Perspectives

Bringing the invisible battle into view

Understanding health care stressors and mental well-being in COVID-19 frontline workers

Frontline caregivers are not always contracting COVID-19, but they are catching unseen side effects such as chronic burnout and post-traumatic stress disorder (PTSD). This report brings insights of empathy that will help you understand the emotional cost of COVID-19 and gives practical steps to help restore wholeness to these heroes.

Executive Summary

The COVID-19 pandemic has caused unprecedented stress in health care workers, from physicians and nurses to food services and sanitation workers.1 And buried within these health care stressors is an unusual combination of pressure and ambiguity: The timeline to recovery is unclear; as people are still trying to understand how best to treat COVID-19, and caregivers are faced with the reality that they can transmit the disease to loved ones and one another due to greater levels of exposure.

Our team conducted virtual focus groups with US-based clinicians on the front lines and secondary research to understand the key stressors that frontline caregivers are facing within the broader context of the pandemic. This point of view details how COVID-19 has amplified preexisting challenges of burnout, distress, and maintaining well-being and provides a list of proactive approaches that health care organizations can leverage to help better support caregiver well-being.

Key stressors

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  • High risk of contracting and/or transmitting the virus
  • Practicing outside of area of expertise to treat surge
  • Treating coworkers
  • Emotional toll of continued grief and guilt
  • Fear of exposing family members
  • Personal and lifestyle stressors (for example, childcare, destressing or recharging activities, spiritual practice, lack of sleep)

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  • Access to sufficient levels of PPE, medical supplies, equipment, and testing
  • Backlog of elective and non–COVID-19 care
  • Uncertainty around treating a novel disease and lack of control around potential future COVID-19 surges
  • Financial ramifications of the pandemic for health systems and caregivers’ lifestyles (such as furloughs or potential hospital shutdowns)

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  • Guilt about not being in a high-volume area
  • Fear of the unknown related to increases in COVID-19 cases
  • Frustration or feelings of anxiety around the disruption of routine
  • Fielding patient anxiety

Caring that really feels like it

Our new report identified 15 practical strategies that hospital administrators and leaders can employ now to address stress in health care workers. These range from mental health and well-being support to operations and culture.

Meeting immediate caregiver need for professional mental well-being services and destigmatizing the use of those services.

Drive adoption of employee assistance programs (EAPs): Encourage utilization of EAPs and hold group therapy—potentially virtual—for patient-facing workforces.

Screening for frontline workers: Consider implementing opt-in, confidential screening programs to identify mental health and connect caregivers to the help they may need.

Expand coverage for mental and behavioral well-being and encourage utilization: Expand benefits to include programs to support well-being and resilience.

Offering programs that support employees’ and their families' holistic well-being, including adoption of programs.

Address short-term caregiver needs: Alleviate external stressors by expanding benefits to frontline staff and their families with child and elder care, food delivery, or temporary housing accommodations, which allows caregivers time to focus on patients.

Empower caregiver community through peer groups: Convene peer groups, facilitated by mental well-being professionals, to discuss day-to-day experiences of being on the front lines.

Rewards optimization: Judge whether rewards offerings effectively meet the needs of the workforce by surveying employees, identifying potential drivers of overall health (such as food insecurity), then implement benefits to address needs.

Embedding a priority of holistic well-being through existing and new processes (such as staffing and existing quality and safety processes).

Testing and vaccines: Widely implement testing and—when available—administer COVID-19 vaccines at no cost to all patient-facing workforce.

Redeploy workforces: Continue redeploying workforces from low- to high-demand areas to support increased capacity, adjust shifts, and increase PTO allowances.

Expand virtual health: Ramp up virtual care and prioritize high-risk caregivers for virtual shifts to help reduce spread among caregivers and patients.

Activating the norms and values that support caregiver well-being.

Leadership activation: Provide training to leaders in topics such as resilient leadership, communications, empathy, and trauma-informed care.

Activate a culture of recognition: If you do not already have one, embed recognition into existing meetings where staff can acknowledge the contribution of coworkers and build a sense of community.

Celebrate caregivers’ commitment to the mission: Continue to celebrate your workforces' commitment to their overall purpose of working in health care by widely sharing and celebrating successes (such as making an announcement on the intercom when a COVID-19 patient is released).

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