APIC’s President Talks About Infection Preventionists and Burnout

Ann Marie Pettis, RN, BSN, CIC, FAPIC: “COVID-19 just never seems to let up. And every time you think you might be making a little bit of progress, some new thing comes along, like right now with potential resistance because of mutations. You can never let your guard down.”

Many who are reading this know all too well how exhausting it has been to fight the coronavirus disease 2019 (COVID-19) pandemic for more than year. Ann Marie Pettis, RN, BSN, CIC, FAPIC, wants infection preventionists (IPs) to understand that help is available to keep them from burning out. And a lot of that help can be found on the website of APIC, the Association for Professionals in Infection Control and Epidemiology. Pettis is APIC’s president she’s also very much on the frontlines, working as the director of infection prevention at UR Medicine in Rochester, New York. Her job duties have changed somewhat since the last time Infection Control Today® interviewed her. “Right now, my focus is primarily on the ambulatory practices,” Pettis tells ICT®. “I’m off looking at those practices to make sure that everything is safe for the patients and for the staff and so forth.” She not only gets it she lives it and applauds the heroic efforts she’s seen firsthand. “Despite things like burnout, despite feeling discouraged, and just battle fatigue, [IPs and other health care professionals] come to work every day and give their best. Because the bottom line is: They all care about the safety of patients.”

Infection Control Today®: Burnout. It has to be a major issue at this point. What do you tell your fellow infection preventionists about burnout?

Ann Marie Pettis, RN, BSN, CIC, FAPIC: Yes, you are so right. I mean burnout, it’s a constant concern, because COVID-19 just never seems to let up. And every time you think you might be making a little bit of progress, some new thing comes along, like right now with potential resistance because of mutations. You can never let your guard down. You’re absolutely right. And I have been so absolutely amazed at my colleagues in infection prevention in particular, but also … day-in and day-out, as I work with other health care providers, at every level in the organization: the commitment, the dedication, the fearlessness. Despite things like burnout, despite feeling discouraged, and just battle fatigue, they come to work every day and give their best. Because the bottom line is: They all care about the safety of patients, their loved ones; safety for their loved ones, and their community. It is important that people recognize the symptoms of burnout. And it’s also important to know what to do perhaps to try to prevent it or if you do feel like you’re suffering from it, what to do in that situation. Those are all important points.

ICT®: Have you ever personally felt burned out?

Pettis: I honestly can’t say that I’ve really experienced burnout. And I think one of the reasons that I’ve been able to not go into a full-fledged burnout is because I’ve had the luxury of being able to both work from home, as well as go into to work. And I think that balance has helped me because I think to myself, “If I had to do everything from home, I would start to feel isolated.” And

for me, who’s kind of a social animal, that would be very difficult for me. On the other hand, just when I’m starting to feel that, then I’ve got things that I need to do in the office or at the hospital, or at the offsites because right now my focus is primarily on the ambulatory practices. I’m off looking at those practices to make sure that everything is safe for the patients and for the staff and so forth. I had that luxury of being able to have sort of the best of both worlds, if you will. I think that that’s sort of inoculated me a bit. But when I do start to feel stress and pressure and so forth…. A spiritual journey, I think for me, helps me in all situations, including this situation. But I think it’s individual. I think each person, there are a lot of different resources and APIC provides many of those resources and has throughout the pandemic. Your community may. Your church might. CDC [Centers for Disease Control and Prevention] has a lot of resources. It really is a personal journey, if you will, and what works for one person may not work for another person?

ICT®: What does burnout look like? Have you ever had to take someone aside and say, “I think you may need a little vacation?”

Pettis: Yes. What I’ve experienced, what I’ve observed is primarily people that normally might be getting along beautifully well in the office or whatever on the unit, all of a sudden, are at each other and short-tempered. When typically, they wouldn’t have been. And I find that the other thing is being able to really focus and pay attention, which can be a real challenge, when what you’re doing is not just taking care of a widget. It’s taking care of human beings. And so, you can’t afford to lose your focus and to not be able to pay attention. And I think that’s one of the one of the most telling signs of burnout is mood swings. Just feeling depressed and having no energy. Those, I think, are some telltale signs. And I have certainly experienced seeing those. Observing those in some of my colleagues,

ICT®: Are you worried that health care professionals will suffer from post-traumatic stress once the pandemic is all over?

Pettis: I think that’s a real concern. And, you know, and I think that that’s when people really need to reach out to their employee assistance programs, EAP, through human resource departments, and whatnot. I think helping one another. If you see something, say something. If you start to see a colleague who normally is easy to get along with, but now is, as I said before, very short-tempered, or just, constantly sort of losing track of where they were at, or whatever. I think that is a time when it behooves us to gently maybe take the person aside, and just, you know, I think just a hug, sometimes. We can’t hug right now, but a virtual hug, if you will, to let somebody know that you’re concerned for them. And it’s the sort of thing where if you’re flying on a plane, and they say, “If we experience turbulence, put the mask on yourself first, before you try to help a small child or your loved one.” It’s the same thing. I think we need to take care of ourselves. And then if we start to see that people are struggling, it’s important that we point that out to them, and direct them to the different resources that we know are available. And what I have found—and I started off by saying how absolutely amazed I am at my colleagues. I find one of the biggest weapons that you can use is that of humor. I do find that that’s been just some of the best medicine; having a humorous approach to a lot of this. And I have experienced that with staff. I think humor, sharing your concern with your staff members. Those things can go a long way.

ICT®: When during the course of this pandemic did you think that some people may have started to feel burnout from it?

Pettis: Things really started in earnest in some spots in the country by March of last year. So almost a year ago. And early on, we knew that burnout was going to be a potential issue. I’m from New York State. New York City, of course, was sort of ground zero for the first surge in the pandemic. So there certainly were other parts of the country that were not experiencing that. But here in New York State, even if we weren’t functioning in New York City, we too were experiencing the effects from what was going on in the state. And so, I would say early on APIC was very aware, because we were running into such challenges with personal protective equipment. And honestly, that was one of the biggest stressors for health care workers, and certainly infection preventionists, who tried to help health care workers with all the personal protective equipment and so forth. We knew early on based on that lack of supply, that people are going to start to really burn out quickly. Lack of information. Changing information. That was a huge problem and still continues to be a challenge. I actually had the amazing opportunity to go to Toronto during SARS-1 and worked at the ground zero hospital. And I saw such profound post-traumatic stress when I went there to help them and their staff. And as bad as SARS-1 was in Canada and other parts of the world, of course, the United States was spared. But sadly, we really didn’t learn a lot of lessons that perhaps we should have learned. But I think APIC was very aware right from the beginning of this thing, that we were going to need to think about how to help our staff, our IPs in particular, who in turn are helping their co-workers.

ICT®: About 40% of infection preventionists are retiring, or at least will be reaching retirement age, within the next 10 years. Just as infection preventionists are much on everybody’s radar. There’s a demand for them outside of the hospital. There seems to be a real problem with supply and demand here. I imagine younger health care professionals are now getting interested in pursuing a career as an infection preventionist. Is that a fair assumption?

Pettis: Yes, I think so. There are data out there showing that people are trying to get into medical school at higher numbers than ever. Certainly, nursing has already had way too many applicants. We were already seeing that even before the pandemic. And certainly, now it has—to your point—really raised the persona of infection prevention. And I think that’s a good thing. But this is something that APIC was trying to address, even before the pandemic, and certainly now with the pandemic. And because of post-traumatic stress and so forth, it wouldn’t be surprising to see more than what we were even anticipating of IPs retiring out or perhaps changing careers because of the pandemic. We were already working on it. We continue to really pay a lot of attention to it. And we have a lot of different things in place to try to address it. For instance, we recently redid our competency model, if you will, for what it takes to be a competent infection preventionist. And then along with that we revised what we call our roadmap for developmental points in your career. We have a roadmap for a novice infection preventionist. We have one for a proficient infection preventionist. And all of that is leading up to becoming an expert infection preventionist. And that would be a fellow of infection prevention. We are looking very carefully at that. We’ve made a lot of revisions to it. I think that’s important. You’ve got to really have that roadmap if you’re going to be able to bring people into the career. The other thing we’re looking at doing is getting out there into programs like in colleges, for public health programs, and areas where perhaps, historically, we have not drawn as many infection preventionists from. We’re looking at a variety of different programs and looking at ways to partner with the universities so that we can run programs so that they become aware of what IPs do and whatnot. Those are just some of the things that were starting to be in place, and now have been accelerated as a result of the concerns that you and I have been discussing.

ICT®: Are you hoping that more young people will start to view infection prevention as a career path?

Pettis: I do. And that’s certainly our hope through APIC through the documents that I described as a basis for that sort of career path. And a lot of organizations have been able to attach dollars to those different levels of competency. And then requirement for certification in infection prevention is a very important topic to us. And New York State has been our first area that we’ve focused on to try to get a law passed to require certification. Illinois, it will be another focus, after we come back to … you know, right now, it’s just not the best time. On the one hand, everybody’s paying attention to infection prevention, but there’s just so many moving parts at this point. But we are keeping that in our sights, as a priority to address that. And then the other thing is that we know that when infection preventionists have come into our profession, often there’s a window of about a one-and-a-half to two-year timeframe where they either decide that it’s not for them for a variety of reasons, or they decide that, you know, this is really fascinating. And then typically, if you can keep them past that, usually they’re going to stick around for quite a while. One of the things that has been done is we have a large group of expert infection preventionists around the country. They’re called corporate IPs. And they actually have developed a fabulous mentorship program. COVID hit right after that was developed. We haven’t really been able to roll it out as robustly as we planned to. But I think that will help support people that get into the career so that they don’t fall away within that two-year window. I think support is very, very important.

ICT®: So just to circle around to the question of burnout: If they happen to have more infection preventionists on site, you’re less likely to have burnout as a problem, right?

Pettis: I would agree.

ICT®: How many states actually require that infection preventionists be certified?

Pettis: Great question. I did have that number. I think it’s two or three.

ICT®: That’s it?

Pettis: That’s it. Yes.

ICT®: Wow. That seems like that would be job number one after this pandemic. You and I have talked about this before: Getting certification on a national level.

Pettis: Well, it has to be state by state. It could not be a federal mandate, but that’s why it takes some time, because you got to get champions, obviously, in the legislature. And then you’ve got to convince groups like the American Hospital Association, or your local … HANY is the Hospital Association of our New York State. You’ve got a lot of important stakeholders that you need to help understand why we’re looking to do that. It’s not the easiest lift. But it’s incredibly important. The public needs to know that there is a basic level of competency for infection preventionists, and certification would provide that for the public. And I think it elevates the profession at large, if you will. We’re very, very committed to picking up that mantle again, once COVID slows down a little bit again. But going back to your question about burnout, I think the more resources that you can help people understand are available, the better. Because as I started off by saying, I think it’s very individual. What might work for one to help them with it may not help the other person. I think you need to have a lot of different options. One of the things we’ve done at APIC is we created a wellness series. And the first one that we did was sort of the prototype, and we teamed up with Mount Sinai in New York City. And they had a fabulous psychologist, who was one of the leads at their center—I’ve got to read it, because I’ll make sure I get it right—their Center for Stress, Resilience, and Personal Growth. And he did like an hour and a half long session. And all IPs were invited to it. And it was virtual, of course. Everything’s been virtual. And it was fabulous. And he gave a lot of background about burnout. He gave a lot of tips and strategies to prophylact against burnout, and also to deal with it if you were experiencing the symptoms of burnout. We did that first and then we followed up with four different sessions. The next one was lessons from the frontline. It was a panel of IPs because I think a lot of people get courage from listening to other people’s stories. They were telling stories about what they’d experienced. And then people were able to chat back and forth. So that was very, very helpful for people. The next one was yoga. Because it’s not just your mind. It’s your body. It’s spiritual. It’s all those things. Then the third one was a person that came in that was a specialist in meditation and taught them about meditation and actually conducted a meditation session, virtually, which is awesome. And then the last one was about resilience. And so that was done. And then we have so many other things from a resource standpoint. We have an APIC COVID Task Force. And then every week, they send out electronic messaging to our membership.

ICT®: Somebody can go to the APIC website and see all those sessions?

Pettis: Yes! Yes! They’re still available on the site, so that if they weren’t able to join, and those were held at 7 p.m. every Monday. I think it was at 7 p.m. Hopefully, people were maybe getting home by that point, so that they could kick back and partake. But they are available still at the website. Yes, all these different resources are available. So the COVID Task Force. We also early on did a nationwide survey on PPE availability. And then from there we had a way for members to reach out to their own legislative representatives to request for input and support to get additional PPE. And eventually, we did start to see the supplies improve. I’m sure there might be some areas that are still struggling with certain things. But in general, personal protective equipment supplies have improved over the pandemic. But it’s been a heavy lift and a very difficult journey with that. So, there are a lot of resources that are available. There are a lot of links to like the CDC, and other organizations that have been very helpful throughout the pandemic. We make all those things available to our to our members.

ICT®: I’ve always assumed—and stop me if I’m wrong—that the background for many infection preventionists is nursing. Is that correct?›

Pettis: Historically? Yes, primarily IPs had been nurses. But now we’re seeing a lot of people coming in from public health, medical technologists, laboratorians. epidemiologist positions. I would say it’s becoming much more diverse than what it has been historically.

ICT®: So how does that affect your certification process? Can somebody come in off the street, so to speak, from any profession and say, “I want to be an infection preventionist?” The way people decide to get a real estate license and just start selling houses? It’s not quite that easy, right? To become an infection preventionist?

Pettis: Honestly, right now, unless you’re in a state that requires certification, it’s up to the organization that you’re working for. And so, some organizations require certification in order to be hired. But many do not. And, for instance, in our organization, we don’t require it. But we do say within two years, the expectation is that you will become certified. So that at least gives them time. Of course, we also have the luxury of having … you pointed out before that if you have several IPs in your program, you’ve got a lot more support. You might not be quite as at risk for burnout than if you’re the only IP. Particularly a lot of IPs around the country are not only the infection preventionist, they might be the head of employee health. They might be the head of emergency preparedness. The list goes on. And so, I do think it’s a variable around the country in terms of what the requirements are. Really more times than not is up to the organization to spell out what the requirements are.

ICT®: And that’s a concern of yours that you just mentioned that you would like to see certification in every state. Circling back, finally, to what we started out with: burnout. How do you protect yourself from burnout and how do you protect others from burnout? You mentioned earlier that humor is a great way to make that happen. What else?

Pettis: I think exercise is just an amazing way to regenerate at the end of the day or on a weekend or whenever you might be able to do it. And you know, a lot of that is being done virtually now. I belong to the YMCA and the YMCA has pre-recorded all sorts of exercise classes and whatnot so that you can do it at any time in your own home. You know, because during the height of the surge in various places, obviously gyms were shut down and whatever. My poor dog was so sick of going out for walks. But for me that really is always my go-to. But I think you know, your loved ones. I think staying in touch with people, even if it’s virtually is incredibly important because human beings are social animals. And you need that social touch all the time.

This interview has been edited for clarity and length.