Doctors and nurses rarely learn in school how to tell a family that their loved one is not going to survive. Yet healthcare professionals face the enormous burden of tragedy, illness and death in an intensely stressful environment as a routine, ongoing part of their work.
Long before the COVID-19 pandemic, research was documentation of rampant stress and burnout among health professionals.
The implications of this the crisis is widespread in the USA In 2022, Surgeon General Dr. Vivek Murthy expressed concerns about the alarming levels of burnout in the healthcare community amid the COVID-19 pandemic.
Studies show that if current trends continue, the U.S. will see a shortage of 1.1 million registered nurses, 3 million other health care workers, and over 140,000 doctors by 2033. A 2022 Mayo Clinic study reported that only 58% of doctors he would choose to become a doctor again if offered the chance to reconsider their career choice, down from 72% from just a year ago.
CORAL
For nearly two decades, our research team – a team of clinicians, researchers, creative arts therapists and writers – has focused on understanding the impact of occupational stress on healthcare workers. In our experience, almost every healthcare worker has a story about navigating the moments when the burden of the profession is too much to bear.
To help address this issue, in 2019, with funding from the National Endowment for the Arts, our team established the Colorado Resiliency Arts Lab, or CORAL. Our aim is to use creative arts therapy as an intervention to improve health professionals’ well-being and restore their sense of purpose in these challenging work environments.
As doctors who have worked in intensive care and emergency medicine For many years, we have believed that this integration of creativity in healthcare is vital. The health of the nation depends on the well-being of the health care workforce. We believe that incorporating creativity and the arts as a tool to build resilience in healthcare workers could help change the culture of emotional isolation in which healthcare workers live.
CORAL
An upcoming challenge
We as healthcare workers push ourselves to the limit to learn new ways to improve human health. The irony is that this often comes at the expense of our own physical, emotional and mental health. We learn to mask our emotions and internalize all the negative events we see in healthcare. But this is unsustainable.
In the 2000s, up to 80% of critical care nurses reported experiencing exhaustion or other forms of psychological distress. This contributed to a high rate of turnover, with 67% of nurses planning to do so leave their positions within three years. This has led to an increase in health care costs, compassion fatigue among workers and reduced quality of care for patients.
Then came the COVID-19 pandemic, which increased the stress on health workers: 3 out of 5 doctors reported burnout by the height of the micron variation in 2022.
A combination of higher work demands, workload, job complexity, work pressure and intensive work time during the COVID-19 pandemic has increased stress among healthcare professionals and led to emotional exhaustion.
Satisfaction with work-life balance decreased from 46.1% in 2020 to 30.2% in 2021.
In the post-COVID-19 era, healthcare workers like us are at higher risk anxiety, depression and post-traumatic stress disorder. Burned out healthcare professionals are unlikely to seek professional treatment and, as a result, tend to experience increased levels of substance use, depression and suicidal thoughts.
CORAL
Art as a way forward
In ancient Greece and Rome, participation in the arts was “prescribed” for people with depression or anxiety. Similarly, for centuries, tribal communities used dance, music and art to facilitate physical and mental healing to individuals.
Our focus at CORAL was to teach health workers how to use art to effectively process trauma and develop coping mechanisms through expression and community. We invite our participants, who include doctors, nurses, social workers, therapists and researchers, to tap into their authentic vulnerabilities and share stories they might not normally tell using pen and paper, brushes, guitars, songwriting and movement.
From 2020 to 2023, we conducted our six cohorts 12-week clinical trial creative arts therapy interventions involving health professionals working at least half-time. Participants were randomly assigned to one of four creative arts therapy groups: art, music, dance/movement, and writing, with 12 weekly 90-min sessions each.
We measured participants’ levels of anxiety, depression, burnout, PTSD, and job satisfaction through validated questionnaires and asked the same questions again after the intervention was completed. We also measured these scores in a control group that did not take part in the intervention.
The results were impressive. Study participants experienced less burnout and expressed less desire to quit their jobs. Burnout scores for anxiety, depression, PTSD, and emotional exhaustion decreased by 28%, 36%, 26%, and 12%, respectively, in participants who received the creative arts therapy intervention. These improvements remained until a year later completion of the program.
Our findings add to the growing body of evidence that creative arts therapy can be an effective tool for coping with burnout of health workers across the globe.
We believe that creative art therapy is effective because it allows these health professionals to be imperfect – freedoms that can heal on their own. They can use these opportunities to speak the unspeakable through an art form, which becomes a vehicle to help explore and recover from trauma.
This in turn can increase their tolerance for imperfections as well as help them feel grace and compassion for themselves and each other. It expands their emotional vocabulary and, in doing so, builds their resilience.
CORAL
Remember what it means to be human
Although the roles of doctors, nurses and other health professionals are often glorified with terms like “superheroes” and “guardian angels”, in reality they are human beings who make mistakes and burn out too.
The creative process invites them to remember what it means to be human, to be vulnerable. A health professional picking up a brush for the first time since kindergarten can explore repressed emotions, buried memories – even forgiveness for mistakes that may have been held for years.
CORAL
A participant in the CORAL program wrote in his comments: “When I am given space to bare and show all sides of who I am, I am creative and engaged. I think more deeply and clearly. I am more willing to take the necessary risks to have achievements. I am a better colleague, mentor, friend, collaborator and scientist. When I feel safe and supported, I can be whole.”
