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Steffinie Brewer

Professor Hellmers

ENG 1201 – B52 

27 November 2021

Temporary Nature

            Per a recent survey conducted to determine job satisfaction among healthcare workers, it

was revealed that nearly 80% of said employees are content with their level of satisfaction,

(Chen, et al). Despite this, healthcare workers remain more vulnerable to melancholic thoughts

and actions, such as attempted and completed suicide, anxiety, and depression than the general

population is, (Beautrais). Healthcare workers are disproportionately more prone to suicidal

ideations and attempts, as well as mental health challenges, than non-medical citizens and

something must be done about these appalling statistics. 

            I personally work in healthcare, so I began writing this paper with more experience than a

non-medical citizen. During the research and preparation for this paper, I learned many more

things I did not know. A term that will be used throughout this paper is “suicidality” meaning the

risk level of suicide. There are also going to be references to “attempted suicide” meaning that a

person attempted, but did not, take their own life, and “completed suicide” which means that an

individual took their own life. “Occupational burn-out” has been described by the World Health

Organization as, “a syndrome conceptualized as resulting from chronic workplace stress that has

not been successfully managed,” (WHO). FDNY EMS stands for Fire Department of New York
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City, Emergency Medical Services. FDNY EMS is the largest civil EMS system in the U.S.

EMT stands for Emergency Medical Technician; these individuals can provide basic life support

(BLS) care, and typically work prehospital, responding to emergency 911 calls. For the purpose

of this paper, “diversion” is a term used mostly by EMS systems and emergency departments to

inform patients and other systems that they can no longer accept patients and are therefore on

diversion. Suicide and mental health can be difficult topics to approach and talk about, but it is

extremely important to have conversations about the risks and what can be done to help

destigmatize mental health and reduce suicidality. 

            Many of the previous reviews, studies, and research papers focus directly on the mental

health of nurses, physicians, and medical students. For this paper, the term “healthcare worker”

is widely encompassing, blanketing from first responders to physicians, and nearly all healthcare

providers in between. 

            As previously mentioned in the introduction, many healthcare providers report a high

level of satisfaction within their job and relationships among colleagues. Regardless of this

statistic, it is a known fact that working in healthcare can very quickly lead to stress and burn-

out. Per a survey by the CDC, it was identified that, “93% of health care workers were

experiencing stress, 86% reported experiencing anxiety, 77% reported frustration, 76% reported

exhaustion and burnout, and 75% said they were overwhelmed,” (Chosewood MD, et al).  These

feelings of anxiety and burn-out are not exclusive to the workers, though. A systematic review in

2013 revealed that, “at least half of all medical students may be affected by burnout during their

medical education. Studies show that burnout may persist beyond medical school, and is, at

times, associated with psychiatric disorders and suicidal ideation,” (Bernstein, et al). 
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            It has become a widely known fact that healthcare workers have higher suicidality rates

than the general population, but it is not talked about enough. A recent article written by a

psychiatrist and psychologist reveals that, “health care workers have always been at

disproportionate risk … physicians and nurses are 2-3 times more likely to complete suicide than

the general population, with female physicians especially at risk,” (Benheim & Jacobs).  A

separate study found a, “70% higher rate of mortality due to suicide and self-inflicted injury

among white male U.S. physicians than among other professionals. Female physicians’ suicide

rate, however, far exceeds that of the general population, in the range of three- to fourfold,”

(Colditz & Schernhammer).

            While mental health has always been an issue amongst healthcare workers, the recent

COVID-19 pandemic has only worsened the feelings of isolation, depression, anxiety, and

burnout for the individuals in healthcare. Staffing has always been an issue, but there is an

additional strain with this pandemic, due to these workers being exposed and testing positive. In

addition to this, there is a massive influx of new patients, and many of these can become critical

very rapidly. All of this is on top of the typical workload and general under-compensation. For

example, FDNY EMS responded to a record number of over 6,500 calls in one single day during

Spring of 2020, (Pskowski). In April of 2020 a brand new EMT, John Mondello, graduated

FDNY EMS’ academy and began working at EMS station 18, one of the city’s busiest stations. It

was not even three months of working in this position, during the beginning of the pandemic,

that Mondello completed suicide. His story is devastating, but it is unfortunately not the only one

like it. There are numerous healthcare providers that cannot handle the stress or pressure and end

up attempting or completing suicide as an attempt to end the misery they are living through. 
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            Now to answer the question everyone might have; why do these groups of occupations

suffer from higher rates of depression, anxiety, and suicidality? This answer is not black-and-

white and may truly never have a definitive answer. However, there are numerous factors that

can lead to this heightened risk. To begin with, healthcare is known for long, grueling, and

everchanging shifts. Many of these workers do not get lunch breaks during their shift; they can

be lucky to even get the opportunity to use the restroom or even sit down. Healthcare providers

will encounter infectious diseases, hazards, and violence from patients and/or patient’s families.

Above all, though, is the routine exposure to suffering and death. Some of the things that

healthcare workers see on a daily basis makes it easy to experience suffering themselves. There

is an article written by an emergency medicine physician that I personally know and work with

that gives a glimpse as to what life is like as healthcare worker, specifically focusing on

emergency medicine. “We suck it up. We learn to turn ‘it’ off. Too well, in fact. What choice do

we have? We cope. We walk into fatal car accidents with our first thoughts (mentally, at least)

being, ‘were they drinking, were they high, they probably weren’t wearing their seat belts.’

Something, ANYTHING, to separate us from this. Something, ANYTHING, … to convince

ourselves that we are not so temporary. That our spouses and our children are not so temporary

…We, more than anyone, understand the temporary nature of it all. The unfairness of it all. That

even children aren’t safe from this awful game of life that, no matter what, ALWAYS ends in

death …this is our job. This is our life. Even if we quit, it’s too late. Once you peep through that

hole you can never pretend you haven’t seen it …If I did this job alone, the isolation would drive

me insane. But I don’t. My co-workers are my sanity. My family: my rock. Together we get

through this life with our eyes wide open,” (Carone MD). 
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            Some people may argue the fact that healthcare workers are not at higher risks for

suicide. They might believe that there is just more research for healthcare providers than there is

for the general population. Other protestors to these statistics may argue that their rates are

higher simply because of the access to lethal drugs that healthcare workers have. It is a frivolous

claim to say that other cases of suicide and mental health are not explored as it was not until the

recent pandemic that brought the mental health of our so called “frontline heroes” into view. It is

more justifiable to say that their suicidality is elevated due to their access to fatal drugs and their

knowledge of how to use them, (Chosewood MD, et al).  Nonetheless, it is impractical to say that

this explains their inordinate risks of suicidal ideations and desperation. To make that claim is to

undermine the severity of the issue at hand. If this were to be true, then suicide would not be as

prevalent as it is amongst the general population. 

            The greatest issues that persist in most healthcare systems are understaffing, under

compensation, and excessive patients. It has been widely known that the nurse-to-patient ratio

can border dangerous levels at times. This risk has forced some states to pass legislation

regarding the number of patients that a nurse can care for at once. For example, “the American

Academy of Emergency Medicine advocates for a 1:3 maximum nurse-to-patient ratio,” (Eales

DO). As mentioned in previous paragraphs, healthcare systems are now seeing more patients

than ever, and many of these patients end up being critically ill and requiring extended care,

which puts a further strain on an already struggling system. In the midst of this pandemic,

hospitals have become overrun and are having to divert patients. There are two primary causes to

this: lack of beds due to excessive patients, and lack of beds due to staffing issues. There was a

recent discussion with a handful of physicians and nurses, and I have included annotations from

this conversation that help explain this, “…with record hospitalizations in Tennessee nearly
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every day. Reinforcements are getting much harder to find. Tennessee built its own field

hospitals, but Dr. Lisa Piercey of the Tennessee Department of Health says the state would have

trouble finding the doctors and nurses to run them. DR. LISA PIERCEY: Hospital capacity is

almost exclusively about staffing. Physical space, physical beds - not the issue,” (NPR). 

            From this point, it should be clear that some of the biggest issues for healthcare personnel

are staffing shortages, under-compensation, and a massive increase in workload. These issues

can very easily lead to stress, which in turn will lead to more troubling issues for this group of

people. Now, to answer the question many people have: what can be done about this?

Unfortunately, this is a very difficult question to answer, mainly because the answer is not black-

and-white. The answer to this varies on a case-by-case basis as no two systems are the same.

Many of these systems are facing their own interior problems that may not fit into the categories

covered today. However, it is possible to help lighten the load. Some of the most overrun

divisions are emergency departments (ED’s) and EMS systems. This is because these are

typically where patients first encounter healthcare. It is up to EMS systems and ED’s to triage

the patients and determine if they need advanced and long-term care. The biggest

recommendation to decrease the stress and workload would be to see less patients. If a person is

unfamiliar with emergency healthcare, that might seem like a preposterous statement. However,

a large survey conducted by the New England Healthcare Institute (NEHI) revealed that 56% of

ED visits were avoidable and unnecessary, (NEHI). Educating the public on what is a justifiable

ED visit would help eliminate a large strain on the staff and make the situation much easier to

manage. With less patients, there would be less need for staff and less demand for higher pay. Of

course, that would not solve all the issues, but it would help tremendously. 
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            Healthcare is a fantastic field to work in, with high levels of job satisfaction and

contentment. And while it is a great career to go into, there are also risks you are predisposed to.

These risks were covered throughout this paper, and primarily include mental health struggles.

At the time this was written, the mental health of our frontline workers is being addressed now

more than ever. While it has been long and grueling, these concerns are finally being addressed.

The future holds brighter days for our healthcare providers, and in turn, brighter days for all of

humanity. 

            Special thanks are given to Heather Carone, MD. for her fantastic article written that

gives a glimpse into the life and loss of healthcare workers all around the world. 

https://epmonthly.com/article/the-peephole/

            

 
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Works Cited

Beautrais, Annette. “Stress and Suicide in Medical Students and Physicians.” Shibboleth

Authentication Request, Apr. 2020, web-s-ebscohost-

com.sinclair.ohionet.org/ehost/detail/detail?vid=6&sid=2dd7f6e8-dbf3-471a-840b-

8a9ca4c7d85b%40redis&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3D

%3D#AN=143166492&db=a9h.

“Burn-out an ‘Occupational Phenomenon’: International Classification of Diseases.” World

Health Organization, World Health Organization, 28 May

2019, www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-

international-classification-of-diseases.

Eales, DO, Tommy. “Unsafe Nursing Ratios Incapacitate EDS, Endanger Patients.” EMRA, 8

Apr. 2019, www.emra.org/emresident/article/nursing-ratios/. 

Edelman, Susan, et al. “EMT John Mondello Kills Himself after Less than Three Months on the

Job.” New York Post, New York Post, 27 Apr. 2020, nypost.com/2020/04/25/nyc-emt-

commits-suicide-with-gun-belonging-to-his-dad/. 

“Hospitals across U.S. Find Themselves Understaffed, with No Reinforcements

Available.” NPR, NPR, 24 Nov. 2020, www.npr.org/2020/11/24/938593066/hospitals-

across-u-s-find-themselves-understaffed-with-no-reinforcements-availab.

Jacobs, MD, Douglas G., and Marci Klein Benheim, Ph.D. “When Helpers Feel Helpless:

Mitigating Suicide Risk of Health Care Workers in a Pandemic.” Stop a Suicide

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Today, stopasuicide.org/when-helpers-feel-helpless-mitigating-suicide-risk-of-health-care-

workers-in-a-pandemic/.

Lu, Yong, et al. “Job Satisfaction and Associated Factors among Healthcare Staff: A Cross-

Sectional Study in Guangdong Province, China.” BMJ Open, British Medical Journal

Publishing Group, 1 July 2016, bmjopen.bmj.com/content/6/7/e011388. 

“A Matter of Urgency: Reducing Emergency Department Overuse A NEHI Research Brief –

March 2010.” New England Healthcare Institute . 

Pskowski, Martha. “'It Doesn't Feel Worth It': Covid Is Pushing New York's Emts to the

Brink.” Kaiser Health News, 24 Feb. 2021, khn.org/news/article/it-doesnt-feel-worth-it-

covid-is-pushing-new-yorks-emts-to-the-brink/.

Schernhammer, MD, Eva S., and Graham A. Colditz, MD. “Suicide Rates Among Physicians: A

Quantitative and Gender Assessment (Meta-Analysis).” Shibboleth Authentication Request,

1 Dec. 2004, web-s-ebscohost-com.sinclair.ohionet.org/ehost/detail/detail?

vid=9&sid=2dd7f6e8-dbf3-471a-840b-8a9ca4c7d85b

%40redis&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3D%3D#AN=15391458&db=a9h.

Tiesman, PhD, Hope, et al. “Suicide Prevention for Healthcare Workers.” Centers for Disease

Control and Prevention, Centers for Disease Control and Prevention, 17 Sept.

2021, blogs.cdc.gov/niosh-science-blog/2021/09/17/suicide-prevention-hcw/. 
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Waguih, Ishak, et al. “Burnout in Medical Students: A Systematic Review.” The Clinical

Teacher, U.S. National Library of Medicine, 10 Aug.

2013, pubmed.ncbi.nlm.nih.gov/23834570/.