Shoring Up the Front Line: Burnout Prevention for Radiologic Technologists in the Wake of COVID-19
By Kathy Hardy
Radiology Today
Vol. 21 No. 7 P. 18

The effects of workplace stress on radiologic technologists (RTs) goes beyond attitudes and job satisfaction, with potential impact on the hospital or imaging facility. Not only can it carry over into personal lives—packed up and taken home—but it can also lead to physical and mental burnout, which, in turn, can impact patient experience. With the medical community now dealing with the ramifications of the COVID-19 pandemic, concerns regarding a heavy workload or feeling underappreciated are being compounded. The imaging community has gone from an onslaught of infection-related stressors to a significant reduction of exams due to the cancelation of nonemergent cases to, now, a slow return to a new normal.

“There are many levels and layers of frontline health care workers in radiology, radiologic technologists and sonographers among them,” says Lori Deitte, MD, FACR, a professor of radiology and vice chair of education at Vanderbilt University School of Medicine. “We need to recognize and thank them all. During this time of social distancing, it’s important that we intentionally cultivate shared communication, a sense of community, and inclusion for all members of our department.”

Deitte, who is also chair of the ACR’s Commission on Publications and Lifelong Learning, was instrumental in the development of the ACR Radiologist Well-being Program. She spoke with Karen Tisdale, BS, RDMS, supervisor of ultrasound at Vanderbilt, for her insights on the issue of sonographer stress. According to Tisdale, sonographers were facing a high clinical demand prior to the COVID-19 pandemic and feeling some degree of burnout due to staffing issues. With the start of the pandemic, sonography clinical volume actually decreased and other factors came into play.

“According to Karen, safety was an initial concern,” Deitte says. “Questions arose about what the recommendations were for PPE [personal protective equipment] since sonographers are in very close contact with their patients during scanning. Fortunately, our sonographers feel well supported with the appropriate PPE.”

Small acts of kindness can also make a big difference to well-being during this time of social distancing, Deitte adds. Picking up the phone and thanking the sonographers or texting messages of gratitude can go a long way.

In a study conducted by Lynn Reingold, MSRS, RT(R)(CT), senior CT technologist for the VA in Salt Lake City, RTs everywhere expressed roughly the same sentiments, pre- and post-COVID: They work hard, wish they were paid more, and do not always feel appreciated, she says. Before COVID-19, cases were sometimes double booked. In the current pandemic environment, RTs initially felt “underworked,” due to a suspension of all elective and nonurgent exams.

“Now, we will have to furiously overwork to catch back up to where we were,” Reingold says.

Good and Bad Change
According to a study Reingold published in 2015, “Stress affects radiologic technologists who must interact with physicians, nurses, department supervisors, emergency department personnel, housekeeping personnel, maintenance staff, patients, and patients’ families. Radiologic technologists often must work rotating shifts, handle trauma situations, and inject iodinated contrast agents that might cause an allergic reaction in the patient. Physical stressors include positioning patients, moving equipment, and the risk of exposure to ionizing radiation, which can cause physical harm.”

Bill Algee, FAHR, CRA, director of imaging services at Columbus Regional Hospital in Columbus, Indiana, notes that in the imaging community, there has been an atmosphere of “do more with less.” Meeting performance metrics and productivity percentages often falls “on the backs” of the radiologic technologists.

“To keep business up, you either need to increase volume or have techs work fewer hours, if you can’t increase the volume,” he says. “This leaves the burden on fewer techs.”

A profession with the number of variables that RTs face on a regular basis and its inherent stressors can also be what attracts people to the field. Jacqui Rose, MBA, CRA, FAHRA, director of medical imaging, telecommunications, IT, and lab at Upper Valley Medical Center in Troy, Ohio, says change can be a benefit and a challenge.

“Imaging tends to change more than other areas of health care,” Rose says. “I think it’s why we attract the people we do. Imaging takes the human touch and adds technology. With technology comes change in the form of growth, improvements, and updates. When you add this aspect to other external stressors, it can lead to burnout.”

Technology advancements, while designed to streamline workflow, come with a level of anxiety for RTs. Reingold notes that the introduction of automated processes can initially cause higher stress, as does any new process or procedure. However, once integrated and working properly, stress levels can be reduced. That said, training on new devices brings its own level of anxiety.

“There are also additional burdens of training related to automation,” she says. “Does automation make staff more complacent and, therefore, might they miss problems or do something wrong if they think automation takes care of everything? There can also be issues with breakdowns in automated functions. If there are problems, how much downtime does that cause on machines?”

Maintaining Connections
Rose, who is president-elect of AHRA, notes that in the diagnostic process, imaging often comes at the front end of the human care cycle. She says this can also contribute to stress among RTs.

“Our patients come to us, and they don’t know what’s wrong with them. They’re scared,” she says. “Staff needs to be able to deal with patient stress and anxiety.”

Reingold adds, “As the human contact, techs can help reduce stress with a professional, yet kind and caring, demeanor and be as supportive to anxious patients as possible. I would say that, with recent events, being the frontline is inherently stressful due to being exposed to illness. However, we still need to be supportive and professional and not let personal stress get in the way of the job.”

While RTs interact with patients at the beginning of a diagnostic journey, they are not diagnosticians; that is the role of the radiologist. Reingold says patients often ask for their results while with the technologist. She says RTs recognize this as “part of the job” and staff needs to be comfortable explaining to patients in a tactful and kind way that they are not able to make a diagnosis.

Regardless of the size of the imaging department or the health care facility, communication plays a large role in positively or negatively impacting RTs’ work experience. Rose sees communication and transparency as keys to keeping stress levels low.

“When you don’t share the ‘why’ behind new decisions or processes, our teammates will create their own ‘why,’ which may not match reality,” she says. “If you don’t have an answer for something, say you don’t know, and then work to find the answer.”

Algee says it’s important to share as much information with RTs as possible, particularly during difficult times. It helps to alleviate the “Why me?” feeling some staff can get when they see different processes in other departments.

“They need to understand that what we do in our department is different than what’s done in other departments,” he says. “Other departments have different margins than we do.”

Also, while smartphone technology can enable collaboration among personnel, some departments miss the sense of interaction that is an integral part of diagnostic radiology. The loss of one-on-one conversations can make an impact.

“We’re used to radiologists being in the room,” Deitte says. “Phone or text conversations work but decrease the camaraderie and collaboration. There’s a sense that feedback suffers when everyone isn’t in the same room. You also lose instructional opportunities when the interaction is not in person.”

Physical Work Environment
The hands-on aspect of RT tasks can lead to physical stress and burnout. There is a consistent need to move and adjust patients. A lack of proper equipment or supplies can result in an unsafe work environment, which can result in workplace injuries.

“Physical stress on the body can become a problem for techs,” Reingold says. “The organization typically has something to offer to staff to reduce these issues, whether it’s a workplace ergonomic person or occupational safety nurse to ensure proper equipment use.”

Environmental issues also can have an impact on workflow, specifically as it pertains to the patient experience.

“Any difficulties in the day-to-day operation of the imaging suite can lead to technologists feeling rushed with their patients,” Deitte says. “Under difficult situations, there’s not much time for small talk with patients. The technologist can come across as less empathetic.”

To help manage the physical environment, Vanderbilt regularly rotates staff schedules so RTs are not always dealing with the same types of cases. Rotating RTs between surgical and outpatient cases is a way to alleviate a single cause of stress, as each area comes with its own unique work demands.

In addition, an increase in nonpatient care tasks, such as reporting and compliance documentation, or other expanded duties, can add stress to the RT routine by creating a distraction from core responsibilities.

“While most of the nonpatient care tasks are not stressful in and of themselves, doing other tasks that take us away from our primary job while leaving other coworkers to [perform the] scan can be stress inducing,” Reingold says. “The need to feel competent in these other tasks can be challenging, and the need to learn additional systems and programs may be hard on some techs.”

Change Where Needed
Reingold adds that unpredictability in the health care industry can also increase stress. Nothing has created more uncertainty in recent months than the outbreak of COVID-19, with increased stress levels created by a lack of information regarding the illness and concerns about sufficient PPE.

“The rules on what is safe have changed almost daily,” she says. “Over time, we will need to adjust to a new normal. Things probably won’t go back to how they were before. We need to be highly diligent about using standard precautions and PPE.”

Moving forward, Reingold says workload is slowly ramping back up. The key will be finding a way to manage cases while reducing stress.

“We will now need to double- and triple-book in order to catch back up on all the back orders,” she says. “We have been down some staff who have needed to take mandatory sick time or self-quarantine due to suspected virus exposure, which increases workload on the rest of the staff.”

Rose says Upper Valley Medical Center was hit particularly hard with COVID-19 cases, due to their close proximity to two nursing homes that had large numbers of cases. However, they train for emergency types of environments and were able to establish isolation areas, following guidance from the Centers for Disease Control and Prevention. That said, there is no single guideline for managing staff stress.

“With communitywide closures, our techs were working long hours here, then going home, where they are parents and teachers, with schools closed,” she says. “They’re feeling the stress everywhere.”

Deitte says it’s important to be flexible and creative with scheduling, not only for safety but to help staff deal with the changes to their daily lives brought on by the pandemic on the home front. Developing new shifts or workday schedules is just one example of how staff with childcare needs can keep their families in order and maintain their work life—a new form of work-life integration.

“We needed to be flexible, to pivot in a short amount of time,” she says. “We can learn from our recent experiences and implement change where needed in the future.”

— Kathy Hardy is a freelance writer based in Phoenixville, Pennsylvania. She is a frequent contributor to Radiology Today.