The Resilience War: Why Aren't Wellness Programs Working for Healthcare Workers?

Everywhere you look, healthcare systems are investing in employee wellness like never before. They offer free therapy sessions, access to wellness coaching and gym memberships, and some even have entire spaces dedicated to on-site wellness with things like massage chairs and aromatherapy.

Let me start by saying I whole-heartedly believe these interventions are wonderful tools in every human being's toolbox. We absolutely should have these resources available, and kudos to employers who are providing them.

HOWEVER...

Wellbeing and stress cannot go hand in hand. When a mind and body (which are very much connected) are stressed, we know they respond with a whole cascade of physiological responses that are innate and unstoppable. Our stress hormones rise, our muscles tense, our heart rate and blood pressure increase, and our brain stays on high alert for signs of threat.

According to Maslow's Hierarchy of Needs (https://www.simplypsychology.org/maslow.html ), safety and security are the second level of needs, just above physiological needs like food, water, and shelter. It is only after we feel safe and secure in a setting that we can develop the feelings of community, belonging, and trust needed to perform roles like nurses and physicians to the best of our abilities.

Additionally, Deci & Ryan's Self-Determination Theory (SDT) states that individuals are innately self-motivated toward growth and change via three universal psychological needs: Autonomy, competence, and relatedness/connectedness (https://www.simplypsychology.org/self-determination-theory.html ). Very basically, autonomy means an individual feels like they have control over their environment to a degree, competence means an individual feels that they have the skills to grow and do well, and relatedness means they have a sense of belonging in a group. All three needs must be met for growth to occur, and though some may have an easier time cultivating them, they are not automatic for anyone -- they require continued tending.

Deci & Ryan also argue that if too much motivation comes from extrinsic factors (such as rewards), individuals' sense of autonomy can suffer. Pizza party, anyone?

Lets synthesize what we have so far: Human beings need to feel safe and secure to feel part of a group, and in order for intrinsic motivation toward growth, people need to feel like they're part of a group. Without creating the environment for people to feel safe to grow in, they become static. . .and when humans become static -- feeling like they're running on a hamster wheel and never getting anywhere (no feeling of meaning or purpose) -- they burn out.

Let's also not ignore the fact that working in healthcare can cause secondary trauma (https://psychcentral.com/health/secondary-trauma ), and that trauma can be repeated shift after shift. Without adequate time to rest and digest (hey, parasympathetic nervous system!) in between exposures, they build up along with the constant stress hormones that wreak havoc on our minds and bodies.

When an individual remains in constant stress, their brain cannot focus on things that are NOT related to keeping them safe from a perceived threat. And in an environment where they've already established they don't feel safe or secure, they are constantly perceiving a threat. In healthcare that could be threat of lawsuit, losing a patient due to unsafe staffing, inability to take much-needed time off due to staffing, etc.

What does all of this mean?

Again, the well-intentioned and evidence-based wellness solutions are fantastic, but currently superfluous for most of the workforce, which can actually cause feelings of frustration and not being heard (lack of autonomy) and worsen the situation.

We have to first create a safe environment for employees to grow. That is beyond the scope of this little opinion piece, but there are MANY initiatives that incredibly smart people are working on currently, including changes to the models of care, reimbursement models, staffing levels, etc.

Changing the system is the only way we are going to get through this.