LAUSR

For more than 2 years, the world has been upended by the COVID-19 pandemic. Arguably, no other group has experienced challenges as intense and unrelenting during this time as hospital-based health care workers (HCWs). These individuals have played, and continue to play, a key role in the battle against COVID-19, risking psychological and physical safety in the face of this historic pandemic. Mounting evidence shows that HCWs have experienced acute psychological distress, with alarmingly high rates of anxiety, depression, burnout, and sleep disturbances that are likely to persist beyond these recurring waves of the COVID-19 outbreak.1 Prior to the pandemic, burnout in particular was common, with almost half of practicing US physicians reporting at least 1 symptom of burnout.2 This prompted the National Academy of Medicine in 2019 to publish a report outlining the causes and consequences of burnout, as well as proposing a framework for a systems approach to take action to mitigate burnout risk. Now, almost 3 years later, and in light of the current pandemic, the US Surgeon General published an advisory on addressing HCW burnout, further underscoring that conducting investigations and supporting HCW well-being must be a national priority.3 In this present study, Sexton and colleagues4 reported their findings examining emotional exhaustion (EE, one dimension of burnout) before (September 2019) and at 2 time points during the COVID-19 pandemic (September 2020 and September 2021/December 2021/January 2022) in more than 30 000 participants across 76 community hospitals in the US. Overall rates of EE were 31.8% (95% CI, 30.0%-33.7%) in 2019, 34.6% (95% CI, 32.5%-36.8%) in 2020, and 40.4% (95% CI, 38.1%42.8%) in 2021/2022, a proportional increase of 26.9% (95% CI, 22.2%-31.8%) during this time. In nurses, rates of EE increased steadily from baseline over the next 2 years (40.6% [95% CI, 38.4%42.9%] to 46.5% [95% CI, 44.0%-49.1%] to 49.2% [95% CI, 46.5%-51.9%]). In physicians, rates reduced initially from 2019 to 2020 (32% [95% CI, 29%-35%] to 28% [95% CI, 26%-31%]), before a sharp rebound from 2020 to 2021/2022 (38% [95% CI, 35%-41%]). The category for all others, comprising all non-physician and non-nurses (eg, pharmacists, technicians, therapists, clinical social workers), showed a steady increase from 2019 to 2021/2022 (31% [95% CI, 30%-33%] to 36% [95% CI, 34%-23%] to 41% [95% CI, 38%-43%]). Sexton and colleagues4 suggest potential contributors to EE in HCWs, including some that may have been uniquely exacerbated during the COVID-19 pandemic. They point to the overt politicization of public health during the pandemic and state that HCWs have had to contend with an intensification of incivility directed at them for following COVID-19 protocols. This claim is well aligned with several studies demonstrating a high prevalence of work-related violence (including verbal and physical) reported by HCWs during the pandemic, which is associated with burnout risk.5 At this time, at least 6 US states have passed or introduced legislation to protect HCWs from workplace violence. More evidence is needed to support such policy efforts by examining the adverse effects of workplace violence on individual, patient, and organizational outcomes. Sexton et al,4 as well as others,6 also point to the role of clerical tasks, such as electronic health record (EHR) documentation burden, as a contributor to EE. They suggest that the temporary flexibility and decrease in EHR requirements during the pandemic (eg, due to gubernatorial executive orders that provided temporary relief of standard documentation mandates) may have accounted for the decline in EE reported by physicians in 2020. EHR use data were not collected in the current + Related article