by Anthony Cirillo

As you may have read this week in FierceHealthcare, two new studies suggest that nurses working in hospitals are much more susceptible to depression than their counterparts in clinics, schools or other locations, especially if their hospital is high-volume.

A study in the May 4 Journal of Clinical Psychiatry looked at the relationship between bed occupancy rates and absenteeism and found that those working in units that were 10 percent more crowded than the optimal rate had twice the rate of depressive illness than their counterparts in less crowded units.

The second study, appearing in the May 19 issue of Health Policy, is based on data from the 2005 National Survey of the Work and Health of Nurses in Canada. While looking at absenteeism in general, the report notes that depression is a "significant determinant" for missed work among RNs and LPNs, and that those who work in a hospital are more likely than those working in other settings to miss work.

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One thing we might first observe is that with health reform, things will get much worse before they get better. At some point, the estimated 35 million newly insured Americans will seek healthcare, potentially burdening the system. And of course this all impacts recruitment and retention and even further impacts whether folks choose to enter into the profession.

So try this on: Here, in part is something I offered in a Hospital Impact post last August:

"Healthcare workers are like firefighters: They do dirty jobs, look death in the eye every day and celebrate the joys of life, too--rescuing a kitten or delivering a baby. So why does the firefighter culture thrive? Low attrition? People clamoring to get in? Firefighters face their mortality every day and they have created a culture where they can talk about it, release it, joke about it and move on. The fire house is their community, their home.

"Healthcare workers do their job and take it home with them. When they are burned out, they leave. Firefighters are treated like heroes; healthcare workers not so much. So part of it, in my opinion, is building cultures that recognize this and help people release the fear and anxiety. That is not part of any rewards and recognition system. It goes fundamentally deeper."

If you want one example where this addressed, look at the Cleveland Clinic. They have something called Code Lavender (see p. 14), which, as the organization explains, is "like Code Blue, but it's for the human spirit instead."

Essentially, any staff member who is undergoing a mental health issue (and that is probably too severe a descriptor -- perhaps a long-term patient just passed on, for example, and the staff member is affected by the loss) can avail themselves of a team that will descend upon the unit and help. This can include mental health, social work, and pastoral care staff.

This kind of behavior helps alleviate some stress so that the worker doesn't take it home.

Systemically all of this goes back to the need to address the employee experience well before you look at patient experience. Instead what most do is add some kind of "program" that deals with customer service and further burdens the staff with one more thing to do.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in patient- and person-centered care and strategic marketing for healthcare facilities.