Burnout Among Primary Care Healthcare Workers During the COVID-19 Pandemic

Newly Acquired Burnout During the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective Cohort Study on the Experiences of New York State Primary Care Clinicians

The well-being of primary care clinicians represents an area of increasing interest amid concerns that the COVID-19 pandemic may have exacerbated already high prevalence rates of clinician burnout. This retrospective cohort study was designed to identify demographic, clinical, and work-specific factors that may have contributed to newly acquired burnout after the onset of the COVID-19 pandemic. An anonymous web-based questionnaire distributed in August 2020 to New York State (NYS) primary care clinicians, via email outreach and newsletters, produced 1,499 NYS primary care clinician survey respondents. Burnout assessment was measured pre-pandemic and early in the pandemic using a validated single-item question with a 5-point scale ranging from (1) enjoy work to (5) completely burned out. Demographic and work factors were assessed via the self-reporting questionnaire. Thirty percent of 1,499 survey respondents reported newly acquired burnout during the early pandemic period. This was more often reported by clinicians who were women, were younger than 56 years old, had adult dependents, practiced in New York City, had dual roles (patient care and administration), and were employees. Lack of control in the workplace prior to the pandemic was predictive of burnout early in the pandemic, while work control changes experienced following the pandemic were associated with newly acquired burnout. Low response rate and potential recall bias represent limitations. These findings demonstrate that reporting of burnout increased among primary care clinicians during the pandemic, partially due to varied and numerous work environment and systemic factors.

Qualitative interview study of strategies to support healthcare personnel mental health through an occupational health lens

BACKGROUND

Employee Occupational Health ('occupational health') clinicians have expansive perspectives of the experience of healthcare personnel. Integrating mental health into the purview of occupational health is a newer approach that could combat historical limitations of healthcare personnel mental health programmes, which have been isolated and underused.

OBJECTIVE

We aimed to document innovation and opportunities for supporting healthcare personnel mental health through occupational health clinicians. This work was part of a national qualitative needs assessment of employee occupational health clinicians during COVID-19 who were very much at the centre of organisational responses.

DESIGN

This qualitative needs assessment included key informant interviews obtained using snowball sampling methods.

PARTICIPANTS

We interviewed 43 US Veterans Health Administration occupational health clinicians from 29 facilities.

APPROACH

This analysis focused on personnel mental health needs and opportunities, using consensus coding of interview transcripts and modified member checking.

KEY RESULTS

Three major opportunities to support mental health through occupational health involved: (1) expanded mental health needs of healthcare personnel, including opportunities to support work-related concerns (eg, traumatic deployments), home-based concerns and bereavement (eg, working with chaplains); (2) leveraging expanded roles and protocols to address healthcare personnel mental health concerns, including opportunities in expanding occupational health roles, cross-disciplinary partnerships (eg, with employee assistance programmes (EAP)) and process/protocol (eg, acute suicidal ideation pathways) and (3) need for supporting occupational health clinicians' own mental health, including opportunities to address overwork/burn-out with adequate staffing/resources.

CONCLUSIONS

Occupational health can enact strategies to support personnel mental health: to structurally sustain attention, use social cognition tools (eg, suicidality protocols or expanded job descriptions); to leverage distributed attention, enhance interdisciplinary collaboration (eg, chaplains for bereavement support or EAP) and to equip systems with resources and allow for flexibility during crises, including increased staffing.

Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017-2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic.

METHODS

We analyzed individual- and healthcare system-level data from 19,894 primary care HCWs in 139 healthcare systems in 2020. We modeled potential relationships between individual-level burnout and turnover intent as outcomes, and individual-level employee engagement, perceptions of workload, leadership, and workgroups. At healthcare system-level, we assessed prior-year levels of burnout and turnover intent, COVID-19 burden (number of tests and deaths), and the extent of virtual care use as potential determinants. We conducted multivariable analyses using logistic regression with standard errors clustered by healthcare system controlled for individual-level demographics and healthcare system complexity.

RESULTS

In 2020, 37% of primary care HCWs reported burnout, and 31% reported turnover intent. Highly engaged employees were less burned out (OR = 0.57; 95% CI 0.52-0.63) and had lower turnover intent (OR = 0.62; 95% CI 0.57-0.68). Pre-pandemic healthcare system-level burnout was a major predictor of individual-level pandemic burnout (p = 0.014). Perceptions of reasonable workload, trustworthy leadership, and strong workgroups were also related to lower burnout and turnover intent (p < 0.05 for all). COVID-19 burden, virtual care use, and prior year turnover were not associated with either outcome.

CONCLUSIONS

Employee engagement was associated with a lower likelihood of primary care HCW burnout and turnover intent during the pandemic, suggesting it may have a protective effect during stressful times. COVID-19 burden and virtual care use were not related to either outcome. Future research should focus on understanding the relationship between engagement and burnout and improving well-being in primary care.

The effects of COVID-19 event strength on job burnout among primary medical staff

BACKGROUND

As a global pandemic, The Corona Virus Disease 2019 (COVID-19) has brought significant challenges to the primary health care (PHC) system. Health professionals are constantly affected by the pandemic's harmful impact on their mental health and are at significant risk of job burnout. Therefore, it is essential to gain a comprehensive understanding of how their burnout was affected. The study aimed to examine the relationship between COVID-19 event strength and job burnout among PHC providers and to explore the single mediating effect of job stress and work engagement and the chain mediating effect of these two variables on this relationship.

METHODS

Multilevel stratified convenience sampling method was used to recruit 1148 primary medical staff from 48 PHC institutions in Jilin Province, China. All participants completed questionnaires regarding sociodemographic characteristics, COVID-19 event strength, job stress, work engagement, and job burnout. The chain mediation model was analyzed using SPSS PROCESS 3.5 Macro Model 6.

RESULTS

COVID-19 event strength not only positively predicted job burnout, but also indirectly influenced job burnout through the mediation of job stress and work engagement, thereby influencing job burnout through the "job stress → work engagement" chain.

CONCLUSIONS

This study extends the application of event systems theory and enriches the literature about how the COVID-19 pandemic impacted PHC medical staff job burnout. The findings derived from our study have critical implications for current and future emergency response and public policy in the long-term COVID-19 disease management period.

Health-care Worker Engagement in Federally Qualified Health Centers and Associations with Confidence in Making Health-care Recommendations: Evidence from the Louisiana Community Engagement Alliance

Throughout the coronavirus disease 2019 (COVID-19) pandemic, there have been numerous demands on primary care practices and providers affecting work engagement and burnout, which can affect health-care delivery and patient outcomes. We determined potentially modifiable factors associated with work engagement among employees of federally qualified health centers (FQHCs) throughout Louisiana. Resilient coping, spirituality, and social support were associated with being engaged at work. FQHC employees perceiving a more chaotic work environment and those with depressive or anxiety symptoms were less likely to be engaged at work. Being engaged was associated with confidence in COVID-19 vaccine recommendation for adults.

The role of primary care during the pandemic: shared experiences from providers in five European countries

BACKGROUND

The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience.

METHODS

The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care.

RESULTS

Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues.

CONCLUSION

Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic.

Using Research to Transform Electronic Health Record Modernization: Advancing a VA Partnered Research Agenda to Increase Research Impacts

BACKGROUND

The U.S. Department of Veterans Affairs (VA) is undergoing an enterprise-wide transition from a homegrown electronic health record (EHR) system to a commercial off-the-shelf product. Because of the far-reaching effects of the EHR transformation through all aspects of the healthcare system, VA Health Services Research and Development identified a need to develop a research agenda that aligned with health system priorities so that work may inform evidence-based improvements in implementation processes and outcomes.

OBJECTIVE

The purpose of this paper is to report on the development of a research agenda designed to optimize the EHR transition processes and implementation outcomes in a large, national integrated delivery system.

DESIGN

We used a sequential mixed-methods approach (portfolio assessment, literature review) combined with multi-level stakeholder engagement approach that included research, informatics, and healthcare operations experts in EHR transitions in and outside the VA. Data from each stage were integrated iteratively to identify and prioritize key research areas within and across all stakeholder groups.

PARTICIPANTS

VA informatics researchers, regional VA health system leaders, national VA program office leaders, and external informatics experts with EHR transition experience.

KEY RESULTS

Through three rounds of stakeholder engagement, priority research topics were identified that focused on operations, user experience, patient safety, clinical outcomes, value realization, and informatics innovations.

CONCLUSIONS

The resulting EHR-focused research agenda was designed to guide development and conduct of rigorous research evidence aimed at providing actionable results to address the needs of operations partners, clinicians, clinical staff, patients, and other stakeholders. Continued investment in research and evaluation from both research and operations divisions of VA will be critical to executing the research agenda, ensuring its salience and value to the health system and its end users, and ultimately realizing the promise of this EHR transition.

Variation in Family Physicians' Experiences Across Different Electronic Health Record Platforms: a Descriptive Study

BACKGROUND

Electronic health records (EHRs) have been connected to excessive workload and physician burnout. Little is known about variation in physician experience with different EHRs, however.

OBJECTIVE

To analyze variation in reported usability and satisfaction across EHRs.

DESIGN

Internet-based survey available between December 2021 and October 2022 integrated into American Board of Family Medicine (ABFM) certification process.

PARTICIPANTS

ABFM-certified family physicians who use an EHR with at least 50 total responding physicians.

MEASUREMENTS

Self-reported experience of EHR usability and satisfaction.

KEY RESULTS

We analyzed the responses of 3358 physicians who used one of nine EHRs. Epic, athenahealth, and Practice Fusion were rated significantly higher across six measures of usability. Overall, between 10 and 30% reported being very satisfied with their EHR, and another 32 to 40% report being somewhat satisfied. Physicians who use athenahealth or Epic were most likely to be very satisfied, while physicians using Allscripts, Cerner, or Greenway were the least likely to be very satisfied. EHR-specific factors were the greatest overall influence on variation in satisfaction: they explained 48% of variation in the probability of being very satisfied with Epic, 46% with eClinical Works, 14% with athenahealth, and 49% with Cerner.

CONCLUSIONS

Meaningful differences exist in physician-reported usability and overall satisfaction with EHRs, largely explained by EHR-specific factors. User-centric design and implementation, and robust ongoing evaluation are needed to reduce physician burden and ensure excellent experience with EHRs.

The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19

BACKGROUND

Burnout has risen across healthcare workers during the pandemic, contributing to workforce turnover. While prior literature has largely focused on physicians and nurses, there is a need to better characterize and identify actionable predictors of burnout and work intentions across healthcare role types.

OBJECTIVE

To characterize the association of work overload with rates of burnout and intent to leave (ITL) the job in a large national sample of healthcare workers.

DESIGN

Cross-sectional survey study conducted between April and December 2020.

SETTING

A total of 206 large healthcare organizations.

PARTICIPANTS

Physicians, nurses, other clinical staff, and non-clinical staff.

MEASURES

Work overload, burnout, and ITL.

RESULTS

The sample of 43,026 respondents (mean response rate 44%) was comprised of 35.2% physicians, 25.7% nurses, 13.3% other clinical staff, and 25.8% non-clinical staff. The overall burnout rate was 49.9% (56.0% in nursing, 54.1% in other clinical staff, 47.3% in physicians, and 45.6% in non-clinical staff; p < 0.001 for difference). ITL was reported by 28.7% of healthcare workers, with nurses most likely to report ITL (41.0%), followed by non-clinical staff (32.6%), other clinical staff (32.1%), and physicians (24.3%) (p < 0.001 for difference). The prevalence of perceived work overload ranged from 37.1% among physicians to 47.4% in other clinical staff. In propensity-weighted models, work overload was significantly associated with burnout (adjusted risk ratio (ARR) 2.21 to 2.90) and intent to leave (ARR 1.73 to 2.10) across role types.

LIMITATIONS

Organizations' participation in the survey was voluntary.

CONCLUSIONS

There are high rates of burnout and intent to leave the job across healthcare roles. Proactively addressing work overload across multiple role types may help with concerning trends across the healthcare workforce. This will require a more granular understanding of sources of work overload across different role types, and a commitment to matching work demands to capacity for all healthcare workers.

Burnout and impostor phenomenon in nursing and newly licensed registered nurses: A scoping review

AIMS AND OBJECTIVE

To identify the prevalence and severity of impostor phenomenon and burnout in newly licensed registered nurses, map the current literature on impostor phenomenon in nursing, and identify related factors affecting the new nurse's transition to practice.

BACKGROUND

Impostor phenomenon is an internalised intellectual phoniness resulting in persistent self-doubt despite prior success. It can evoke feelings of emotional exhaustion associated with burnout, negatively affecting employee retention. Due to changes in nursing education resulting from COVID-19, self-doubt and uncertainty among new nurses are expected to be heightened, leading to burnout which adversely effects nurse well-being, patient care and retention.

DESIGN

The scoping review follows the methodological framework developed by Arksey and O'Malley (2005) and the Reporting Checklist for Scoping Reviews (PRISMA-ScR) guidelines.

METHODS

The literature search was conducted utilising PubMed, CINAHL and PsycINFO. Inclusion criteria were studies published between 2011 and 2021, written in English, peer-reviewed, and focused on newly licensed registered nurses. Eighteen articles were reviewed.

RESULTS

Studies on impostor phenomenon in nursing are limited to nursing students and clinical nurse specialists. Prevalence of impostor feelings in these populations range from 36% to 75%, and 12.3% to 46% of new nurses report burnout. Impostor feelings arise from role ambiguity, lack of self-compassion, transitions, and minimal clinical experience. Burnout was associated with stress, feeling unprepared, inadequate socialisation, and lack of self-compassion. Overlap in these factors could increase impostor feelings and burnout in new nurses.

CONCLUSIONS

Effects of impostor phenomenon and burnout can negatively impact the well-being of the new nurse. Currently, no studies simultaneously examine impostor phenomenon and burnout in new nurses. Further research on the relationship between these phenomena should be conducted.

RELEVANCE TO CLINICAL PRACTICE

Understanding the impact of impostor phenomenon and burnout on new nurses could help mitigate challenges they face transitioning into practice.

Burnout Among Public Health Workers During the COVID-19 Pandemic in South Korea

OBJECTIVE

This study aimed to investigate the prevalence of burnout experiences and factors associated with burnout among Korean health care workers during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A nationwide survey was conducted in 2021, and the sample comprised 1000 public health center employees. Multivariate linear regression was used to examine the factors associated with burnout among the participants during the COVID-19 pandemic. Perceived factors contributing to burnout were also analyzed using an open-ended question.

RESULTS

Personal (e.g., age, gender, and self-rated health) and work-related factors (e.g., type of job tasks and COVID-19-related discrimination experience) affected burnout among health care workers. However, organizational support, including emotional support and sufficient financial compensation, was associated with lower burnout.

CONCLUSIONS

Ensuring sufficient support and rewards for health care workers is essential to guaranteeing their well-being during the current public health crisis.

Health Consequences of the COVID-19 Pandemic among Health-Care Workers: A Comparison between Groups Involved and Not Involved in COVID-19 Care

Health consequences have been reported among health-care workers (HCWs) exposed to COVID-19. Sweden chose to manage the pandemic with a lower and more equal long-lasting work strain and shorter periods of recovery than in other countries. Few studies have examined the health consequences among HCWs working in such conditions. This study compared the health consequences after the first wave of the COVID-19 pandemic between HCWs involved in the care of COVID-19 patients and other HCWs and between occupational groups working in COVID-19 care. Multinomial logistic regression and univariate general linear models were used to identify differences. The levels of depression, emotional and physical fatigue, sleep quality, and general health were measured 6 months after the onset of the pandemic in 3495 HCW employed in Sweden. HCWs directly involved in COVID-19 care reported significantly poorer sleep quality and higher scores on emotional and physical exhaustion than those not involved in such care. Health consequences did not differ significantly between different occupational groups involved in COVID-19 care except for specialist nurses/midwives. HCWs more frequently involved in COVID-19 care reported higher levels of emotional and physical fatigue and poorer sleep but less severe than those reported in more severely affected countries.

Association of Electronic Health Record Inbasket Message Characteristics With Physician Burnout

IMPORTANCE

Physician burnout is an ongoing epidemic; electronic health record (EHR) use has been associated with burnout, and the burden of EHR inbasket messages has grown in the context of the COVID-19 pandemic. Understanding how EHR inbasket messages are associated with physician burnout may uncover new insights for intervention strategies.

OBJECTIVE

To evaluate associations between EHR inbasket message characteristics and physician burnout.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional study in a single academic medical center involving physicians from multiple specialties. Data collection took place April to September 2020, and data were analyzed September to December 2020.

EXPOSURES

Physicians responded to a survey including the validated Mini-Z 5-point burnout scale.

MAIN OUTCOMES AND MEASURES

Physician burnout according to the self-reported burnout scale. A sentiment analysis model was used to calculate sentiment scores for EHR inbasket messages extracted for participating physicians. Multivariable modeling was used to model risk of physician burnout using factors such as message characteristics, physician demographics, and clinical practice characteristics.

RESULTS

Of 609 physicians who responded to the survey, 297 (48.8%) were women, 343 (56.3%) were White, 391 (64.2%) practiced in outpatient settings, and 428 (70.28%) had been in medical practice for 15 years or less. Half (307 [50.4%]) reported burnout (score of 3 or higher). A total of 1 453 245 inbasket messages were extracted, of which 630 828 (43.4%) were patient messages. Among negative messages, common words included medical conditions, expletives and/or profanity, and words related to violence. There were no significant associations between message characteristics (including sentiment scores) and burnout. Odds of burnout were significantly higher among Hispanic/Latino physicians (odds ratio [OR], 3.44; 95% CI, 1.18-10.61; P = .03) and women (OR, 1.60; 95% CI, 1.13-2.27; P = .01), and significantly lower among physicians in clinical practice for more than 15 years (OR, 0.46; 95% CI, 0.30-0.68; P < .001).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, message characteristics were not associated with physician burnout, but the presence of expletives and violent words represents an opportunity for improving patient engagement, EHR portal design, or filters. Natural language processing represents a novel approach to understanding potential associations between EHR inbasket messages and physician burnout and may also help inform quality improvement initiatives aimed at improving patient experience.

Burnout in Intensive Care Nurses during the COVID-19 Pandemic: A Scoping Review on Its Prevalence and Risk and Protective Factors

BACKGROUND

The COVID-19 pandemic has strained hospitals and healthcare workers engaged in combating the virus with limited knowledge and resources. Intensive care unit (ICU) nurses are among the healthcare workers most affected by the pandemic and are at risk for developing burnout syndrome.

OBJECTIVE

The present study aims to explore burnout symptoms prevalence among ICU nurses and to identify the individual, organizational, and contextual risk, and protective factors of burnout in ICU nurses during the COVID-19 pandemic.

METHODS

A scoping review was conducted by searching PubMed, Scopus, and Web of Science. Only papers with empirical data and referred to ICU nurses were included. A total of 350 initial results were yielded, and 40 full texts were screened. Twelve papers constituted the final sample in the analysis.

RESULTS

High levels of symptoms of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) were registered among ICU nurses during the COVID-19 pandemic. Increased workload, lack of equipment, social stigma, and fear of contagion emerged as key risk factors. Social support from leaders and colleagues, professional recognition, use of personal protective tools, and witnessing patients' successful recovery emerged as major protective factors.

CONCLUSIONS

The results may inform the development of timely actions to counter burnout in ICU nurses during this COVID-19 pandemic and in a post-COVID-19 scenario.

Clinician Perspectives on Monoclonal Antibody Treatment for High-Risk Outpatients with COVID-19: Implications for Implementation and Equitable Access

BACKGROUND

There is an urgent need to identify and address factors influencing uptake and equitable access to monoclonal antibody (mAb) treatment for high-risk outpatients with COVID-19.

OBJECTIVE

To assess clinician knowledge, beliefs, and experiences regarding obtaining mAb treatment for eligible patients.

DESIGN AND PARTICIPANTS

Survey of clinicians (N = 374) practicing in the state of Colorado who care for patients with COVID-19 in primary care, emergency medicine, and other clinical settings.

MAIN MEASURE(S)

Diffusion of innovation theory concepts including knowledge, perceived strength of evidence, barriers, and experience with, ease of use, preparedness, and feasibility, appropriateness, and acceptability of mAb referral systems and processes.

KEY RESULTS

Most respondents indicated little to no knowledge about mAb therapies for COVID-19 (67%, 74%, 77%, for bamlanivimab, bamlanivimab+etesivimab, and casirivimab+imdevimab, respectively). About half reported little to no familiarity with eligibility criteria (50.9%) and did not know the strength of evidence (31%, 43%, 52%, for bamlanivimab, bamlanivimab+etesivimab, and casirivimab+imdevimab, respectively). Lack of knowledge or confidence in treatment was a top barrier to mAbs use; other barriers included complicated referral processes, patients not eligible when seen, and out-of-pocket costs concerns. Respondents rated four mAb referral steps as generally acceptable, appropriate, and feasible to complete in their primary outpatient clinical setting. Only 24% indicated their clinical setting was very prepared to facilitate referrals, 40% had ever referred a patient for mAbs, and 43% intended to refer a patient in the next month.

CONCLUSIONS

Clinician education on strength of evidence and eligibility criteria for mAbs is needed. However, education alone is not sufficient. Given the urgent need to rapidly scale up access to treatment and reduce hospitalizations and death from COVID-19, more efficient, equitable systems and processes for referral and delivery of care, such as those coordinated by health systems, public health departments, or disaster management services, are warranted.

Organizational responses to the COVID-19 pandemic in Victoria, Australia: A qualitative study across four healthcare settings

Objective

Organizational responses that support healthcare workers (HCWs) and mitigate health risks are necessary to offset the impact of the COVID-19 pandemic. We aimed to understand how HCWs and key personnel working in healthcare settings in Melbourne, Australia perceived their employing organizations' responses to the COVID-19 pandemic.

Method

In this qualitative study, conducted May-July 2021 as part of the longitudinal Coronavirus in Victorian Healthcare and Aged Care Workers (COVIC-HA) study, we purposively sampled and interviewed HCWs and key personnel from healthcare organizations across hospital, ambulance, aged care and primary care (general practice) settings. We also examined HCWs' free-text responses to a question about organizational resources and/or supports from the COVIC-HA Study's baseline survey. We thematically analyzed data using an iterative process.

Results

We analyzed data from interviews with 28 HCWs and 21 key personnel and free-text responses from 365 HCWs, yielding three major themes: navigating a changing and uncertain environment, maintaining service delivery during a pandemic, and meeting the safety and psychological needs of staff . HCWs valued organizational efforts to engage openly and honesty with staff, and proactive responses such as strategies to enhance workplace safety (e.g., personal protective equipment spotters). Suggestions for improvement identified in the themes included streamlined information processes, greater involvement of HCWs in decision-making, increased investment in staff wellbeing initiatives and sustainable approaches to strengthen the healthcare workforce.

Conclusions

This study provides in-depth insights into the challenges and successes of organizational responses across four healthcare settings in the uncertain environment of a pandemic. Future efforts to mitigate the impact of acute stressors on HCWs should include a strong focus on bidirectional communication, effective and realistic strategies to strengthen and sustain the healthcare workforce, and greater investment in flexible and meaningful psychological support and wellbeing initiatives for HCWs.

Trends in Insomnia, Burnout, and Functional Impairment among Health Care Providers over the First Year of the COVID-19 Pandemic

Background

COVID-19 pandemic has negatively impacted the psychological well-being and quality of life of health care providers (HCPs).

Objectives

This study assessed the trends in prevalence and predictors of insomnia, burnout, and functional impairment among HCPs over the first year of the pandemic.

Methods

An online survey was conducted one month after the pandemic's onset (onset group) and a year later (one-year group). The demographic features of participants were collected. Insomnia, burnout, and functional impairment were assessed using Insomnia Severity Index (ISI), Mini-Z survey, and Sheehan Disability Scale (SDS), respectively.

Results

The onset group included 211 HCPs (mean (SD) age 34.7 (9.3) years and 73% men), while 212 HCPs participated in the one-year survey (mean (SD) age 35.9 (10.5) years and 69% men). High prevalence estimates were found in both onset and one-year groups of symptoms of insomnia (52% vs. 49%), of diagnosis of clinical insomnia (15% vs. 18%), with a high mean ISI score (8.4 vs. 8.7), but with no significant difference between the onset and one-year groups. Risk factors for clinical insomnia included age in both groups, lower income and contact level with COVID-19 patients/samples in the onset group, and lower Mini-Z scores and higher SDS scores in the one-year group. Approximately one-third of respondents reported at least one or more burnout symptoms, with a higher percentage in the one-year group (35.4%) than in the onset group (24.2%) (p=0.012). Younger age, lower monthly income, and higher ISI and SDS scores were risk factors for burnout in both groups. Greater perceived changes in social life were associated with burnout in the onset group. In contrast, higher weekly working hours, worse participants' evaluation of their institution's preparation, and more changes in workload were risk factors for burnout in the one-year group. The SDS score and its subscales scores were higher in the one-year group than in the onset group. Changes in workload and social life predicted higher SDS scores among both groups. Living with older people predicted higher SDS scores among the onset group, while contact level and estimated number of COVID-19 patients that participants engaged in during caring predicted higher SDS scores among the one-year group. ISI scores were significantly correlated with the Mini-Z scores and SDS scores in both groups, while the Mini-Z and SDS scores were significantly correlated only in the one-year group.

Conclusion

This study demonstrated high rates of insomnia, burnout, and functional impairment among HCPs during the pandemic. It reveals a significant rise in job burnout and functional impairment of HCPs overtime during the pandemic. Furthermore, high-risk subgroups are also highlighted for whom comprehensive psychosocial and occupational interventions might be warranted.

The Impact of COVID-19 on Primary Care Teamwork: a Qualitative Study in Two States

BACKGROUND

The emergence of coronavirus disease 2019 (COVID-19) disrupted how primary care physicians (PCPs) and their staff delivered team-based care.

OBJECTIVE

To explore PCPs' perspectives about the impact of stay-at-home orders and the increased use of telemedicine on interactions and working relationships with their practice staff during the first 9 months of the pandemic.

DESIGN

Qualitative research.

PARTICIPANTS

Participants included PCPs from family and community medicine, general internal medicine, and pediatrics.

APPROACH

One-on-one, semi-structured video interviews with 42 PCPs were conducted between July and December 2020. Physicians were recruited from 30 primary care practices in Massachusetts and Ohio using a combination of purposeful, convenience, and snowball sampling. Interview questions focused on work changes and work relationships with other staff members during the pandemic as well as their experiences delivering telemedicine. All interviews were audio-recorded, transcribed verbatim, and coded using deductive and inductive approaches.

KEY RESULTS

Across respondents and states, the context of the pandemic was reported to have four major impacts on primary care teamwork: (1) staff members' roles were repurposed to support telemedicine; (2) PCPs felt disconnected from staff; (3) PCPs had difficulty communicating with staff; and (4) many PCPs were demoralized during the pandemic.

CONCLUSIONS

The lack of in-person contact, and less synchronous communication, negatively impacted PCP-staff teamwork and morale during the pandemic. These challenges further highlight the importance for practice leaders to recognize and attend to clinicians' relational and work-related needs as the pandemic continues.

Evaluating the impact of coronavirus disease on burnout among healthcare workers using maslach burnout inventory tool: A systematic review

Background

Burnout has been prevalent among healthcare workers (HCWs). However, the effect of the Coronavirus Disease (COVID-19) pandemic on this phenomenon in HCWs is unclear.

Objective

This systematic review aims to evaluate the impact of COVID-19 on burnout of HCWs using Maslach Burnout Inventory (MBI).

Methods

A systematic search was performed on PubMed database for articles published between 1 December 2019 and 30 June 2021. Search strategy combined terms for HCWs, COVID-19, burnout, and MBI. The main outcome of interest was burnout, including both mean prevalence and MBI scores for high emotional exhaustion (EE), high depersonalisation (DP) and low personal accomplishment (PA).

Results

Four cohort studies, 90 cross-sectional studies and one randomised-controlled trial were included for review. Only one cohort study compared burnout data among HCWs before and during COVID-19. It reported a statistically significant increase in mean EE and PA scores from 21.9 to 24.8 ( p = .001), and 42.7 to 48.7 ( p = .001), respectively. The remaining studies only evaluated burnout data during COVID-19 but were missing burnout data prior to the pandemic for comparison. Across these studies, the overall mean prevalence of burnout among HCWs was 39.95%, with mean MBI EE scores of 22.07, DP scores of 7.83, and PA scores of 32.53. Burnout outcomes were generally comparable across specific healthcare professions such as doctors and nurses.

Conclusion

Whilst quality research elucidating the effect of pandemic on burnout is lacking, current burnout prevalence among HCWs during COVID-19 is notable.

Work‐related stress and coping methods of internists and primary care physicians during the COVID ‐19 pandemic in Japan: A mixed‐method study

Background

The COVID‐19 pandemic has affected the mental health of health care workers. This study aimed to investigate the stress factors that cause burnout in Japanese physicians and their coping methods during the COVID‐19 pandemic.

Methods

We conducted a sequential explanatory mixed‐method study to investigate the psychological responses of physicians in the early stages of the pandemic. A cross‐sectional, web‐based, anonymous survey was conducted among members of the American College of Physicians Japan Chapter to quantitatively investigate the stress factors and prevalence of burnout. An open‐ended questionnaire with questions about stress factors and coping methods was additionally administered. The qualitative data were analyzed using qualitative content analysis.

Results

Among the 1173 physicians surveyed, 214 (18.2%) responded. Among the participants, 107 (50.0%) responded “yes” to the question “I feel or have felt very stressed at work during the COVID‐19 pandemic,” and 68 (31.8%) reported burnout symptoms. Those who reported feeling stress (117 respondents) were asked to select 12 items of the stress factors related to COVID‐19. The most significant stress factor related to COVID‐19 was “Perceived risk of spreading COVID‐19 to family members” (n = 47). Content analysis identified 12 categories for the stress factors and 7 for stress‐coping methods corresponding to COVID‐19 (Cohen's kappa = 0.84 and 0.95, respectively).

Conclusion

Several distinct stressors existed during the COVID‐19 pandemic, which might be related to burnout among physicians. Practicing stress‐coping strategies, as identified in the present study, may help reduce work‐related stress and prevent burnout.

Return to Work during the COVID-19 Outbreak: A Study on the Role of Job Demands, Job Resources, and Personal Resources upon the Administrative Staff of Italian Public Universities

Background: Compared to healthcare workers and teleworkers, occupational wellbeing of employees who continued or suddenly returned to work during the COVID-19 pandemic have received less attention thus far. Using the Job Demand–Resource model as a framework, the present study aimed at evaluating the role of job demands and job and personal resources in affecting emotional exhaustion among university administrative staff. Methods: This cross-sectional study analyzed data collected through an online questionnaire completed by 364 administrative employees that continued working in presence (WP) and 1578 that continued working blended (WB), namely, partly remotely and partly in presence. Results: Among job demands, quantitative job demand overloads and perceived risk of being infected were positively associated with higher levels of emotional exhaustion. Among job resources, colleague support was significantly associated with lower emotional exhaustion for both WB and WP, whereas supervisor support and fatigue management were salient only for WB. Among personal resources, personal contribution in managing COVID-19-related risk at work emerged as a protective factor for emotional exhaustion. Conclusion: Insights for the development of targeted preventive measure for a more psychologically safe and productive return to work can be derived from these results.

Effect of Face Masks on Blood Saturation, Heart Rate, and Well-Being Indicators in Health Care Providers Working in Specialized COVID-19 Center

This study aims to investigate whether wearing face masks (filtering facepieces, FFP class 2) with personal protective equipment (FPP2/PPE), while working a 12-h shift in a COVID-19 referral center, affects the blood saturation, heart rate (HR), and well-being of health care providers (HCPs). The study included a group of 37 HCPs. To perform continuous recordings of the SpO₂ and heart rate (HR) in real time, we used a Nellcor PM10N (Covidien, Mansfield, MA, USA) portable monitoring system. SpO₂, HR, and HCP well-being scales were measured during two 3-h shifts, while HCPs worked during a 12-h period. Additionally, each subject completed a questionnaire concerning their well-being. The difference in the SpO₂ level between the 1st and 2nd working shifts while wearing an FFP2/PPE was small, with a median decrease in SpO₂ of -1%. The scales of the well-being indicators increased within the shift. They were mainly fatigue and thirst with median scores of 2 out of 6 (range 0-4). We assume that during a 12-h period, a work scheme that consists of a 3-h shift in FFP2/PPE and a 3-h rest period (working without FPP2/PPE) is a reliable and safe solution for HCPs working in specialized COVID-19 referral hospitals.

The impact of FFP3 respirators on the blood saturation

This study aims to investigate whether wearing a filtering facepiece class 3 respirators with personal protective equipment (FPP3/PPE) during work in the intensive care unit (ICU) affects the blood saturation (SpO2), the heart rate (HR), and the well-being of health care workers (HCWs). This preliminary study included a group of 21 volunteers (including 16 females (76%), with a median age of 23 years). Each worker served as his own control and performed the test two times: they wore the FFP3/PPE and did not wear it for a three-hour shift in the ICU. The working with an FFP3/PPE compared to not working with an FFP3/PPE caused a significant, but within normal ranges, influence on the level of SpO2 with a mean decrease of - 1.43%. The highest reduction in the SpO2 was - 2.29% and occurred after 150 min of work. All of the score scales of the well-being markers increased consecutively but moderately during the shift while wearing the FFP3/PPE. We assume that a 3-h shift rhythm is a safe and reliable solution, i.e., three hours of working in the FFP3/PPE in the ICU, followed by rest or working without an FFP3/PPE.

Decreasing Wellbeing and Increasing Use of Negative Coping Strategies: The Effect of the COVID-19 Pandemic on the UK Health and Social Care Workforce

Many health and social care (HSC) professionals have faced overwhelming pressures throughout the COVID-19 pandemic. As the current situation is constantly changing, and some restrictions across the UK countries such as social distancing and mask wearing in this period (May-July 2021) began to ease, it is important to examine how this workforce has been affected and how employers can help rebuild their services. The aim of this study was to compare cross-sectional data collected from the HSC workforce in the UK at three time points during the COVID-19 pandemic: Phase 1 (May-July 2020), Phase 2 (November 2020-January 2021) and Phase 3 (May-July 2021). Respondents surveyed across the UK (England, Wales, Scotland, Northern Ireland) consisted of nurses, midwives, allied health professionals, social care workers and social workers. Wellbeing and work-related quality of life significantly declined from Phase 1 to 3 (p &lt; 0.001); however, no significant difference occurred between Phases 2 and 3 (p &gt; 0.05). Respondents increasingly used negative coping strategies between Phase 1 (May-July 2020) and Phase 3 (May-July 2021), suggesting that the HSC workforce has been negatively impacted by the pandemic. These results have the potential to inform HSC employers' policies, practices, and interventions as the workforce continues to respond to the COVID-19 virus and its legacy.