The trait that makes a good nurse is also a risk factor

Most occupational risk factors are things done to a worker. This list contains
one that is done by them, and it is the one the profession admires.

**Many healthcare workers place the well-being of others before self. On the
surface, this dedication to patients may seem admirable. However, it can
ultimately be harmful if it delays or prevents workers from getting the help
that they need for their own health and well-being.**

The conditions, before any pandemic

**Working conditions have always been challenging for healthcare workers, even
before the pandemic.** The work involves:

• Intensely stressful and emotional situations caring for people who are
  sick
• Exposure to human suffering and death
• Unique pressures from relationships with the patient, the family and the
  employer
• Ongoing risk of hazardous exposures
• Demanding physical work, with injury risk from handling patients

And the shape of the working week

The scheduling items are listed separately, and they share one quality —
unpredictability, not merely length:

• As-needed scheduling
• Unexpected double shifts
• Unpredictable intensity of on-call work
• Unstable and unpredictable work lives, and financial strain, for many
• High administrative burdens and little control over schedules

"Little control over schedules" is the thread. A demanding job that a person
can plan around is a different job from the same hours arriving without
warning.

What COVID-19 added

The pandemic exacerbated fatigue, strain, stress, loss and grief. **Many
faced increased workloads alongside short staffing and shortages of critical
personal protective equipment**, which brought **anxiety and the risk of
personal harm** — being asked to do more of the work with less of the
protection.

**Some report symptoms consistent with post-traumatic stress disorder related
to the pandemic**, and **some report residual symptoms from their own COVID-19
infection.**

The second trap

**There is a strong and historical stigma related to healthcare workers
seeking care for mental health concerns or substance use disorders.**

Put beside the first: a workforce trained to put others first, working
unpredictable hours under a professional culture that penalises asking for
help. The self-sacrifice delays it and the stigma discourages it — and the
people involved are the ones who would recognise these symptoms immediately in
somebody else.

NIOSH says it is **well positioned to address the mental health of health
workers** because of an **extensive cross-disciplinary research portfolio and
collaborative partners across the United States** — which is the right shape
for a problem whose causes are a rota, a workload, a professional culture and
a stigma all at once. None of those is a clinical problem, and none of them is
fixed one worker at a time.

Source: Centers for Disease Control and Prevention (NIOSH).