and do nothing.

But what will get them back down to baseline physiologically is really participating in the hobby they enjoy. If it's walking the dog, going fishing, connecting with friends, that's more effective than just laying there watching TV all day, in terms of getting back down to your baseline. So I always encourage the healthcare professionals to put things on the calendar, times to connect, keep doing your hobbies, even though it's a crazy time. It's more important than ever. In our culture nowadays, the crazier our lives get, stress level goes up, self care goes down. Really, as our stress level goes up, we need to up our game and how we take care of ourselves.

Sunny: That's so important for you to say that because, especially with our travelers out there, I think it's really doubly important to engage yourselves into something while you're on the road., I would like for you to speak, especially to our travelers as to how they can recognize, because they're alone. If they're not traveling with someone, they are alone. They have to be able to identify when they are reaching that point of fatigue or that point of where they are reaching that breaking point where they're not just tired from just having too many shifts or they're just getting to the end of their travel assignment, but where they're reaching that point where they need to reach out and either talk to their recruiter or talk to someone that says, "Hey, I need help. This is more than just regular, every day. I need a break. This is where I need to maybe talk to someone." How can they recognize that for themselves when they are alone?

Stephanie: I think that isolation the traveling healthcare workers are dealing with, everyone to some degree is dealing with some isolation right now. So it's even worse for them when they don't have those roots in cities. Some of the things to look for, if you are doing your hobbies and your coping things, and it doesn't help. Like, if you spend a day golfing, most people feel better afterwards. If you're not able to enjoy things you used to enjoy, that's a red flag. If you are not sleeping, if you're not eating, it's like your body is reacting and giving you signals and you need to address it and look at, how can I help myself in this? Get back to the basics, eat, sleep, reach out to someone, whether that's a therapist or a friend, but recognize that, "Okay, I'm doing what I normally do. I'm just not able to snap out of this. I may need some extra support."

Sunny: I always say, too, if people start saying things. Like, if your recruiter is saying things like, "That doesn't sound like you," those are key statements to also remember. "That doesn't sound like you, are you okay?" Maybe you should take a step back because, believe it or not, your recruiter relationship is really, really strong, especially if you've been working with that person for a long, long time. When they start to hear, "You don't sound like yourself, is everything okay?", then maybe, for our listeners out there, start keying in on that and start wondering, "Gosh, I wonder why they're asking me that question.

Maybe I need to do a self-reflection and maybe listen in to myself, and if I'm not sleeping, if I'm not feeling A-okay, maybe I do need to talk to Matt over here and find out I'm not okay." So maybe doing a self-reflection or wondering why they're asking me that or why my teammates at work are asking me that I'm not maybe looking my best.

Stephanie: Definitely. I think that the recruiter, people on the team, or even family members, if they're not in the same city, over the phone, they can pick it up before even the person. Because when you're in the middle of it, you don't necessarily see it. Then be like, "Yeah, you haven't been acting like yourself, are you okay?" Or, "Every time I talk to you, you're exhausted and at the end of your rope. Every time. So when can we get you more support because no one wants to feel that way all the time."

Sunny: Yeah. That's true. Where are some areas in which they can seek support?

Stephanie: I know right now there are a lot of online support groups for healthcare workers, so I will give some resources to you guys that you can post or however you do that. But there's online support groups. There is also within hospitals, hopefully, some support groups in person. Then also just connecting with whatever resources are available, EAP, therapists in the community, things like that, to help with this whole process for them.

Matt: Yeah. I think that would be very helpful. I would appreciate the information. I think there's a lot out there. There's certainly more support out there than there were years ago. I think that it's more important now to recognize that there are mechanisms out there to go and seek that support. I want to talk a little bit about the stigma in the healthcare industry and the barriers for people to reach out. Because while it's easy to say, "Well, there's plenty of support groups. There's EAP.", it's one thing to say it, it's another thing to say that there is a stigma to doing that and the barriers besides life and besides the job. Can you talk a little bit about that, Stephanie?

Stephanie: Yes. There's a stigma with mental health and working with first responders, there's definitely the stigma with mental health and I've seen how the culture is starting to shift. Within healthcare, being the person who is the caretaker, it's so hard to wave the flag and say, "I need help," but I really believe that healthcare workers should be doing a check in with a therapist every six months or so to have a place to dump some of this. It's a lot to carry. I encourage people who do go to therapy to be open about going to therapy, which is very vulnerable. But if you are willing to be brave and say that, it gives everybody else in your unit or on your team permission to say it too. It's when everyone has to be handling everything okay is when the culture can become very secretive and stigmatized.

That's not what we want. Being real is, "this is hard and I'm struggling." So if someone's brave enough to say, "I'm getting help for it," without even realizing it, they've given other people permission to do the same. That's where I've seen the cultural shifts among the police and fire departments, is it takes one of the strong dudes that can handle anything to say, "I'm struggling." Then you have 15 other people raising their hand saying, "Oh, me too. If he's struggling, and in my mind he can handle anything, it's okay if I struggle and say something too." The same thing needs to happen in the healthcare industry.

Sunny: I like that. It's an invitation of self-care.

Stephanie: Absolutely.

Matt: It sounds like both you and Sunny have mentioned talking with peers is such an important part. Is that where you would say to start? If they're recognizing that they need, is talking with the peers is where you would recommend? Because everybody's in it together and you're experiencing similar challenges, similar crises, similar situations inside the facility. Is that the best place or where's the best place to start?

Stephanie: I would start with talking to a peer and connecting with someone you trust and saying, "I'm struggling with this," and seeing how that helps you. Maybe you need a therapist, maybe you don't. Maybe just having a really honest with a peer. In the first responder world, we do a lot of peer support where you keep each other accountable and say, "Okay, well, what can you do for yourself that would be healthy? How can we move forward? I'll check in with you in a week." It'd be great if the same sort of peer support was available and made amongst the health care workers. It's just a friend who cares that you could be honest with and will check in with you.

Now, of course, if things are more at a crisis level and severe, and there may be substance abuse or suicidal thoughts, peer support is wonderful, but it's not treatment. They need treatment at that point.

Sunny: Sure. Don't look for a counselor in your peers.

Stephanie: Yeah, exactly.

Sunny: Work within your scope.

Stephanie: Yes, exactly. Stay within your scope. It'll be fine.

Sunny: Also to our listeners, we want to make sure that that you're hearing us and you're listening. One of the things that we want to encourage you to do is, the first step is to talk with your travel company, your recruiter, to find out what benefits are available to you. I'm sure that they have a way for you to reach out to an EAP, to find out what mental health benefits are also available to you. That's your first step, but we encourage you to do so, especially during these times, but anytime. Then as Stephanie mentioned, she'll also give us stuff to post. But going forward in post pandemic, what may a healthcare professional who has been on the front lines of the pandemic experience during the months and perhaps years to come, what can they be, or should they be, on the lookout for, be aware of?

Stephanie: There's going to be an adrenaline dump and exhaustion, but after getting rest and a vacation, they should come back to their baseline. Everything should, over time, shift back to their baseline. If they're not able to do that, they're still exhausted, if they're having intrusive thoughts about some of what they saw on the front lines, if they're not able to get to who they felt like they were before this, that's when they would really need to start looking for some help.

Matt: Well, Stephanie, we could go on and on and on. I think as you'd mentioned, this is just the beginning. Quite honestly, the aftereffects of what we're going through in the world will be felt for years. So unfortunately, or maybe fortunately, we'd love to have you back someday. We'd love to know maybe your thoughts a few months from now about where we're at, especially with mental health, with our healthcare workers. So we'd love to invite you back someday to talk more about what you're seeing at that state. Before we let you go, we ask all of our guests a really important question, one of the cornerstones of our podcast. Stephanie, we'd like to know what is your why?

Stephanie: Well, my why is I've always been a caring person that wanted to help and give people a voice in some way. It's interesting throughout my journey as being a therapist, I saw myself working in one field and then started working with first responders and realized I wanted to give people a voice and break down those stigmas. Like nurses, first responders, they don't get to choose who their patients are. They can't say, "That call sounds horrible. I'm not going to go." They have to go. So I want to give support and a voice to the people that don't necessarily understand the mental health ramifications that they're getting into when they signed up for the job, and all the trauma they're facing that they can't even fathom that their brain doesn't know what to do with. So it's really about taking care and supporting others in their journey.

Matt: I love it. That's a pretty important why.

Sunny: Yep.

Matt: Thank you very much for joining us today on this podcast. It's been really interesting and I think it just highlights some of the really important factors out there when we're talking about our folks on the front line, when it comes to healthcare. So thank you again from Sunny and myself, Stephanie, we appreciate having you today.

Sunny: Thank you.

Stephanie: Thank you for having me.

Sunny: We encourage all of our listeners to please listen to what we and Stephanie, especially what Stephanie, had to say and really take care of you. Hopefully, we hear some more about all of the good things that Stephanie has to say in the future. We love to hear from our listeners, so please drop us a review and let us know what your thoughts are on today's topic or anything else you'd like to discuss. Thank you for listening to Cardium podcast.

Matt: Bye-bye, everybody.

Voice Over: You've been listening to Cardium from Aureus Medical with your hosts, Sunny and Matt. We are the podcast that gets to the heart of travel healthcare. To subscribe, access show notes, or to learn more, visit, C-A-R-D-I-U-M Or wherever you're listening, be sure to rate us, review, and subscribe. Thanks for tuning in. Until next time.

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