After a stress injury, offering long-term support at work is vital

If a colleague has taken time off work to take care of their mental health, that doesn’t mean healing the physician’s stress injury has ended.

As your colleague comes back to work after a stress injury—severe and persistent distress or loss of ability to function after exposure to overwhelming stressors of fatigue, trauma, loss or moral injury—it’s critical that the return is to an environment that offers ongoing support and rebuilds strength for the long haul. Such an environment will not only help that individual physician, but everyone else in the workplace too.

The AMA STEPS Forward™ toolkit “Stress First Aid for Health Care Professionals,” provides tips that can help your health care organization support long-term recovery.

“When a person takes time off and comes back to the environment, it’s really a critical time to integrate them back in a way that helps them to feel comfortable,” said Patricia Watson, PhD, a psychologist at the National Center for PTSD and a co-creator of the AMA toolkit. “Bosses can have conversations about what a person has learned and what they can be doing differently now. And they can remind them of their value and that they are happy they are back.”

The toolkit’s co-creator Richard Westphal, PhD, RN, co-director of the Wisdom and Wellbeing Program at the University of Virginia Health System in Charlottesville, added that “part of the advantage of this model is that it also allows us to ask what is going on in our environment that makes it really difficult to work here. Was the person who had the stress injury the canary in the mineshaft? Did they give the early warning signal? Is there a larger systems issue? If so, what needs to change?”

The toolkit also outlines the stress first aid framework and helps physicians and others in health care recognize and respond early to stress injuries, and manage them as one would any other injury. The peer-support and self-care model that health systems can provide to improve self-care is based on years of research. It is practical, flexible and tailored to specific styles and needs of those involved in recuperating from stress injury.

There are seven core functions of stress first aid to improve self-care or support a person who may be experiencing a stress injury: check, coordinate, cover, calm, connect, competence and confidence.

For the “connect” core function of stress first aid, it’s important to determine whether there is isolation or alienation that contributes to the physician’s distress. The toolkit explores these three approaches to reestablish connections for individuals and teams.

• Assess social resources. This includes identifying the best possible sources of social support for an individual.
• Determine obstacles to obtaining or receiving social support by understanding why an individual is not using all the available resources.
• Intervene to remove obstacles to social support for an individual or team.

For the “competence” core function of stress first aid, use the “stop, back up and move forward” approach below to restore and enhance competence after a stress injury.

• Stop and make sure there is time to rest and recover; identify challenges and stop doing what isn’t working.
• Back up and retrain, and refresh, old occupational, well-being or social skills. Provide training in new skills. Help mentor, solve problems or explore new options.
• Move forward by providing opportunities to practice and refresh old skills, offering support to perfect new skills and helping find and set new directions and goals.

The “Stress First Aid for Health Care Professionals” toolkit outlines the other core functions of stress first aid in detail. The AMA STEPS Forward™ open-access toolkits offer innovative strategies that allow physicians and their staff to thrive in the new health care environment.

STEPS Forward is part of the AMA Ed Hub™, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.

Learn more about AMA CME accreditation.