By N. Adam Brown, MD, MBA

Since the article, "No, I Won't Watch 'The Pitt'" was published, I have been flooded with texts, emails, and direct messages that all, essentially, say the same thing: "you aren't alone" or "me too."

Not every healthcare worker felt the same -- many do love it because it is raw, rich, and makes them "feel heard." But other commenters said they'd been afraid to label their experience as what it was: post-traumatic stress disorder or "practitioner trauma." Having seen the type of physical and mental trauma soldiers endure, they didn't want to equate their experiences in a field they loved with the battlefield.

I'm glad my column turned attention to this other reality. I'm glad these commenters spoke up. Frankly, I'm glad I spoke up. Something is deeply misaligned within our healthcare system when caregivers feel like they often can't voice their frustration and despair.

This trauma and collective lived experience deserve deeper exploration, and it demands an answer from the medical community and policy leaders. If we let this pain fester, at best, the nation's healthcare worker shortage will grow. At worst, people will die.

Healthcare Workers Are Not Okay

A growing body of research demonstrates U.S. healthcare workers are not okay. I cannot capture all the data in one column, so I will focus on a June 2024 study by the University of Washington's Center for Health Workforce Studies. Researchers compared physical and mental health outcomes for more than 10 million healthcare workers to outcomes for nearly 105 million non-healthcare workers.

What they found was poorer physical and mental health among healthcare workers. When compared to the general population, healthcare workers:

- Had a higher prevalence of mental illness (14.6% vs 9.6%), especially depression (8% vs 4.9%) and anxiety (2.9% vs 1.9%). Hospital workers had a higher probability of depression than other healthcare workers.

- Had a higher prevalence of chronic illnesses (19.2% vs 12.3%) and cancer (4.6% vs 4.2%). Long-term care workers were more likely to suffer from cardiovascular diseases, diabetes, and cancer; ambulatory care workers had a higher prevalence of respiratory illnesses, and hospital workers were more likely to suffer from arthritis. Licensed practical and vocational nurses, on average, had the worst health outcomes.

When healthcare workers are ailing, hospitals, practices, and patients suffer. Poor mental health in particular is linked to a higher rate of medical errors. "For [healthcare] workers, health problems can reduce the probability of obtaining employment, negatively affect productivity, and result in long-term absences from the workplace," the University of Washington researchers concluded.

The Hospital as a Battlefield

In Minneapolis just a few weeks ago, nurse Alex Pretti had been trying to help another protester who had been pushed into a snow bank by federal agents when he was sprayed with pepper spray and subsequently shot to death. Given that he was an ICU nurse, I would assume Pretti had played the role of protector before.

According to a review of federal research by the American College of Surgeons, healthcare workers are five times more likely to experience workplace violence than employees in other industries. A 2023 study by National Nurses United (NNU) was nothing short of horrifying. It found:

- 81.6% of nurses had experienced at least one type of workplace violence within the past year.

- Nearly half of nurses (45.5%) reported an increase in workplace violence on their unit in the previous year.

- More than two-thirds of nurses (67.8%) have been verbally threatened; 38.7% have been physically threatened; 36.2% have been punched, slapped, or kicked; and 19.8% have been groped or touched inappropriately.

What do these statistics look like on a daily basis? "Lots of hitting, kicking, scratching," one nurse told NNU. "Management does nothing but tell us to fill out a work-place violence incident report ... Even the workplace violence training is aimed at protecting yourself from physical abuse ... not how to prevent it." Such acts of violence can have long-term effects on one's mental and physical health.

Personally, I've had patients throw things and try to slap me. In the moment, I've generally normalized it, believing violent patient or family member behavior was just another part of emergency medicine. But it should not be normalized. One incident continues to stay with me. I remember a mid-morning patient encounter where I sat by the patient's bedside and he just stared at me and said, "Doc, I wanted to shoot you today but you were nice." (He had a loaded gun in his pocket.) I still get goosebumps thinking about that moment.

Workplace violence, just like poor mental and physical health among staff, harms the hospital's bottom line, costing hospitals nearly $18.3 billion in 2023. Yet, little has been done to meaningfully protect healthcare workers.

How Can We Begin to Solve This Problem?

Thankfully, lawmakers have begun to wake up to this problem.

As part of the latest federal budget deal, lawmakers reauthorized the Lorna Breen Health Care Provider Protection Act. ("The Pitt" star Noah Wyle lobbied Congress in favor of Breen reauthorization last year.) The legislation continues funding for healthcare worker mental health programs through fiscal year 2030 and mandates annual stigma-reduction campaigns. But there is more Congress can do. The Save Healthcare Workers Act, bipartisan legislation that would make it a federal crime to assault hospital workers, is a good place to start.

For the medical community, the National Academies' 2024 National Plan for Health Workforce Well-Being outlined several priority areas. A few highlights include: investing in programs that prevent and reduce burnout, foster professional well-being, and support quality care; increasing the amount of research on healthcare worker well-being; eliminating barriers to seeking mental health support services; and institutionalizing well-being as a long-term value.

"Collective action is urgently needed to prevent a dissolution of the health professions and to ensure a strong and interconnected health system for the nation," the National Academies concluded. "Health workers have been operating in a survival state for a long time, but change is possible."

"The Pitt," and Noah Wyle, have revealed what that survival state looks like. Maybe now the world will listen.