We have all seen the memes and picture frames on social media. I can’t stay home – I am a health care worker.

I am a health care worker.

But I have been mostly home the past eight weeks, and the thought of returning to the office full-time has left me grappling with anxiety and fear.

As a nurse practitioner in dermatology, I have had the luxury of dramatically changing the way I treat patients. Telehealth has been a saving grace – allowing me to care for patients’ urgent needs. Effectively preventing patients from utilizing COVID burdened emergency departments.

I know how fortunate I am – still employed, still practicing, but relatively protected from COVID-19.

I know many nurses and physicians on the front lines in Boston, Detroit, and New York. I am aware of the unfathomable work conditions. The lack of personal protective equipment. The hopelessness that is felt watching patients get worse, rarely better. The fear of bringing the virus home.

Knowing all of this makes me feel guilty and conflicted. Why should I get to stay home when my friends and colleagues risk their lives during a pandemic?

I can’t stay home – I am a nurse.

More and more, the seemingly innocent phrase infiltrates my thoughts.

As governors across America begin to open up and declare that providers can perform elective procedures – more and more of us will be following the creed: I can’t stay home – I am a health care worker.

My experience providing for patients is about to change – again. The transition to telehealth was a herculean effort. But it insulated me from the looming threat of COVID-19. Now, as we resume in-person appointments – an attempt to return to business as usual – there are new protocols, new procedures, and new risks. Risk mitigation will be challenging at best and impossible at worst. How do you social distance while performing a skin biopsy on someone’s face?

Ever since this announcement, I feel I am in the clutch of two epidemics. The epidemic of fear and the crisis of COVID-19 itself.

I am overcome with uncertainty. Anxious and afraid that I may contract the virus and spread it to my loved ones. Questioning whether my profession and livelihood are worth my life. Feeling my contribution to the pandemic is trivial.

As these thoughts race through my brain, they run into a firewall of guilt that attempts to shut them down. These thoughts are unjustified and irrational. I have no right to feel this way. My friends and colleagues are on the front line. My fear is unjust.

I tell myself that these feelings belong to the heroes on the front line, not an outpatient provider riding out the storm from the comfort of home.

I have never experienced this incessant drone of negativity.  The constancy of it all is exhausting – there is no respite. The resulting depletion in energy and barrage of negative thoughts has me asking myself – is this burnout? Am I the only outpatient provider who feels this way?

Even asking this question seems foolish. The naysayer inside taunts me and asks: what reason, what right, do you have to be burned out? After all, you have been safely at home.

The rational part of me knows there is no outpatient privilege with burnout. Burnout can affect anyone. Until now, burnout was something I knew academically, not personally.

Exhaustion, depersonalization, and lack of efficacy: the cardinal symptoms of burnout.

Am I exhausted? Sometimes.

Do I feel disconnected from my patients? Yes, if I am being honest. Most presenting problems seem trivial compared to COVID.

Have I doubted the meaning of my work? Everyday. I regularly ask myself: is my contribution enough?

The symptoms of burnout are not new or unique to COVID-19. Clinicians across the health care system – inpatient and outpatient – have seen a rise in burnout over the past decade. In some pre-COVID studies, relatively half of the surveyed clinicians suffered from burnout.

Rates of burnout are projected to increase due to the stress of COVID-19. Seemingly we are on the precipice of another epidemic– an epidemic of burned out clinicians – and I feel like patient zero.

In preparation for this new epidemic, The American Medical Association has created a roadmap to caring for health care workers. Strategies have been developed to enhance resilience in times of crisis.

The strategies are specific to large health care organizations – many are hospital-based.  However, these same strategies could be extrapolated to outpatient practices. These include providing basic daily resources, effective communication, and supporting psychosocial and mental health.

But how can the system support smaller practices where an organizational infrastructure does not exist? Practices like mine.

When the private sector fails during times of crisis, someone else, like the state or federal government, will need to be responsible for developing and deploying necessary resources. My contribution to the pandemic does and should matter. Outpatient providers also need basic daily resources, effective communication, and support for psychosocial and mental health.

The risk of burnout secondary to COVID-19  may be more insidious then we know. We cannot only consider the risk to front line clinicians. Outpatient providers cannot be collateral damage in the fight against COVID.  Those on the periphery – providers like me who are not inundated with known COVID patients – have never-the-less been impacted.

During COVID, sharing experiences is meaningful. Combating burnout requires reflection and honesty – now more than ever.

Naila Russell is a nurse practitioner. She can be reached on Twitter @nailarussell.

Image credit: Shutterstock.com