The Opioid Epidemic and Rural Provider Burnout

“If it gets much worse, we will need full-time security”
— Lori, RN

·A while back, I blogged about my theory that healthcare provider burnout is related to patients’ untreated mental health issues. Since healthcare providers are ‘orchids’ (my term for sensitive, feeling people), we tend to absorb the suffering around us. Dynamic forces in the healthcare industry, coupled with an increase in patient suffering, have conspired to create a parallel process in which healthcare providers now experience many of the same mental health issues as our patients.

Back in November, I was in rural Ohio training nurses on how to use STI with chronic care patients. About thirty minutes into the first training session, I asked the nurses about their most challenging patients.

What happened next completely shocked me.

It started when a 30-something female nurse stood up and announced that she was tired of being yelled at by patients looking for pain pills. Before she could finish her thought, other nurses chimed in, talking over one another about the daily struggle of being the “pain-med-cop,” as one nurse called it. They went on to discuss the following situations, emphasizing that these are daily occurrences:  

  •  Patients stalk providers on the phone and leave profanity-laced messages about prescription refills.
  • Patients show up without appointments, yelling and screaming for their pain medications in the waiting room, inciting other patients.
  • Near riots form in waiting rooms, as patient anger spreads.
  • ·Patients tell elaborate, complicated stories of lost pain medications.
  • Drug seeking patients journey between the doctor’s office and the police station.
  • Police reports alleging stolen medications and uncorroborated crimes are commonplace.
  • Teenagers attend “skittle parties,” wherein high school age children bring their parents’ medications to parties and mix them in a bowl. Partygoers then take these pills to “see what happens.”
  • Geriatric patients joke with providers about needing more “Xannies” (Xanax pills) and “Blueies” (Oxycontin pills).

As participants told story after story, a nurse in the front row began convulsing with sobs. I stopped the class and asked her what was wrong. She said she wasn’t sure if she could continue working as a nurse. She has been a nurse for 14 years, but said it was too upsetting for her to see “good teenagers becoming drug addicts.”

Prior to this moment I had been surprised, but kept calm and logical. As this nurse sobbed with desperation about the situation, I began to feel panicked. 

You have no idea what we go through every day
— Macie, LVN

Why did I feel panicked?

  • Because this nurse’s desperation felt real.
  • Because in the twenty minutes leading up to the crying nurse, not one participant had expressed compassion for the patients struggling with substance abuse.
  • Because I have worked with these nurses and know them to be compassionate professionals.
  • Because when it was suggested that the patients’ behaviors might not be rooted in disrespect, but rather based on a desperation that comes with withdrawal and addiction, I was roundly corrected by the group: “You don’t know what we go through every day.”
  • Because it is an uphill battle when people are not open to alternate perspectives, but cling to possible thought distortions.
  • Because this type of anger is destructive to these nurses and the healthcare organization, and it is contagious to their patients.
  • Because these nurses reported having problems at home as a result of stress at work.
  • Because if these compassionate professionals were unwilling or unable to help patients struggling with substance abuse, who would help these patients?
  • Because I wasn’t sure how these nurses could do STI when they were clearly struggling themselves.

I quickly changed course and decided to teach the nurses how to use STI on themselves to increase their existing coping skills. The training felt different from others. It felt like there was a pressure on me to save these nurses for their sake, and for the sake of their patients.

My panic turned to profound sadness when one of the nurses shared the following story:

One of our male patients called about a month ago, sobbing. He begged me to help him. He said he knew he was addicted to his Vicodin, but couldn’t stop. He said he was on the verge of using heroin and asked if we could help him.

The nurse tried to get this patient into rehab but the process took weeks. By the time insurance approved the rehab stay, the patient couldn’t be found. His family said he was on the street. 

I asked the nurse how this situation affected her. She said she was okay, that this kind of thing happened all the time.  (My interpretation: This nurse had already shut down, which is a sure sign of provider burnout.)

After the training ended, I scoured the web for resources. What would a patient do if he or she wanted help with an addiction? There were no drug rehab facilities within 50 miles of the hospital and only four Narcotics Anonymous meetings each week in a town fifteen minutes away.  

The healthcare community needs to start recognizing the connection between all of these problems. We can’t talk about healthcare outcomes and provider burnout without talking about the social and economic issues that plague our patients. Untreated mental health issues, economic problems, globalization, the opioid epidemic, et cetera, need to be made part of the conversation.

The recent election results have made it abundantly clear that small town America feels marginalized and ignored by the rest of the country. It’s time to roll up our sleeves and collectively work on creative solutions to solve the seemingly intractable problems that plague many of our patients, especially those patients and providers living in small towns.

ADAMH Board statistic

ADAMH Board statistic

Having witnessed the devastation firsthand, the Stellicare team is committed to ending the suffering caused by the opioid epidemic. To that end, we will help the Ohio ADAMHS Opiate Task Force create solutions for patients and providers.