The recently growing attention to the burnout crisis in health care has begun a much-overdue conversation. However, the discussion has thus far been focused primarily on physicians and nurses and has not yet considered the larger health care team enduring the same environments. This includes receptionists, pharmacy assistants, medical scribes, personal support workers (PSWs), rehabilitation support workers (RSWs), and many more. These are the unregistered health care personnel (HCPs) that often go unnoticed and unrecognized, even though they too endure exceptional levels of burnout and turnover.

In hospitals and clinics, receptionists, pharmacy assistants, and medical scribes are often the first point of contact with patients in their most vulnerable states. They bear the brunt of the anger and frustration that comes from long wait times, over which they have no control. They do this while handling the mountains of paperwork that is essential to keeping the health care operation running. According to the Canadian Medical Association, 75 percent of physicians agree that the current amount of paperwork is impeding the level of care they can provide, with an estimated 55.6 million possible patient visits that could be completed per year with the time it takes to attend to the current administrative burden. These roles alleviate a significant portion of this burden while handling those first-contact conflicts, making them invaluable to the team.

For patients who require long-term care, particularly within the mental health field, PSWs and RSWs spend more time with the patient than any other HCP. They are responsible for daily personal care, facilitation of care plans from physicians and therapists, medication administration, and crisis intervention. The daily outbursts, the panic attacks, the tough conversations about abandoned dreams and burdened families are addressed in these very roles. These roles are present for every step toward recovery and every step away from it. They also bear the responsibility to remain present, positive, and proactive during events of verbal abuse or threats of violence as they often work alone or in small teams without the added security of a setting like a hospital, leaving little room for rest and recovery within a shift.

These issues are exacerbated when we take into consideration that these positions often attract young graduates aspiring to build careers in health care. They are less likely to demand higher wages or better working conditions due to their lack of experience and their goal to build connections. While gaining experience in such environments provides valuable lessons that shape the strong and resilient health care workers we need, we cannot ignore the risk of burnout that physicians and nurses in the same environments have been well-documented to experience for years. Those employed in these positions hold an especially vulnerable place because they lack the financial freedom to seek help due to the often part-time and low-wage nature of the jobs. All of these roles are essential front-line positions that are rarely mentioned in discussions about health care reform, despite their presence in every corner of the system, including hospitals, clinics, rehabilitation centers, and private homes.

So what is the solution? We can start within the context of policy and law that protects all health care workers. More specifically, requiring employers to provide frequent check-ins, better-planned breaks, safety measures, and health care benefits is a great place to start. First, because of the high mental load of working in health care, frequent check-ins with a mental health care professional will allow organizations to catch signs of burnout early and give HCPs the tools needed to recognize and attend to it. Second, HCPs rarely take breaks within a shift time, even though it is technically available to be taken. This is because of the time-sensitive issues that occur, which often require immediate attention. Even if breaks are taken, it can be difficult to detach from the work if there is a possibility you will be called back in to resolve an issue.

Proper staffing to cover all the patients or clients even when a staff member is on a break, and a decided plan to not interrupt breaks will help HCPs rest and recover before they return. Third, no HCP should be working alone with patients who are known to be violent or verbally abusive. In positions where one-on-one hours are needed, such as during home visits, HCPs should be supplied with panic buttons and preset exit routes from the residence. In residential facilities, safety measures such as security cameras and panic buttons when housing violent patients should be considered to maintain safety for all staff, as well as other patients. Lastly, most facilities do not provide proper health care packages to unregistered HCPs, especially if they were not hired as full-time employees. However, these HCPs might be working full-time hours anyway due to insufficient staffing. Ensuring all HCPs receive an adequate health care package will allow them to take care of themselves, seek help as needed, and prevent or treat burnout without barriers.

While these steps will require careful planning, at its core, health care is a team-driven field with the strength of the collaborative effort at the forefront. Therefore, by nurturing every role within the team, we make an investment in the overall integrity of the system, which, as we have learned over the past few years, is essential to the health of the larger community.

Chayanika Tyagi is a neuro-rehabilitation therapist.