Impacts on Health Care Workers

This report by Weine et al. provides an analysis of impacts of the COVID-19 pandemic on the health care workforce and recommendations for minimizing adverse impacts now and over time. The authors are an interdisciplinary group of over four dozen faculty experts across the University of Illinois System and includes both case studies and broader overviews.

Among the major impacts identified are:

• Direct health risks to providers
• Challenges in transportation, housing, childcare, and other family responsibilities
• Mastering new ways of delivering care via telemedicine
• Economic and emotional strain due to being furloughed or having wages reduced due to contracting revenues
• Strains on families and loved ones due to infection risk, separation due to work demands, or need to reside outside the home to reduce risks
• Emotional and mental health consequences for health care workers, including exhaustion, stress, PTSD, depression, anxiety, suicidality, domestic violence, and substance abuse.

Using the framework of the Emergency Management Cycle, the report assesses issues under four phases: Response, Recovery, Mitigation, and Preparedness, discussing both operational needs (people, information, processes, and space/equipment/technology) and human experience needs (physical and psychosocial).

This article by Gray et al. discusses stress and workplace shortages reported by critical care physicians treating COVID-19 patients based on a survey conducted in late 2020. The survey participants had previously reported stress and shortages in an earlier April-May 2020 survey, allowing the present study to investigate changes as the pandemic situation evolved. In the present study, 50.7% of critical care physicians reported moderate or high levels of emotional distress (compared to 67.6% in the earlier spring survey). Reports of staffing shortages persisted (46.5% in fall vs. 48.3% in spring), but reports of medication and equipment shortages common in the spring were largely alleviated by the fall survey. One notable exception was PPE; while reported shortages declined by half, shortages were still reported by 21.9% of respondents. The study also found that stress levels remained higher in areas of the country experiencing a case surge, and staffing shortages were also worse in hotspots. While cases have generally receded, the findings of this study offer important warnings about potential adverse impacts on the health care workforce should there be further surges due to new variants or lack of vaccination.

This article by Gibson & Greene assesses nursing home compliance with CDC guidance on COVID_19 transmission-based precautions (TBP) by examining how frequently nursing homes had shortages of PPE or staff in weeks when they admitted COVID-positive patients (circumstances that would make it more difficult to follow TBP). Overall, the study found that over a 40-week period, 39% of nursing homes admitted COVID-positive patients during at least 1 week in which they experienced PPE or staffing shortages. Facilities that admitted patients during shortages tended to have lower CMS quality ratings compared to other facilities and tended to admit a higher share of residents who were Black. However, few facilities that admitted positive patients during shortages were located in counties with severe shortages. The authors conclude that these findings indicate that admission practices may have placed residents and staff at heightened risk of infection.

This article by Ness et al. provides a qualitative analysis of health care providers’ challenges during the pandemic, focusing on psychosocial impacts. Most respondents (78%) were nurses and most (78%) were female. Providers cam from 12 states, including Indiana. Consistent with the other studies discussed above, four major themes were revealed by the analysis:

• Managing isolation, fear, and increased anxiety
• Adapting to changes in healthcare practice and policy
• Addressing emotional and physical needs of patients and their families
• Navigating evolving workplace safety.

Among other noteworthy findings, more than half of respondents were required to change their practice area during the pandemic, and most reported restrictions on PPE use (43%) and/or reuse of disposable PPE (57%).

The authors suggest that hospital administrations can proactively support health care providers during this and future pandemics by ensuring that these professionals have access to mental health programs, standardizing communication, and developing plans that address equipment and supply availability.