Perspectives on an exhausted medical radiation practitioner workforce: emotional labour and the impact of compassion fatigue

Keywords: burnout, compassion fatigue, COVID‐19, emotional labour, healthcare, job demands, medical radiation practitioner, wellbeing human resource management.

Due to changed worldwide conditions, allied healthcare workers are at high risk of contracting coronavirus disease 2019 (COVID-19).¹ These frontline workers manage excessive workloads, with the potential exposure to infections and risk of mental health issues.^2,3 The patience, understanding and resilience of healthcare workers has been demonstrated during the COVID-19 pandemic, but the system is stretched due to a lack of staff.⁴ Workers are at risk of exhaustion⁵ and they will struggle when a surge of cases are expected to inundate hospitals.⁶

Medical radiation practitioners are part of the allied healthcare workforce and are considered frontline ‘high risk hospital workers’ being ranked in the top 10 Australian professions at greatest risk of contracting COVID-19.⁷ The increased personal stress and anxiety at work⁸ is exacerbated by claustrophobia wearing restrictive personal protective equipment, fear of catching COVID-19 and health and financial risks to family.^9,10 We argue medical radiation practitioners are at risk of emotional issues leading to compassion fatigue. The paucity in evidence to mitigate risks to allied health workers needs to be investigated. Therefore, we examine workforce vulnerabilities and make recommendations to better support these frontline workers.

Allied healthcare practitioners are constantly faced with long work hours and excessive workloads due to COVID-19.¹¹ Continued pressures due to the pandemic have highlighted the psychological impact on the healthcare workforce¹² who are mostly females,^12,13 representing 68.5% of the medical radiation practitioner workforce.¹⁴ Healthcare workers are suffering as a result of the emotional labour that is being undertaken daily.^15,16 Emotional labour is ‘the processes by which individuals influence which emotions they have, when they have them and how they experience and express these emotions’ (p. 275).¹⁷ Emotional labour impacts on how personal feelings are managed.¹⁸ However, job resources¹⁹ that enhance wellbeing may mitigate against the negative outcomes of these emotional demands, potentially reducing the health issues related to compassion fatigue.^12,20

Compassion fatigue is defined as the ‘cost of caring’. It results from repeated caregiver exposures to situations that require high levels of empathetic engagement,²¹ producing a state of chronic physical and mental distress and exhaustion.²⁰ Whilst skill building such as resilience building,²⁰ coping skills²⁰ and social support^20,21 are protective factors against compassion fatigue, these factors may be overlooked during challenging times such as the global pandemic. Outcomes of compassion fatigue include stress, burnout, decreased work satisfaction,²⁰ and a reduced capacity and interest in being empathetic with others, including trauma survivors.²¹

Stress and burnout impacts allied healthcare workers’ and occurs when an individual is struggling to cope with work pressures, job intensification and dealing with critical health conditions.⁸ Job burnout is excessive exposure to various workplaces stress related issues.²² We suggest compassion fatigue happens in a cyclical process where the healthcare worker experiences stress, leading to withdrawal behaviours, which is exacerbated by feelings of guilt because they have withdrawn compassion from patients.²³

To expedite Australia’s roadmap to combat COVID-19 and deliver the National Plan, frontline healthcare workers in Victoria have been invited to join the vaccination program (The Victorian Department of Health, COVID‐19 Vaccination team, pers. comm.). This is part of a surge workforce to prepare and/or administer the COVID-19 vaccine under a time-limited Public Health Emergency Order (The Victorian Department of Health, COVID‐19 Vaccination team, pers. comm.). This workforce will become part of the COVID-19 Community Activation and Social Isolation team. Healthcare workers need to exercise compassion for ‘self’ as this is paramount to their health and wellbeing going forward, particularly if work intensifies.²⁴ These workers need to be mindful of their own health needs first before they can effectively care for others.

Managers in the allied healthcare sector mainly focus on providing quality health care, albeit with budgetary pressures, to maximise profits/operating surplus.²⁵ Additional managerial challenges experienced during the global pandemic resulted in rapid adjustment of patient capacity, a redesign of patient care models, management of financial loss, and redeployment or reduction of staff.²⁶>^,27 These challenges, compounded by a lack of training and development to prepare workers for the impact of adverse events, will affect their emotional wellbeing.²⁸ The high turnover of staff in allied health practices highlights that management needs to focus more on the wellbeing of staff.²⁹ Human resource management (HRM) performs administrative functions to recruit staff, meet the conditions of enterprise bargaining agreements and comply with legislation.³⁰ We argue HRM needs to be better prepared for any future pandemic and develop strategies to support these critical workers.

We recommend that allied health providers ensure their Human Resource departments work with medical radiation practitioners to develop interventions that address compassion fatigue by:

1. Forming a task force of HRM specialists and allied healthcare workers who will examine systemic gaps in governance and workplace conditions to recommend mutually agreed plans and practices.^31,32

2. Providing a platform for allied healthcare workers to ‘voice’ and share their experiences that result in compassion fatigue.³³

3. Developing interventions to manage and mitigate compassion fatigue.³⁴

4. Providing policies and procedures for wellbeing-oriented human resource practices, to retain and maintain the allied health workforce.³¹

Interventions include coping mechanism education, mentoring, debrief sessions,³ access to and encouraging the use of Employee Assistance Programs and other psychosocial assistance. Finally, open communication, clarity of messaging and provision of critical information and encouragement of work life balance is vital.^3,9

Creating and maintaining a stable healthcare infrastructure will require significant workplace commitment. Policy options and interventions supporting these healthcare workers, including medical radiation professionals will require internal and external stakeholders to take action collectively. The immediate focus should be on ensuring the wellbeing of the healthcare workforce and supporting staff retention.

Data sharing is not applicable as no new data were generated or analysed during this study.

The authors declare no conflicts of interest.

This research did not receive any specific funding.

Ethics approval has been provided by the Human Research Ethics Committees at RMIT University (22395). Research has been undertaken with appropriate informed consent of participants.