Doctors and nurses rarely learn in school how to tell a family that a loved one will not survive. Yet healthcare workers face the enormous burden of tragedy, illness, and death in a highly stressful environment as a constant routine part of their jobs.
Long before the COVID-19 pandemic, research was documenting the prevalence of stress and burnout among healthcare workers.
The effects of this crisis are widespread in the United States In 2022, Surgeon General Dr. Vivek Murthy raised concerns about alarming levels of burnout in the healthcare community amid the COVID-19 pandemic.
Studies indicate that if current trends continue, the United States will be short 1.1 million registered nurses, three million other health care workers, and more than 140,000 physicians by 2033.
A 2022 Mayo Clinic study found that only 58 percent of physicians would choose to become doctors again if given the opportunity to reconsider their career choice, down from 72 percent just one year earlier.
For nearly two decades, our research group—a team of clinicians, researchers, creative arts therapists, and writers—has focused on understanding the impact of work-related stress on health care workers.
In our experience, almost every healthcare worker has a story about dealing with times when the burden of the profession is more than they can bear.
As physicians who have worked in critical care and emergency medicine for many years, we believe that integrating creativity into healthcare is vital.
The health of the nation depends on the well-being of the healthcare workforce. We believe that incorporating creativity and the arts as a tool to build resilience among healthcare workers can help change the culture of emotional isolation that healthcare workers experience.
Long awaited challenge
As healthcare professionals, we strive to learn new ways to improve human health. Ironically, this often comes at the expense of our own physical, emotional, and mental health.
We have learned to hide our feelings and internalize all the negative events we see in healthcare. But this is not sustainable.
In the first decade of the 21st century, up to 80 percent of critical care nurses reported experiencing burnout or other forms of psychological distress.
This has contributed to high employee turnover, with 67% of nurses planning to leave their jobs within three years. This has led to higher healthcare costs, worker burnout, and lower quality of patient care.
Then came the COVID-19 pandemic, which added to the stress on healthcare workers: 3 in 5 doctors reported severe burnout during the peak of the Omicron variant in 2022.
The combination of higher work demands, work volume, work complexity, job stress, and intense working time during the COVID-19 pandemic has increased stress among healthcare workers and led to emotional burnout.
The work-life balance satisfaction rate decreased from 46.1% in 2020 to 30.2% in 2021.
In the post-COVID-19 era, healthcare workers like us are more vulnerable to anxiety, depression, and PTSD.
Health care workers who are experiencing burnout are less likely to seek professional treatment and, as a result, tend to experience higher levels of substance abuse, depression, and suicidal thoughts.
Art as a means of moving forward
In ancient Greece and Rome, participation in the arts was “recommended” for people suffering from depression or anxiety. Similarly, tribal societies have used dance, music, and art for centuries to facilitate physical and mental healing in individuals.
We focused on teaching healthcare workers how to use art to effectively process trauma and develop coping mechanisms through expression and community.
We invite our participants, who are doctors, nurses, social workers, therapists, and researchers, to tap into their authentic vulnerabilities and share stories they don’t usually tell using pen and paper, paintbrushes, guitars, songwriting, and movement.
From 2020 to 2023, we conducted six cohorts of our 12-week clinical trial of creative arts therapeutic interventions that included healthcare professionals working at least part-time.
Participants were randomly assigned to one of four creative arts therapy groups: art, music, dance/movement, and writing, with 12 weekly sessions lasting 90 minutes each.
We measured participants’ levels of anxiety, depression, burnout, PTSD, and job satisfaction with validated questionnaires and asked the same questions again after the intervention ended. We also measured these scores in a control group that did not participate in the intervention.
The results were astonishing. Study participants experienced less burnout and expressed less desire to leave their jobs.
Participants who received the creative arts therapy intervention had scores of fatigue related to anxiety, depression, PTSD, and emotional exhaustion reduced by 28%, 36%, 26%, and 12%, respectively. These improvements were maintained for up to one year after the program ended.
Our findings add to the growing body of evidence that creative arts therapy can be an effective tool for dealing with burnout among healthcare workers around the world.
We believe that creative art therapy is effective because it allows these healthcare professionals to be imperfect—freedoms that can be therapeutic in themselves.
They can use these opportunities to talk about the untalkable through an art form, which becomes a vehicle to help explore and heal from trauma.
This in turn can increase their tolerance for imperfection, as well as help them feel compassion and empathy for themselves and each other. It also expands their emotional vocabulary, thus building their resilience.
Remember what it means to be human.
Although the roles of doctors, nurses, and other healthcare workers are often glorified with terms like “superheroes” and “guardian angels,” they are actually human beings who make mistakes and get burned out, too.
The creative process invites them to remember what it means to be human, and to be vulnerable.
A healthcare professional who picks up a paintbrush for the first time since kindergarten can explore feelings that have been repressed, memories that have been buried—and even forgive mistakes they may have held onto for years.
One program participant wrote in his notes: “When I am given space to reveal and show all sides of my personality, I am creative and engaged. I think more deeply and more clearly.
“I have become more willing to take the risks necessary to achieve. I have become a better colleague, teacher, friend, partner, and scientist. When I feel safe and supported, I can be whole.”
Mark Moss is a professor of medicine at the University of Colorado Anschutz Medical Campus.
Raffaella Mantelli is a program director at the Colorado Resilience Arts Lab and a researcher in pulmonary science and critical care medicine.