Sick Leave and Intention to Quit the Job among Nursing Staff in German Hospitals during the COVID-19 Pandemic

Psychological resilience and effort-reward imbalance as predictors of work-life balance among nurses

The nursing profession, pivotal in healthcare and on the front lines during the coronavirus outbreak, faces significant physical and psychosocial risks.The study was conducted to evaluate the work-life balance, psychological resilience, and effort-reward balance of nurses, and to explore the relationships between these factors.The study was a as a cross-sectional correlational study and the sample consisted of 360 nurses in a hospital. Data were collected using the Work-Life Balance Scale, the Abbreviated Version of the Connor-Davidson Psychological Resilience Scale, and the Effort-Reward Imbalance Scale.It was indicated that the average score of the participants' effort-reward imbalance ratio was above 1 and they received low reward for high effort. The Psychological Resilience Scale mean score was 21.89   ±   7.22 and the Work-Life Balance Scale mean score was 47.53   ±   8.49, and the scale scores were at an average level. It was concluded that psychological resilience significantly predicted work-life balance. (F = 61.124; p = .000), psychological resilience did not have a significant effect on effort-reward balance-ratio (F = 2.277, p = .132). In line with these results, it can be said that nurses received poor rewards despite their great efforts, which was accompanied by high occupational stress and work-life balance and psychological resilience. It is necessary to identify nurses experiencing low levels of resilience, work-life balance, and effort-reward imbalance, provide targeted support programs (e.g. stress management and coping techniques), and protect nurses' physical, mental, and professional resilience.

Impact of COVID-19 on Selected Nurse and Patient Outcomes in Emergency Units Across South Africa

INTRODUCTION

Worldwide, emergency nurses experience worse nurse outcomes (burnout, physical and mental health, compassion fatigue, and job and career satisfaction), further exacerbated by the coronavirus disease 2019 pandemic, although poorly reported in developing countries. Therefore, this study aimed to determine the pandemic's impact on nurse and patient outcomes in emergency units in South Africa.

METHODS

A cross-sectional correlational design was used, with data collected from 2 different groups in the public and private sectors after the second and third coronavirus disease 2019 waves using a questionnaire. Purposive sampling of 116 private sector and 27 public sector emergency units (total n = 143) and total population sampling of nurses (n = 332) were used.

RESULTS

South African emergency nurses experienced high levels of emotional exhaustion (mean = 28.03; SD = 1.08) and moderate job satisfaction (mean = 2.81; SD = 0.07), being particularly dissatisfied with salary/wages (mean = 2.15; SD = 0.07). More than a quarter (25.30%) planned to quit their jobs. Participants rated patient safety positively (mean = 2.32; SD = 0.09). Nurses responding after the third wave of the pandemic reported higher rates of compassion fatigue (odds ratio, 3.2; 95% CI, 1.01-10.1; P = .047) and dissatisfaction with both professional status (odds ratio, 2.23; 95% CI, 1.13-4.40; P = .02) and independence at work (odds ratio, 2.21; 95% CI, 1.24-3.94; P = .047, P = .01). There were practically significant correlations between job satisfaction and recommending one's workplace (r = -0.44; P < .001) and emotional exhaustion and confidence in postdischarge care (r = 0.40; P < .001).

DISCUSSION

An association between coronavirus disease 2019 and nurse and patient outcomes in South African emergency units exists, highlighting emotional exhaustion, compassion fatigue, and job dissatisfaction concerns. Significant correlations were identified between nurse and nurse-reported patient outcomes. Addressing these concerns is critical to achieving better outcomes and planning for future health emergencies.

Workplace Violence and Health Status of Female Nurses: A Cross-Sectional Study

As a female-dominant profession, nurses are at risk of workplace violence. However, the health outcomes of workplace violence among female nurses have been mostly studied in isolation from their history of lifetime violence experiences. Although social and organizational factors shape workplace violence, our understanding of its effects on female nurses' health is limited in different cultural contexts. This study examined how workplace violence affects the physical and mental health and the frequency of medication intake and sick leave of nurses employed in the Saudi healthcare system while controlling for the effect of lifetime violence experiences. A cross-sectional study was conducted with 340 female nurses working in tertiary hospitals in Saudi Arabia. Among the female nurses, 67.6% had experienced at least one act of workplace violence during the last 12 months. The highest level of workplace violence was recorded in nurses employed in psychiatric units. After controlling for the effect of child abuse and partner violence, workplace violence is associated with female nurses' physical health (β  = 0.335, t(336) = 6.73, p < 0.001), mental health (β  = 0.224, t(336) = 4.09, p < 0.001), medication intake (β  = 0.240, t(336) = 4.45, p < 0.001), and frequency of sick leave days (β  = 0.206, t(336) = 3.82, p < 0.001). The results indicate a need for a zero-tolerance policy against workplace violence and multidimensional strategies to address the issue. Additionally, gender and multi-component health interventions for female nurses who are survivors of violence are needed.

[Mental health and mental healthcare as elements of pandemic and crisis preparedness]

BACKGROUND

The COVID-19 pandemic was challenging in terms of the mental health of the population and the provision of mental health services.

AIMS OF THE STUDY

To gain insights from the pandemic for an improved pandemic and crisis preparedness for the future.

MATERIAL AND METHODS

Recommendations are derived from the results of reviews on mental health and psychiatric psychotherapeutic care during the pandemic.

RESULTS

Large sections of the population proved to be resilient in terms of mental health. Populations at risk showed increased stress, particularly children, adolescents, women, people with low socioeconomic status, people in nursing homes and healthcare workers. People with long/post-COVID were also particularly affected. At the same time there were significant restrictions on the provision of psychiatric psychotherapeutic care, particularly in the inpatient sector. Insufficient current data on the mental health of the population and a lack of surveillance of service utilization, despite an existing data basis, made it difficult for timely detection of stress and care restrictions and an adequate response for crisis management. The rigid sectorization of the mental healthcare system often prevented alternative outpatient care.

DISCUSSION

The national mental health surveillance should be continued and further developed. Structures should be provided for the time-sensitive consolidation of data and the multiprofessional generation of recommendations in order to be able to detect and respond to challenges due to bottlenecks in the provision of care and stress in risk groups. Flexible, cross-sectoral mental healthcare should be made possible throughout Germany.

Nurse Staffing Configurations and Nurse Absence Due to Sickness

Importance

Rates of work-related stress and sickness absence are high among nurses. The consequences of sickness absence are severe for health systems' efficiency and productivity.

Objective

To examine the association between nurse staffing configurations and sickness absence in hospital inpatient unit nursing teams.

Design, Setting, and Participants

This retrospective longitudinal case-control study using routinely collected hospital data among 4 general acute care hospitals in England examined 18 674 registered nurses (RNs) and nursing support (NS) staff working in 116 hospital units. Data were analyzed from April 1, 2015, to February 29, 2020.

Exposure

Nursing team skill mix, temporary staffing hours, understaffing, proportion of long shifts (≥12 hours) worked, and full-time or part-time work status in the previous 7 days.

Main Outcome and Measure

The main outcome was the number of episodes of sickness absence, which was defined as a sequence of sickness days with no intervening days of work.

Results

There were 2 690 080 shifts and 43 097 sickness episodes. The incident rates for starting a sickness episode were 2.0% for NSs and 1.4% for RNs. In total, there were 18 674 members of staff; 2 188 562 (81.6%) were shifts by staff classified as working full time and 493 400 (18.4%) by staff classified as working part time. A skill mix composed of more RNs was associated with a 2% reduction in the odds of RN sickness absence for each 10% change in the proportion of RN hours (odds ratio [OR], 0.98; 95% CI, 0.96-0.99). Moving from the lower quartile skill mix (ie, approximately 55% of the nursing hours worked by RNs) to the upper quartile (ie, approximately 75% of the nursing hours worked by RNs) was associated with a 4% reduction in odds of sickness absence. Working only long shifts in the prior 7 days was associated with a 26% increase in the odds of sickness absence for RNs compared with working no long shifts (OR, 1.26; 95% CI, 1.19-1.33). Part-time work for RNs was associated with higher sickness absence (OR, 1.09; 95% CI, 1.03-1.15). For RNs, there was a significant interaction between part-time work and RN understaffing, whereby short staffing in the previous week increased sickness absence for full-time staff but not among those working part time. NS understaffing was not associated with sickness absence for any staffing group.

Conclusions and Relevance

This retrospective case-control study found that exposure to RN understaffing increased the risk of sickness absence in nursing teams. Adverse working conditions for nurses, already known to pose a risk to patient safety, may also create risks for nurses and the possibility of further exacerbating staff shortages.

Nurse retention in peri- and post-COVID-19 work environments: a scoping review of factors, strategies and interventions

OBJECTIVES

The COVID-19 pandemic highlighted the deterioration of nurses' working conditions and a growing global nursing shortage. Little is known about the factors, strategies and interventions that could improve nurse retention in the peri- and post-COVID-19 period. An improved understanding of strategies that support and retain nurses will provide a foundation for developing informed approaches to sustaining the nursing workforce. The aim of this scoping review is to investigate and describe the (1) factors associated with nurse retention, (2) strategies to support nurse retention and (3) interventions that have been tested to support nurse retention, during and after the COVID-19 pandemic.

DESIGN

Scoping review.

DATA SOURCES

This scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. MEDLINE, Embase, CINAHL and Scopus databases were searched on 17 April 2024. The search was limited to a publication date of '2019 to present'.

ELIGIBILITY CRITERIA

Qualitative, quantitative, mixed-methods and grey literature studies of nurses (Registered Nurse (RN), Licenced Practical Nurse (LPN), Registered Practical Nurse (RPN), Publlic Health Nurse (PHN), including factors, strategies and/or interventions to support nurse retention in the peri- and post-COVID-19 period in English (or translated into English), were included. Systematic reviews, scoping reviews and meta-syntheses were excluded, but their reference lists were hand-screened for suitable studies.

DATA EXTRACTION AND SYNTHESIS

The following data items were extracted: title, journal, authors, year of publication, country of publication, setting, population (n=), factors that mitigate intent to leave (or other retention measure), strategies to address nurse retention, interventions that address nurse retention, tools that measure retention/turnover intention, retention rates and/or scores. Data were evaluated for quality and synthesised qualitatively to map the current available evidence.

RESULTS

Our search identified 130 studies for inclusion in the analysis. The majority measured some aspect of nurse retention. A number of factors were identified as impacting nurse retention including nurse demographics, safe staffing and work environments, psychological well-being and COVID-19-specific impacts. Nurse retention strategies included ensuring safe flexible staffing and quality work environments, enhancing organisational mental health and wellness supports, improved leadership and communication, more professional development and mentorship opportunities, and better compensation and incentives. Only nine interventions that address nurse retention were identified.

CONCLUSIONS

Given the importance of nurse retention for a variety of key outcomes, it is imperative that nursing leadership, healthcare organisations and governments work to develop and test interventions that address nurse retention.

Depression and anxiety among nurses during the COVID-19 pandemic: Longitudinal results over 2 years from the multicentre VOICE-EgePan study

AIMS

To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population.

BACKGROUND

The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain.

DESIGN

A multicentre prospective longitudinal study.

METHODS

Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April-July 2020, T2: November 2020-January 2021, T3: May-July 2021, T4: February-May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined.

RESULTS

Throughout the study (T1-T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4).

CONCLUSION

During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health.

RELEVANCE TO CLINICAL PRACTICE

The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals.

IMPLICATIONS FOR THE PROFESSION

Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems.

REPORTING METHOD

The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method.

PATIENT CONTRIBUTION

Five hundred and seven nurses completed the questionnaire and provided data for analysis.

TRIAL AND PROTOCOL REGISTRATION

The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.

[Workload and mental health of nursing staff in Germany during the COVID-19 pandemic-a scoping review]

BACKGROUND

In March 2023, there was no comprehensive overview of job demands, resources, and mental health consequences for nurses in Germany during the COVID-19 pandemic. Because of country-specific differences with regard to the course/management of the pandemic and the organization of the healthcare system, data from Germany were analyzed specifically.

METHODS

A systematic search in databases (PubMed/Medline, PsycINFO) yielded 50 relevant studies that were included in the scoping review.

RESULTS

The studies were based on cross-sectional designs, mostly from the hospital setting and the first year of the pandemic. Frequently investigated job demands were work intensification, lack of protective equipment, rapidly changing regulations, contact with COVID-19 patients, and pandemic-related worries/anxieties. Pandemic phase and setting-specific demand cascades became clear. Frequently examined mental health problems (including stress experience, anxiety, depression, burnout, and intention to change career/job) were higher in groups with higher levels of reported job demands. Nurses generally reported less favorable values than medical professionals. Social support, reward/appreciation, humor, resilience, and sense of coherence proved to be resources.

CONCLUSION

In preparation for further pandemics and crises, pre-pandemic job demands should be reduced through targeted measures and relevant resources should be strengthened. Pandemic-specific job demands should be systematically reflected and cross-organizational solutions developed. Longitudinal studies using validated instruments and intervention studies should be the focus of future research funding.

The effect of the challenges experienced by nurses during the pandemic on their intention to leave work: the mediating role of the performance

BACKGROUND

During the COVID-19 pandemic, negative working conditions in the nursing profession have worsened, and nurses have experienced various challenges that have increased their intention to leave work. Findings on the role of nurse performance under such conditions are limited.

AIMS

This study aimed to investigate the role of performance in the effect of the challenges experienced by nurses during the pandemic on their intention to leave work.

METHODS

This descriptive and cross-sectional study was conducted between July 2022 and August 2023 in Turkey using an online survey. A total of 462 nurses participated in the study, which employed the non-probability random and snowball sampling methods.

RESULTS

The mediating factors in the effect of the challenges experienced by nurses during the pandemic on their intention to leave work were task performance (β = 0.07), contextual performance (β = 0.05), and counterproductive work behavior (β = 0.12), respectively.

CONCLUSIONS

This study determined that task performance, contextual performance, and counterproductive work behavior played an important role in the effect of the challenges experienced by nurses during the pandemic on their intention to leave work. The present results may serve as a guide in determining effective strategies to be employed in possible pandemic situations.

[Workplace-related stress experience and mental health of healthcare workers during the COVID-19 pandemic: risk and protective factors from the VOICE study]

BACKGROUND

Healthcare workers have an increased risk of depression and anxiety, and medical staff have faced a wide variety of challenges, especially during the COVID-19-pandemic. The aim of the VOICE study was to investigate risk and protective factors for workplace-related stress experience and mental health.

METHOD

A multicentre, web-based and prospective survey (VOICE study) was initiated in the spring of 2020 by a network of five psychosomatic university clinics (Erlangen, Ulm, Bonn, Cologne and Dresden). More than 25,000 respondents took part in the study at five measurement points.

RESULTS

Of 3678 employees examined in a hospital setting during the first wave of the pandemic, 17.4% and 17.8% of physicians, 21.6% and 19.0% of nurses and 23.0% and 20.1% of medical-technical assistants (MTA) were affected by symptoms of depression and anxiety, respectively, to a clinically relevant extent. The most important risk factors for depressive and anxiety symptoms were insufficient relaxation during leisure time, increased alcohol consumption, lower trust in colleagues in difficult work situations and increased fear of becoming ill with COVID-19. Predictors for increased post-traumatic symptoms were increased generalized anxiety and depression as well as increased fear of infecting family members. Sense of coherence, social support, optimism and reward level acted as protective factors.

DISCUSSION

The psychological effects of workplace-related stress during the pandemic were found to be significant. Therefore, regular mental health screening and prevention programmes for healthcare workers are indicated.

Factors affecting occupational burnout in medical staff: a path analysis based on the job demands-resources perspective

Objective

To assess occupational burnout conditions and work-related factors among frontline medical staff during the COVID-19 pandemic and analyse the relationships among these factors utilizing the job demands-resources (JD-R) model as a theoretical framework.

Methods

An online survey was distributed to medical staff in one city via convenience sampling during 12/29/2022-1/10/2023. Path analysis was utilized to explore the relationship between work-related factors and occupational burnout among frontline medical staff during the COVID-19 outbreak.

Results

Among 474 respondents, 455 frontline medical staff (female=79.56%) were included in the final analysis. Medical staff aged <35 exhibited higher levels of occupational burnout than did older staff. Depression/anxiety and workload were positively correlated with occupational burnout and negatively correlated with self-compassion, workplace health/safety, and workplace support. Path analysis indicated the direct effects of workplace support, depression/anxiety, workplace health/safety, self-compassion, and workload on occupational burnout. There were also partial mediating effects of workplace support, depression/anxiety, workplace health/safety, and self-compassion on occupational burnout. The model demonstrated good fit.

Conclusion

Workplace support, a crucial job resource, can improve occupational burnout among frontline medical staff in various ways. Reducing anxiety, depression, and workload and improving workplace support, health/safety, and self-compassion are practical and effective measures for mitigating occupational burnout.

Factors influencing the formation of balanced care teams: the organisation, performance, and perception of nursing care teams and the link with patient outcomes: a systematic scoping review

BACKGROUND

The composition of care teams is crucial for delivering patient-centered healthcare, yet assembling a well-balanced team remains a challenge. This difficulty stems from the intricate dynamics of team capacity, culture, context, and the demands of the job. The current literature offers limited guidance for decision-makers on how to effectively navigate these dynamics to compose a balanced care team.

METHODS

We conducted a systematic scoping review of literature spanning from 2009 to 2022. The aim was to identify factors that significantly influence the work environment, team performance, nursing outcomes, and patient outcomes within healthcare settings. Our review focused on extracting and synthesizing evidence to uncover these influencing factors.

RESULTS

Our analysis identified 35 factors that play a significant role in shaping the work environment and influencing team performance, nursing outcomes, and patient outcomes. These factors were categorized into nine key domains: workload, leadership, team composition, stress and demands, professional relationships, safety, logistics and ergonomics, autonomy and responsibility, and transparency and task clearness.

CONCLUSIONS

To improve patient care and nursing job satisfaction, policymakers and decision-makers can consider these influencing factors in the design and management of care teams. The findings advocate for strategic adjustments in these domains to enhance a team's balance. Furthermore, our review underscores the need for further research to fill the identified gaps in knowledge, offering a directive for future studies into optimal care team composition. This systematic approach to team composition can significantly impact patient outcomes and nurse satisfaction, providing a roadmap for creating more effective and harmonious teams.

High overcommitment and low reward as potential predictors for increased depressive symptoms, suicidal ideation, and suicide risk in German veterinarians

Higher rates of depression, suicidal ideation and suicide risk have been reported for veterinarians in Germany. In this study, several demographic and job-related factors were examined to determine whether they could be considered possible predictors of depression, suicidal ideation, and suicide risk. For this purpose, a survey was conducted among veterinarians in Germany. The demographic factors surveyed were gender, age, working status (employed/self-employed), income, field of work (practicing/non-practicing veterinarian), weekly working hours and community size. For assessing job-related factors, the Effort-Reward-Imbalance questionnaire (effort, reward, overcommitment), several subscales of the Copenhagen Psychosocial Questionnaire (quantitative demands, emotional demands, demands for hiding emotions, meaning of work, work-privacy-conflict, thoughts of leaving the job) and the Copenhagen Burnout Inventory were used. A hierarchical logistic regression analysis was performed with the demographic and job-related factors as independent variables and depressive symptoms, suicidal ideation, and suicide risk as dependent variables, respectively. A total of 3.118 veterinarians (78.8% female) between 22 and 69 years (mean age 41.3 years) were included in the study. The factors used resulted in the highest variance explanation for depressive symptoms (57%), followed by suicidal ideation (34%) and suicide risk (23%). Low reward and high overcommitment were found to be the most important predictors of depressive symptoms, suicidal ideation, and suicide risk. Significant relationships with depressive symptoms, suicidal ideation, and suicide risk were also found for burnout, demands for hiding emotions, and thoughts of leaving the job. The results of this study point to opportunities for changes in the veterinary working environment, for the development of prevention and intervention programs for veterinarians, and for the further development of the veterinary curriculum to strengthen the mental health of veterinarians in Germany.

The Impact of COVID-19 on Healthcare Utilization in Turkey

OBJECTIVES

This study investigates the impact of the COVID-19 pandemic on healthcare utilization in Turkey.

METHODS

We utilized individual-level data derived from Turkish Statistical Institute's annual surveys between 2014 and 2022 and estimated probit regression models.

RESULTS

We find that COVID-19 pandemic reduced healthcare utilization by 11.8% after taking into account a large set of background variables. Although our study finds that the elderly and those with health problems are more likely to use healthcare services under normal circumstances, the COVID-19 pandemic has caused notable drops in the healthcare utilization among the elderly (-6.5%) and those with health problems (-3.8%). Although those without health insurance had lower utilization of healthcare services before the pandemic, during the pandemic they were not particularly hit.

CONCLUSION

We conclude that the pandemic did not lower the healthcare utilization in Turkey because of the supply constraints. Also, the evidence points to the reduced demand due to the fear of contagion rather than financial concerns.

[Nurses' health during the COVID-19 pandemic in Switzerland: A longitudinal study with mixed methods design]

Nurses' health during the COVID-19 pandemic in Switzerland: A longitudinal study with mixed methods design Abstract: Background: The COVID19 pandemic has had a significant impact on healthcare systems worldwide. Nurses have played a crucial role in responding to the crisis, often at the expense of their own health and wellbeing. Aim: The aim of the study was to investigate the physical and mental health status as well as the resources of certified nurses during the pandemic, in German-speaking Switzerland. Methods: In a longitudinal study with a mixed methods design, data were collected among nurses from acute hospitals between 2021 and 2022 using a questionnaire survey and focus group interviews. The data were analysed using multiple regression analysis, knowledge mapping and the Neuman system model. Results: The results show improvements in health, quality of life and job satisfaction, and a decrease in stress; whereby influencing extrapersonal factors are, among others, reorganisations within hospitals with the active involvement of nurses. On the interpersonal level, support from managers or colleagues proved helpful. At the intrapersonal level, the recognition of the nurses' competencies was deemed particularly important, to help them to remain healthy during the pandemic. Conclusions: Increased recognition, participation, training and career opportunities as well as flexible working models need to be implemented in the long term to ensure a sustainable improvement of the health and well-being of nurses.

Why Are Healthcare Providers Leaving Their Jobs? A Convergent Mixed-Methods Investigation of Turnover Intention among Canadian Healthcare Providers during the COVID-19 Pandemic

BACKGROUND

Staffing shortages across the healthcare sector pose a threat to the continuity of the Canadian healthcare system in the post-COVID-19 pandemic era. We sought to understand factors associated with turnover intention as well as Canadian healthcare providers' (HCPs) perspectives and experiences with turnover intention as related to both organizational and professional turnover.

METHOD

A convergent questionnaire mixed-methods design was employed. Descriptive statistics and ordinal logistic regressions were used to analyze quantitative data and ascertain factors associated with turnover intention. Thematic analysis was used to analyze qualitative open-field textbox data and understand HCPs' perspectives and experiences with turnover intention.

RESULTS

Quantitative analyses revealed that 78.6% of HCPs surveyed (N = 398) reported at least a 25% turnover likelihood regarding their organization, with 67.5% reporting at least a 25% turnover likelihood regarding their profession. Whereas regression models revealed the significant impact of years worked, burnout, and organizational support on turnover likelihood for organizations, age, sex, burnout, and organizational support contributed to the likelihood of leaving a profession. Patterns of meaning drawn from participants' qualitative responses were organized according to the following four themes: (1) Content to stay, (2) Drowning and no one cares, (3) Moral stressors, and (4) Wrestling with the costs and benefits.

CONCLUSIONS

Many HCPs described weighing the costs and benefits of leaving their organization or profession during the COVID-19 pandemic. Although challenging working conditions, moral stressors, and burnout may play a significant role in HCPs' experiences of turnover intention, there is ample room to intervene with organizational support.

What does "urgency" mean when prioritizing cancer treatment? Results from a qualitative study with German oncologists and other experts during the COVID-19 pandemic

PURPOSE

Cancer care in Germany during the COVID-19 pandemic was affected by resource scarcity and the necessity to prioritize medical measures. This study explores ethical criteria for prioritization and their application in cancer practices from the perspective of German oncologists and other experts.

METHODS

We conducted fourteen semi-structured interviews with German oncologists between February and July 2021 and fed findings of interviews and additional data on prioritizing cancer care into four structured group discussions, in January and February 2022, with 22 experts from medicine, nursing, law, ethics, health services research and health insurance. Interviews and group discussions were digitally recorded, transcribed verbatim and analyzed using qualitative content analysis.

RESULTS

Narratives of the participants focus on "urgency" as most acceptable criterion for prioritization in cancer care. Patients who are considered curable and those with a high level of suffering, were given a high degree of "urgency." However, further analysis indicates that the "urgency" criterion needs to be further distinguished according to at least three different dimensions: "urgency" to (1) prevent imminent harm to life, (2) prevent future harm to life and (3) alleviate suffering. In addition, "urgency" is modulated by the "success," which can be reached by means of an intervention, and the "likelihood" of reaching that success.

CONCLUSION

Our analysis indicates that while "urgency" is a well-established criterion, its operationalization in the context of oncology is challenging. We argue that combined conceptual and clinical analyses are necessary for a sound application of the "urgency" criterion to prioritization in cancer care.

Using Heart Rate Variability to Assess Nurses' Stress During the COVID-19 Pandemic

OBJECTIVE

This study aimed to assess subjective and objective parameters of stress among nurses during the COVID-19 pandemic and to examine the recovery effect of a day off.

METHODS

In this prospective observational trial, we measured heart rate variability (using a wearable device) and perceived stress levels on 3 working days and 1 day off. We obtained the following data using an online questionnaire: working conditions, COVID-19-related problems, depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), effort-reward imbalance, and work-family conflict in a sample of German nurses (N = 41).

RESULTS

When comparing working days with a day off, we observed a significant difference for physical load (Cohen's d = 0.798, P < .001), mental load (Cohen's d = 0.660, P = .001), emotional exhaustion (Cohen's d = 0.945, P < .001), and overburdening (Cohen's d = 0.585, P = .002) with higher scores on working days. Regarding heart rate variability, we did not find a difference. Correlational analyses revealed a significant association between being afraid to get infected with COVID-19 and lower heart rate variability (r = -0.336, P = .045) and between being afraid to infect relatives and lower heart rate variability (r = -0.442, P = .007). Furthermore, a higher total sum score of work-family conflict was significantly associated with lower heart rate variability (r = -0.424, P = .01).

CONCLUSION

As heart rate variability observations were different from those regarding subjectively perceived stress, further studies are needed to evaluate and differentiate the influence of work stress and other types of stress on heart rate variability.

COVID-19 pandemic: what factors compromised the mental capacity to work of nursing technicians?

OBJECTIVES

to identify the factors that influenced the mental capacity to work of nursing technicians during the COVID-19 pandemic.

METHODS

a cross-sectional study, carried out at two reference hospitals in assisting the population during the COVID-19 pandemic. A total of 237 professionals from Intensive Care Units participated and answered a questionnaire. Multiple linear regression models were used to assess the correlation between mental capacity to work and variables related to risks of contamination, institutional support and health.

RESULTS

lack of COVID-19 tests, lack of knowledge of routine, absences in 2021 and mental illness contributed to worse mental capacity to work. Management embracement and physical capacity were considered protective factors.

CONCLUSIONS

reduced work capacity in relation to mental demands can affect professional performance and quality of care, with implications for patients and health institutions.

Relationship between mental workload and musculoskeletal disorders with intention to leave service among nurses working at neonatal and pediatric departments: a cross-sectional study in Iran

BACKGROUND

Despite the challenge of nursing shortage in the world and its subsequent impact on care quality as well as aggravation of the situation by intention to leave service, this issue has not been properly addressed, especially among neonatal and pediatric nurses. The present study aims to identify the relationship between mental workload and musculoskeletal disorders with intention to leave the service among nurses working at neonatal and pediatric departments.

METHODS

This descriptive-analytical study was conducted on 145 nurses working at neonatal and pediatric departments in six hospitals in Bushehr Province using full-census method. The data were collected using national aeronautics and space administration-task load index (NASA-TLX), Cornell musculoskeletal discomfort questionnaire(CMDQ) and Mobley and Horner's voluntary turnover questionnaire. The data were analyzed using descriptive statistics, independent t-test, Mann-Whitney U test, one-way analysis of variance (ANOVA), Kruskal-Wallis test, Pearson's and Spearman correlation tests and hierarchical linear regression in simultaneous model in SPSS 19.0.

RESULTS

The mean score of intention to leave the service was 9.57 ± 3.20 (higher than the moderate level) and the mean mental workload was 71.65 ± 15.14 (high level). Pain in at least one of the legs (100%), back (77.3%) and knees (76.6%) was highly prevalent. However, no statistically significant correlation was found between musculoskeletal disorder categories and intention to leave the service (p > 0.05). The regression analysis results revealed among mental workload domains, only effort-induced workload was negatively and significantly correlated with intention to leave the service (p = 0.003; β=-0.078). However, the number of night shifts per month was positively and significantly correlated with intention to leave the service (p = 0.001; β = 0.176).

CONCLUSIONS

Planning for appropriate allocation of night shifts, investigating the etiology of musculoskeletal disorders and providing solutions for reducing mental workload should be prioritized by policymakers, while maintaining pediatric nurses' motivation for making efforts.

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study

BACKGROUND

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations.

OBJECTIVE

This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization.

METHODS

A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021).

RESULTS

In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round.

CONCLUSION

The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Determinants of intention to leave among nurses and physicians in a hospital setting during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The global outbreak of COVID-19 has brought to light the profound impact that large-scale disease outbreaks can have on healthcare systems and the dedicated professionals who serve within them. It becomes increasingly important to explore strategies for retaining nurses and physicians within hospital settings during such challenging times. This paper aims to investigate the determinants of retention among nurses and physicians during the COVID-19 pandemic.

METHOD

A systematic review of other potential determinants impacting retention rates during the pandemic was carried out. Secondly, a meta-analysis on the prevalence of intention to leave for nurses and physicians during the COVID-19 pandemic.

FINDINGS

A comprehensive search was performed within four electronic databases on March 17 2023. Fifty-five papers were included in the systematic review, whereas thirty-three papers fulfilled the eligibility criteria for the meta-analysis. The systematic review resulted in six themes of determinants impacting intention to leave: personal characteristics, job demands, employment services, working conditions, work relationships, and organisational culture. The main determinants impacting the intention to leave are the fear of COVID-19, age, experience, burnout symptoms and support. Meta-analysis showed a prevalence of intent to leave the current job of 38% for nurses (95% CI: 26%-51%) and 29% for physicians (95% CI: 21%-39%), whereas intention to leave the profession for nurses 28% (95% CI: 21%-34%) and 24% for physicians (95% CI: 23%-25%).

CONCLUSION

The findings of this paper showed the critical need for hospital managers to address the concerning increase in nurses' and physicians' intentions to leave during the COVID-19 pandemic. This intention to leave is affected by a complex conjunction of multiple determinants, including the fear of COVID-19 and the confidence in and availability of personal protective equipment. Moreover, individual factors like age, experience, burnout symptoms, and support are maintained in this review. Understanding the influence of determinants on retention during the COVID-19 pandemic offers an opportunity to formulate prospective strategies for retaining nurses and physicians within hospital settings.

The Impact of the COVID-19 Pandemic on Esophageal and Gastric Cancer Surgery in Germany: A Four-Year Retrospective Single-Center Study of 287 Patients

Background: Disruptions to surgical care for cancer patients during the COVID-19 pandemic remain an ongoing debate. This study assesses the effects of the COVID-19 pandemic on perioperative outcomes in a continuous series of surgically treated esophageal and gastric carcinoma patients at a large university hospital in Europe over 48 months. Methods: We conducted a retrospective single-center cohort study at a tertiary referral center. All patients who underwent oncologic esophageal or gastric resection between March 2018 and February 2022 were included in the analysis. The sample was split into a 24 months COVID-19 and an equivalent pre-COVID-19 control period. Outcome variables included caseload, in-hospital mortality, morbidity, treatment course, and disease stage at presentation. Results: Surgeons performed 287 operations, with around two-thirds (62%) of the cohort undergoing esophagectomy and one-third (38%) gastrectomy. The in-hospital mortality was 1% for the COVID-19 and the control periods. Patients did not present at a later disease stage nor did they wait longer for treatment. There was no decrease in caseload, and patients did not suffer from more perioperative complications during COVID-19. Conclusions: Esophageal and gastric carcinoma patients received safe and timely surgical care during the pandemic. Future pandemic protocols may streamline oncologic care towards tertiary referral centers.

Development and validation of a questionnaire for measuring team cohesion: the Erlangen Team Cohesion at Work Scale (ETC)

BACKGROUND

Team cohesion is a crucial factor when it comes to job satisfaction and turnovers. However, in Germany, economic measures for team cohesion are scarce. The aim of this study was to develop and validate an economic self-report questionnaire for measuring team cohesion in a work setting in health care.

METHODS

The questionnaire was developed in a stepwise procedure. After item analysis, exploratory factor analysis was conducted to assess factor structure. Reliability was tested via internal consistency. To assess convergent and divergent validity, we applied the Copenhagen Psychosocial Questionnaire (COPSOQ), the Perceived Cohesion Scale (PCS), the ENRICHD Social Support Inventory (ESSI), the Effort-Reward Imbalance Scale (ERI) and the Patient Health Questionnaire (PHQ-4), respectively.

RESULTS

The pilot version was tested in a sample of n = 126 adult nurses. Item analysis resulted in a total of 13 items for the final version. Exploratory factor analysis indicated a two-factor structure. Internal consistency for the two subscales was good, with α = 0.88 and α = 0.84, respectively. Convergent validity with the subscales of COPSOQ and PCS was moderate to high (r =.26- r =.64). For divergent validity, correlations with the ESSI were low (r =.01- r = -.09). We further found significant correlations with depression symptoms (r=-.22- r=-.37), as well as reward (ERI) (r =.41 -r =.47) and effort (ERI) (r=-.20 - r = -.24).

CONCLUSIONS

We developed and validated the Erlangen Team Cohesion at Work Scale (ETC), a self-report measure for team cohesion with very good psychometric properties. Due to its economic deployment, it is suitable for measuring team cohesion in work settings, especially in health care.

How did the COVID-19 pandemic affect burn centres in German-speaking countries?

The exponential growth of COVID-19 cases in early 2020 presented a massive challenge for healthcare systems and called for the adaptation of emergency care routines and intensive care capacities. We, therefore, analyzed a possible impact of the COVID-19 pandemic on the general structure and emergency preparedness of burn centers in German-speaking countries through a cross-sectional descriptive survey questionnaire. The survey was conducted for the first time in January 2019 by Al-Shamsi et al. before the beginning of the COVID-19 pandemic. It was performed for a second time in November 2020 during the second wave of COVID-19 infections in German-speaking countries. We noticed a pronounced increase in the preparation for a great number of patients in need of intensive care including the enlargement of overall capacity when necessary. We also showed a notable decrease in the specific preparation for burn disasters and also reduced communication with first responders and other burn centers. To what extent these alterations were caused by the impact the pandemic had on healthcare systems could not be determined in this study and should be the subject of future research.

Nurses' Workplace Perceptions in Southern Germany-Job Satisfaction and Self-Intended Retention towards Nursing

Our cross-sectional study, conducted from October 2022 to January 2023, aims to assess post-COVID job satisfaction, crucial work dimensions, and self-reported factors influencing nursing retention. Using an online survey, we surveyed 2572 nurses in different working fields in Bavaria, Germany. We employed a quantitative analysis, including a multivariable regression, to assess key influence factors on nursing retention. In addition, we evaluated open-ended questions via a template analysis to use in a joint display. In the status quo, 43.2% of nurses were not committed to staying in the profession over the next 12 months. A total of 66.7% of our surveyed nurses were found to be dissatisfied with the (i) time for direct patient care. Sources of dissatisfaction above 50% include (ii) service organization, (iii) documentation, (iv) codetermination, and (v) payment. The qualitative data underline necessary improvements in these areas. Regarding retention factors, we identified that nurses with (i) older age, (ii) living alone, (iii) not working in elder care, (iv) satisfactory working hours, (v) satisfactory career choice, (vi) career opportunities, (vii) satisfactory payment, and (viii) adequate working and rest times are more likely to remain in the profession. Conversely, dissatisfaction in (ix) supporting people makes nurses more likely to leave their profession and show emotional constraints. We uncovered a dichotomy where nurses have strong empathy for their profession but yearn for improvements due to unmet expectations. Policy implications should include measures for younger nurses and those in elderly care. Nevertheless, there is a need for further research, because our research is limited by potential bias from convenience sampling, and digitalization will soon show up as a potential solution to improve, e.g., documentation and enhanced time for direct patient time.

The impact of COVID-19 on nurse alcohol consumption: A qualitative exploration

AIMS AND OBJECTIVES

To explore the long-term impact of the COVID-19 pandemic on nurse alcohol consumption.

BACKGROUND

The COVID-19 pandemic has caused immense disruption to healthcare services worldwide, and nurses have not been immune, experiencing burnout, declining mental health and ultimately, attrition from the profession. Increases in alcohol consumption have been reported across subsections of society, including those with pre-existing mental ill health and experiencing high stress, and exploring this phenomenon in nurses is essential for workforce well-being and sustainability.

DESIGN

Qualitative descriptive study design.

METHODS

Secondary analysis of individual, semi-structured interviews with nurses (N = 42) from diverse settings across Australia, including community, primary and hospital settings, conducted in July and August 2021. Data were analysed using structural coding and reported in accordance with the CORE-Q guidelines.

FINDINGS

Two key themes were found after analysis of the data: (1) factors influencing alcohol consumption (subthemes: workplace factors and external factors), and (2) the pandemic's influence on alcohol consumption (subthemes: increased consumption, moderation of consumption and alcohol as a reward).

CONCLUSIONS

Several participants described increased alcohol consumption because of the COVID-19 pandemic, particularly due to the stress of working in an environment where resources were scarce. Workplace factors such as overtime, missed breaks and heightened workload were all described as driving stress, and in turn increased alcohol consumption.

RELEVANCE TO CLINICAL PRACTICE

Increased alcohol consumption has been associated with burnout, absenteeism and intention to leave. The nursing profession is currently undergoing significant continuing stress providing care and management to patients with the SARS-CoV-2 virus, and increased alcohol consumption is a significant threat to personal and workforce well-being, workforce sustainability and quality nursing care.

Compassion fatigue in healthcare providers: a scoping review

The detrimental impacts of COVID-19 on healthcare providers' psychological health and well-being continue to affect their professional roles and activities, leading to compassion fatigue. The purpose of this review was to identify and summarize published literature on compassion fatigue among healthcare providers and its impact on patient care. Six databases were searched: MEDLINE (Ovid), PsycINFO (Ovid), Embase (Ovid), CINAHL, Scopus, Web of Science, for studies on compassion fatigue in healthcare providers, published in English from the peak of the pandemic in 2020 to 2023. To expand the search, reference lists of included studies were hand searched to locate additional relevant studies. The studies primarily focused on nurses, physicians, and other allied health professionals. This scoping review was registered on Open Science Framework (OSF), using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping review. From 11,715 search results, 24 met the inclusion criteria. Findings are presented using four themes: prevalence of compassion fatigue; antecedents of compassion fatigue; consequences of compassion fatigue; and interventions to address compassion fatigue. The potential antecedents of compassion fatigue are grouped under individual-, organization-, and systems-level factors. Our findings suggest that healthcare providers differ in risk for developing compassion fatigue in a country-dependent manner. Interventions such as increasing available personnel helped to minimize the occurrence of compassion fatigue. This scoping review offers important insight on the common causes and potential risks for compassion fatigue among healthcare providers and identifies potential strategies to support healthcare providers' psychological health and well-being.

Impact of the COVID-19 pandemic on Australian community health service staff's occupational and personal lives: a longitudinal study

BACKGROUND

Little is known about the impact of the coronavirus disease 2019 (COVID-19) pandemic on community health service staff. The aim of this study was to assess the immediate and longer-term psychosocial impacts of COVID-19 on community health service staff in Australia.

METHODS

A prospective cohort design with an anonymous cross-sectional online survey that was administered at two time points (March-April 2021; n =681 and September-October 2021; n =479). Staff (clinical and non-clinical) were recruited from eight community health services in Victoria, Australia. Study-specific questions evaluated the impact of COVID-19 on respondents' work and personal lives. Space was provided at the end of the surveys for free-text comments.

RESULTS

There were no significant differences in respondent characteristics between the two surveys. At both survey time points, respondents were mostly concerned about their family's health. Compared to the first survey, survey two respondents were significantly more likely to report concerns about infecting family members (48.8% vs 41.6%, P =0.029), clients having COVID-19 (43.2% vs 36.2%, P =0.035), getting COVID-19 at work (53.7% vs 45.6%, P =0.014), not being prepared to care for clients with COVID-19 (27.5% vs 18.8%, P =0.006) and feeling more stress at work (63.7% vs 50.8%, P P =0.026).

CONCLUSIONS

The COVID-19 pandemic has had a considerable impact on the work and personal lives of community health service staff. Staff would benefit from continued and targeted initiatives that address their wellbeing and concerns.

Nursing students' perceived stress, social support, self-efficacy, resilience, mindfulness and psychological well-being: A structural equation model

Nursing students' stress, protective factors (e.g. resilience, social support, mindfulness and self-efficacy) and psychological well-being (PWB) have been well reported in the literature. However, the interactions of these variables were scarcely examined in the latter part of the COVID-19 pandemic and in the context of a developing country. This cross-sectional correlational study complying with STROBE guidelines tested a hypothetical model of the interrelationships of nursing students' stress, protective factors and PWB using structural equation modelling (SEM). Nursing students (n = 776) from five nursing schools in the Philippines were conveniently recruited from September 2022 to January 2023. Six validated self-report scales (Perceived Stress Scale, Multi-dimensional Scale of Perceived Social Support, Generalized Self-Efficacy Scale, Connor-Davidson Resilience Scale, Mindful Attention Awareness Scale, and Psychological Wellbeing Scale) were used to collect data. SEM, mediation analyses and path analyses were used for data analysis. The emerging model demonstrated acceptable model fit parameters. Stress negatively impacted protective factors, while all the protective factors positively influenced PWB. Social support mediated the influence of stress on resilience, mindfulness and PWB. Resilience is a significant mediator of stress, self-efficacy, social support and PWB. Mindfulness mediated the influence of stress, social support and self-efficacy on PWB. Finally, self-efficacy had a mediating role between resilience and mindfulness. Nursing institutions and nurse educators can use the proposed model as their basis for empirical and theoretical evidence in creating programmes that will strengthen nursing students' protective factors, thus reducing stress while improving PWB and learning outcomes.

Modelling the significance of organizational conditions on quiet quitting intention among Gen Z workforce in an emerging economy

The phenomenon of "quiet quitting" has gained significant attention globally through various platforms, raising concerns about the impact of workplace stress on individuals' personal lives and sparking social movements and investigations. As the number of Generation Z individuals is projected to surpass millennials by 2050, understanding and addressing the quiet quitting behaviour of this generation becomes crucial, considering their negative experiences during the COVID-19 pandemic and their preference for a work-life balance, which has led to a rejection of intense competition and a desire for a more relaxed lifestyle. Thus, this study investigated the factors (work conditions, job security, perceived career development opportunities, affective organizational commitment, and perceived organizational support on job burnout and employee well-being) determining the quiet quitting intention among Chinese Gen Z employees. It used an online survey to obtain cross-sectional data from 683 respondents, which were then tested using partial least squares structural equation modelling. The results showed that work conditions, job security, perceived career progression opportunities, affective organizational commitment, and perceived organizational support had a significant positive effect on employee well-being and that job burnout had a major negative effect. Furthermore, employee well-being had a significant negative impact on China's Gen Z employees' quit quiting decision and job burnout had a significant positive influence on China's Gen Z employees' quit quiting decision. The findings provide valuable insights for organizations and practitioners, enabling them to address these factors and effectively reduce quiet quitting intentions. Moreover, this study aligns with the Social Exchange Theory (SET), which explains how the interactions between employees and their organizations influence expectations and outcomes. By considering the SET framework, organizations can understand the motivations behind employees' behaviours and make informed decisions to foster a positive work environment and enhance employee well-being.

Effects of the Pandemic on the Care of Patients With Colorectal Cancer

BACKGROUND

During the COVID-19 pandemic, there was a decrease in the rates of diagnosis and treatment of cancer. However, only a few detailed analyses have been made to date regarding the effect of the pandemic on the care of cancer patients in Germany. Such studies are needed as the basis for well-founded recommendations on health-care delivery priorities during pandemics and other, comparable situations of crisis.

METHODS

This review is based on publications that were retrieved by a selective search of the literature for controlled studies from Germany on the effects of the pandemic on colonoscopies, first diagnoses of colorectal cancer (CRC), surgical procedures for CRC, and CRC-related mortality.

RESULTS

Compared to 2019, the rate of screening colonoscopies performed by physicians in private practice was 1.6% higher in 2020 and 4.3% higher in 2021. On the other hand, the rate of diagnostic colonoscopies in the inpatient setting was 15,7% lower in 2020, while that of therapeutic colonoscopies was 11.7% lower. According to the data evaluated here, first diagnoses of CRC were 2.1% less common in January to September in 2020 than they had been in 2019; according to routine data collected by the statutory health insurance provider GRK, surgery for CRC was 10% less common in 2020 than in 2019. With regard to mortality, sufficient data from Germany were lacking to draw definite conclusions. International modeling data suggest an increase in mortality due to decreased colorectal screening rates during the pandemic that may at least be partially compensated for by intensified screening strategies following the pandemic.

CONCLUSION

Three years after the onset of the COVID-19 pandemic, there is still only a limited evidence base for an evaluation of the effects of the pandemic on medical care and on the outcomes of patients with CRC in Germany. The implementation of central data and research infrastructures will be necessary for further study of the long-term effects of this pandemic, as well as to enable optimal preparedness for future crisis situations.

The prevalence of effort-reward imbalance and its associations with working conditions, psychosocial resources and burden among health care workers during the COVID-19 pandemic: Results of the egePan-Voice study

OBJECTIVE

The association between a measure of effort-reward imbalance (ERI) and profession as well as gender in a sample of health care workers (HCW) during the first wave of the COVID-19 pandemic in Germany using the egePan-Voice study. In addition, we examined, which factors are associated with an effort-reward imbalance ratio (ERI ratio) >1.

METHODS

In a large sample of HCW (N = 6174) we assessed occupational stress with the short version of the effort-reward imbalance (ERI) questionnaire, working conditions, COVID-19-related problems and psychosocial resources (ENRICHD Social Support Inventory, ESSI; Sense of Coherence Scale, SOC-3 and optimism, SOP2).

RESULTS

The prevalence of a ERI ratio >1 among HCW was 50.9%. The prevalence's of an ERI ratio >1 were statistically significant different between gender as well as the occupational profession. The proportion of women (51.8%) with ERI ratio >1 was significantly higher than among men (47.8%). The highest ERI imbalance was found among nurses (62.8%), followed by medical technical assistants (MTA) (58.8%), while psychologists/psychotherapists revealed the lowest value (37.8%), followed by physicians (41.8%). In the total sample, most essential factors reported at this time for increased ERI ratio were: insufficient staff for the current work load, insufficient recovery, feeling insufficiently protected by measures taken by the hospital/the employer, high occupancy rate of the wards, insufficient trust in colleagues and being a nurse as compared with being a physician.

CONCLUSION

The findings indicate a high proportion of HCW with effort-reward imbalance and substantial profession-related differences. Preventive interventions should be offered to vulnerable groups among the HCW to decrease the imbalance measured by work stress.

Mental burden and moral distress among oncologists and oncology nurses in Germany during the third wave of the COVID-19 pandemic: a cross-sectional survey

PURPOSE

There is evidence for mental burden and moral distress among healthcare workers during the pandemic. However, there is scarcity of analyses regarding possible correlations of mental burden and moral distress in this context. This study provides data to quantify mental burden and possible associations with moral distress among physicians and nurses working in oncology in Germany.

METHODS

We conducted a cross-sectional online survey with physicians and nurses working in oncology in Germany between March and July 2021. Next to sociodemographic characteristics and working conditions, mental burden and moral distress were assessed using standardized instruments. Binary multivariate logistic regression using the enter method was performed in order to explore the relationship between mental burden and moral distress.

RESULTS

121 physicians and 125 nurses were included in the study. Prevalence of clinically relevant depressive symptoms, anxiety, somatic symptoms, burnout symptoms and moral distress was 19.2, 14.5, 12.7, 46.0 and 34.7% in physicians and 41.4, 24.0, 46.8, 46.6 and 60.0% in nurses respectively. Mental burden was significantly associated with moral distress, being female/diverse, younger age < 40 and increase in workload. Nurses who felt sufficiently protected from COVID-19 reported significantly less moral distress.

CONCLUSION

To improve pandemic resilience, there is a need to ensure safe working environment including psychosocial support. Further evidence on risk and protective factors for moral distress is needed to be able to develop and implement strategies to protect healthcare workers within and beyond the pandemic.

Compassion fatigue in healthcare providers during the COVID-19 pandemic: a scoping review protocol

INTRODUCTION

The COVID-19 pandemic has negatively impacted the psychological health and well-being of healthcare providers. An amplification in chronic stressors, workload and fatalities may have increased the risk of compassion fatigue and disrupted the quality of patient care. Although current studies have explored the general psychological status of healthcare providers during the COVID-19 pandemic, few have focused on compassion fatigue. The purpose of this review is to explore the impacts of the COVID-19 pandemic on compassion fatigue in healthcare providers and the repercussions of compassion fatigue on patient care.

METHODS AND ANALYSIS

This scoping review will follow Joanna Briggs Institute and Arksey and O'Malley scoping review methodology. Comprehensive searches will be conducted in the following relevant databases: MEDLINE (Ovid), PsycINFO (Ovid), Embase (Ovid), CINAHL, Scopus, Web of Science. To expand the search, reference lists of included studies will be handsearched for additional relevant studies. Included studies must report on the impact of COVID-19 pandemic on compassion fatigue in healthcare providers and have been published in English since January 2020.

ETHICS AND DISSEMINATION

This review does not require research ethics board approval. By examining the impacts of the COVID-19 pandemic on compassion fatigue in healthcare providers, this scoping review can offer important insight into the possible risks, protective factors and strategies to support healthcare providers' psychological health and patient care amidst persisting stressful conditions.

Impact of the COVID-19 pandemic on sick leave among healthcare workers: a register-based observational study

OBJECTIVES

To assess the impact of the COVID-19 pandemic on sick leave among healthcare workers (HCWs) in primary and specialist care and examine its causes.

METHODS

Using individual-level register data, we studied monthly proportions of sick leave (all-cause and not related to SARS-CoV-2 infection) from 2017 to February 2022 for all HCWs in primary (N=60 973) and specialist care (N=34 978) in Norway. First, we estimated the impact of the pandemic on sick leave, by comparing the sick leave rates during the pandemic to sick leave rates in 2017-2019. We then examined the impact of COVID-19-related workload on sick leave, by comparing HCWs working in healthcare facilities with different levels of COVID-19 patient loads.

RESULTS

HCWs had elevated monthly rates of all-cause sick leave during the COVID-19 pandemic of 2.8 (95% CI 2.67 to 2.9) and 2.2 (95% CI 2.07 to 2.35) percentage points in primary and specialist care. The corresponding increases for sick leave not related to SARS-CoV-2 infection were 1.2 (95% CI 1.29 to 1.05) and 0.7 (95% CI 0.52 to 0.78) percentage points. All-cause sick leave was higher in areas with high versus low COVID-19 workloads. However, after removing sick leave episodes due to SARS-CoV-2 infections, there was no difference.

CONCLUSIONS

There was a substantial increase in sick leave among HCWs during the pandemic. Our results suggest that the increase was due to HCWs becoming infected with SARS-CoV-2 and/or sector-wide effects, such as strict infection control measures. More differentiated countermeasures should, therefore, be evaluated to limit capacity constraints in healthcare provision.

The impact of COVID-19 pandemic on mental burden and quality of life in physicians: Results of an online survey

Background

In previous pan-/epidemics such as the SARS epidemic of 2002/2003, negative effects on the wellbeing and an increase in symptoms of depression and anxiety were observed in doctors due to social isolation and the threat they experienced. Therefore, it is feared that the COVID-19 pandemic will also have a negative impact on the mental health and quality of life of doctors.

Objective

The impact of the COVID-19 pandemic on the mental health of physicians. In particular, on the subjective anxiety and burden, depression and quality of life for the total sample and subsamples (work in COVID-19 units vs. no work in COVID-19 units).

Materials and methods

In an online survey, 107 physicians (23-42 years) were asked about their mental health during the COVID-19 pandemic. In addition to socio-demographic data, pandemic- and work-related data were also included. For example, infection control measures, deployment on COVID-19 wards and the subjective perceived threat posed by the pandemic. The physicians were asked to rate their perceived anxiety and stress, retrospectively, at 7 different points in time during the pandemic. The Hospital Anxiety and Depression Scale (HADS) was used to retrospectively assess symptoms of anxiety and depression before and after the onset of the pandemic. The quality of life of the participants after 2 years of the pandemic was assessed using the WHO Quality of Life (WHOQOL-BREF).

Results

Both subjective anxiety and burden showed wave-like patterns with higher scores in autumn, winter and spring. We observed significant differences between the seven measurement time points for anxiety [Chi2(6) = 197.05, p < 0.001] as well as for burden [Chi2(6) = 106.33, p < 0.001]. Symptoms of depression and anxiety increased significantly during the COVID-19 pandemic (M = 14.16, SD = 7.83) compared to the pre-pandemic time [M = 7.31, SD = 5.14, t (106) = -10.67, p < 0.001]. Physicians who worked at COVID-19 units showed higher scores in quality of life related to social relationships (M = 70.39, SD = 17.69) than physicians not working at COVID-19 units [M = 61.44, SD = 24.55, t (90.14) = -2.145, p = 0.035]. The multi-factorial ANOVA showed that previous psychiatric illness (p < 0.001), greater difference in depression scores (p = 0.014), higher anxiety scores (p = 0.048) and less work experience (p = 0.032) led to lower quality of life.

Conclusion

Hospitals should offer specific support, such as supervision, to prevent the development of longer-term psychiatric sequelae likely to lead to sick leave and high costs for the healthcare system.

Trial registration

The study has been registered at the German Clinical Trials Registry (DRKS-ID: DRKS00028984).

Digital Patient-Reported Outcome Measures Assessing Health-Related Quality of Life in Skull Base Diseases-Analysis of Feasibility and Pitfalls Two Years after Implementation

Health-related quality of life (HRQoL) assessment is becoming increasingly important in neurosurgery following the trend toward patient-centered care, especially in the context of skull base diseases. The current study evaluates the systematic assessment of HRQoL using digital patient-reported outcome measures (PROMs) in a tertiary care center specialized in skull base diseases. The methodology and feasibility to conduct digital PROMs using both generic and disease-specific questionnaires were investigated. Infrastructural and patient-specific factors affecting participation and response rates were analyzed. Since August 2020, 158 digital PROMs were implemented in skull base patients presenting for specialized outpatient consultations. Reduced personnel capacity led to significantly fewer PROMs being conducted during the second versus (vs.) the first year after introduction (mean: 0.77 vs. 2.47 per consultation day, p = 0.0002). The mean age of patients not completing vs. those completing long-term assessments was significantly higher (59.90 vs. 54.11 years, p = 0.0136). Follow-up response rates tended to be increased with recent surgery rather than with the wait-and-scan strategy. Our strategy of conducting digital PROMs appears suitable for assessing HRQoL in skull base diseases. The availability of medical personnel for implementation and supervision was essential. Response rates during follow-up tended to be higher both with younger age and after recent surgery.

Technical Readiness and Stereotypes in Hospital Nursing-A Question of Gender and Age?

(1) Background: The nursing profession is associated with various stereotypes. These social images or prejudices against specific groups can inhibit the personal growth of individuals, e.g., sociodemographic characteristics influence the social image of nurses. Based on the forward-looking topic digitization, we examined and discussed the influences of sociodemographic characteristics and motives of hospital nurses on technical readiness to gain insights into the digitization process in hospital nursing. (2) Methods: As part of an online survey on technical readiness among German hospital nurses, we particularly examined sociodemographic influences on technical readiness and the relationship between sociodemographic characteristics and professional motives. Furthermore, we included a qualitative analysis of optional comment fields. (3) Results: The analysis included 295 responses. Age and gender had a significant influence on technical readiness. Furthermore, the importance of motives differed between gender and age. The analysis of the comments produced three categories specifying our results: beneficial experiences, obstructive experiences and further conditions. (4) Conclusions: In general, the nurses showed high technical readiness. In order to gain high motivation for digitization and promote personal growth, special targeting and cooperation between gender and age groups can be beneficial. However, there are more sites at system level, such as funding, cooperation and consistence.

Inclusive leadership can improve nurses' psychological ownership and reduce their turnover intention under the normalization of COVID-19 prevention

Introduction

The COVID-19 pandemic continues to impact people's lives and professions worldwide. Chinese nurses face immense work pressure under the normalization of COVID-19 prevention and control, resulting in greater turnover intention. It is, therefore, crucial to study the mechanisms that influence the turnover intention of nurses in this situation.

Objective

Many studies have examined the impact of leadership style on nurses' turnover intention; however, few researchers have investigated this influence during the COVID-19 pandemic. Based on the leader-member exchange theory, this study empirically studied the effect of inclusive leadership on turnover intention of nurses under the normalization of COVID-19 prevention and control in China, while assessing the mediating role of psychological ownership.

Design

Cross-sectional study with multi-center data.

Participants

Two thousand, two hundred ninety-nine registered nurses from 17 hospitals in China were recruited from January to March, 2022, under the normalization of COVID-19 prevention and control in China.

Methods

A demographic questionnaire and scales of inclusive leadership, psychological ownership, and turnover intention integrated into an online survey were sent to registered nurses of different hospitals. Maximum likelihood structural equation modeling (ML-SEM) was used to analyze data.

Results

Independent variable inclusive leadership has a significant effect on the overall turnover intention of nurses, p < 0.001. The direct effect path coefficient from inclusive leadership to psychological ownership is significant, p < 0.001. The direct effect path coefficient from psychological ownership to turnover intention is significant, p < 0.001. The indirect effect path coefficient from inclusive leadership to turnover intention is significant, p < 0.001.

Conclusion

Psychological anxiety, burnout, turnover intention, and even suicidal thoughts were the main symptoms of Chinese nurses under the normalization of COVID-19 prevention and control in China. The absence of a mechanism to counteract these negative conditions may ultimately lead to personal psychological distress for nurses and collapse of the healthcare system. Inclusive leadership can improve nurses' psychological ownership level and reduce their turnover intention by treating them fairly, providing them with opportunities for self-development, paying attention to communication with them, and increasing their sense of belonging, self-efficacy, and self-identity.

Effort-reward imbalance and its association with sociocultural diversity factors at work: findings from a cross-sectional survey among physicians and nurses in Germany

OBJECTIVE

Due to staff shortages and reports of high work stress, work conditions of hospital physicians and nurses receive wide attention. Additionally, sociocultural diversity of the workforce and patient population is increasing. Our study aim is to analyze how individual and organizational diversity-related factors are associated with the experience of staff's work stress.

METHODS

A cross-sectional online survey was conducted with healthcare staff from 22 acute hospitals operated by two healthcare organizations in Germany in 2018. Sociodemographic, occupational and organizational factors were surveyed. Participants further reported work conditions related to the sociocultural diversity of colleagues and patients. Effort-reward imbalance (ERI) was measured with the German short version. Multivariable regression models were calculated with ER ratio as an outcome.

RESULTS

N = 800 healthcare staff were included. Variables associated with higher ERI were longer work experience (β = 0.092, p < 0.05), not holding a leading position (0.122, < 0.01), being a witness (0.149, < 0.001) or victim (0.099, < 0.05) of discrimination at one's own ward, reporting frequent burden due to language barriers with patients (0.102, < 0.01) and colleagues (0.127, < 0.001), and having restricted access to translators at work (0.175, < 0.001). Factors associated with lower ERI were having a first generation migration background (- 0.095, < 0.05) and being a physician (- 0.112, < 0.05).

CONCLUSIONS

Catering to the needs of healthcare personnel in dealing with the additional effort related to language barriers at work, e.g., readily available translator services, and creating non-discriminatory work environments might be one cornerstone for the prevention of work-related ill health and retention of qualified hospital staff.

Burnout among hospital staff during the COVID-19 pandemic: Longitudinal results from the international Cope-Corona survey study

OBJECTIVE

Long-term changes in burnout and its predictors in hospital staff during the COVID-19 pandemic were investigated in an international study.

METHODS

Two online surveys were distributed to hospital staff in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) between May and October 2020 (T1) and between February and April 2021 (T2), using the following variables: Burnout (emotional exhaustion and depersonalization), job function, age, gender, and contact with COVID-19 patients; individual resources (self-compassion, sense of coherence, social support) and work-related resources and demands (support at the workplace, risk perception, health and safety at the workplace, altruistic acceptance of risk). Data were analyzed using linear mixed models repeated measures, controlled for age.

RESULTS

A total of 612 respondents were included (76% women). We found an increase in burnout from T1 to T2. Burnout was high among personnel with high contact with COVID-19 patients. Individual factors (self-compassion, sense of coherence) and work-related factors (support at the workplace, risk perception, health and safety at the workplace) showed associations with burnout. Low health and safety at the workplace at T1 was associated with an increase in emotional exhaustion at T2. Men showed an increase in depersonalization if they had much contact with COVID-19 patients.

CONCLUSION

Burnout represents a potential problematic consequence of occupational contact with COVID-19 patients. Special attention should be paid to this group in organizational health management. Self-compassion, sense of coherence, support at the workplace, risk perception, and health and safety at the workplace may be important starting points for interventions.

REGISTRATION

Müller, M. M. (2020, August 30). Cope-Corona: Identifying and strengthening personal resources of hospital staff to cope with the Corona pandemic. Open Science Foundation.

NURSE: Five Micropractices to Reduce Stress

The Coronavirus pandemic affected patients' health and heightened stress among the frontline caregivers, especially radiology nurses. Although there is literature on the effects of stress on nurses, there is a gap on interventions to mitigate the impact of stress. There are evidence-based mindful interventions to maintain balance in stressful situations and reduce perceived stress in sports, neuroscience, and positive psychology. Studies show that even brief periods of self-care reduce stress and cortisol levels. Nurses work long hours and have personal, family, and community responsibilities. Nurses may not have the luxury of extra time to devote to self-care. Therefore, this essay summarizes what stress does to the body; the tangible and intangible costs associated with unmanaged stress among nurses. Five self-care micropractices requiring no additional time called NURSE are offered. When practiced consistently, these micropractices can enhance nurses' well-being, leading to the retention of nursing talent and improved patient care.

Prevalence of Post-Traumatic Stress Disorder (PTSD) in Healthcare Workers following the First SARS-CoV Epidemic of 2003: A Systematic Review and Meta-Analysis

The world is still in the grip of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, with putative psychological consequences for healthcare workers (HCWs). Exploring the prevalence of post-traumatic stress disorder (PTSD) during the first SARS-CoV-1 epidemic in 2003 may inform us of the long-term effects of the actual pandemic, as well as putative influencing factors such as contact with the virus, time effects, or the importance of some sociodemographic data. This information may help us develop efficient preventive strategies. Therefore, we conducted a systematic review and meta-analysis on the prevalence of PTSD in HCWs following the SARS-CoV-1 in 2003. PubMed, Embase, Google Scholar, Psychinfo, and Web of Science were searched until September 2022. Random-effects meta-analyses were stratified by the time of follow-up. We included 14 studies: 4842 HCWs (32.0 years old, 84% women). The overall prevalence of PTSD was 14% (95CI 10 to 17%). The prevalence of PTSD was 16% (8 to 24%) during the epidemic, 19% (16 to 22%) within 6 months after the epidemic, and 8% (4 to 13%) more than one year after the end of the epidemic. The longest follow-up was three years after the epidemic, with 10% of HCWs with PTSD. Nevertheless, the prevalence of PTSD was significantly lower more than one year after the end of the epidemic than the first six months after the epidemic (Coefficient -10.4, 95CI -17.6 to -3.2, p = 0.007). In conclusion, the prevalence of PTSD in HCWs was high during the first epidemic of SARS-CoV in 2003 and remained high in the long term. The lessons from the SARS-CoV-1 epidemic may help prevent a wave of PTSD following the latest COVID-19 pandemic.

A global overview of healthcare workers' turnover intention amid COVID-19 pandemic: a systematic review with future directions

BACKGROUND

Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic.

METHODS

A mixed studies systematic review was conducted. The PubMed, Embase, Scopus, CINAHL, Web of Science and PsycINFO databases were searched from January 2020 to March 2022. The Joanna Briggs Institute's Critical Appraisal Tools and the Mixed Methods Appraisal Tool version 2018 were applied by two independent researchers to critically appraise the methodological quality. Findings were synthesised using a convergent integrated approach and categorised thematically.

RESULTS

Forty-three studies, including 39 quantitative, two qualitative and two mixed methods studies were included in this review. Eighteen were conducted in the Middle East, ten in the Americas, nine in the Asia-Pacific region and six in Europe. Nurses (n = 35) were included in the majority of the studies, while physicians (n = 13), allied health workers (n = 11) and healthcare administrative or management staff (n = 7) were included in a smaller proportion. Five themes emerged from the data synthesis: (1) fear of COVID-19 exposure, (2) psychological responses to stress, (3) socio-demographic characteristics, (4) adverse working conditions, and (5) organisational support.

CONCLUSIONS

A wide range of factors influence healthcare workers' turnover intention in times of pandemic. Future research should be more focused on specific factors, such as working conditions or burnout, and specific vulnerable groups, including migrant healthcare workers and healthcare profession minorities, to aid policymakers in adopting strategies to support and incentivise them to retain them in their healthcare jobs.

Working Conditions and Wellbeing among Prison Nurses during the COVID-19 Pandemic in Comparison to Community Nurses

The psychological health and work challenges of nurses working in prisons during the COVID-19 pandemic are understudied. We evaluated the work and wellbeing characteristics of a California prison nurse group, with a comparison to those of a community nurse group. From May to November 2020, an online survey measured psychosocial and organizational work factors, sleep habits, psychological characteristics, COVID-19 impacts, and pre-pandemic recall among 62 prison nurses and 47 community nurses. Prison nurses had significantly longer work hours (54.73 ± 14.52, p < 0.0001), higher pandemic-related work demands, and less sleep hours (5.36 ± 1.30, p < 0.0001) than community nurses. Community nurses had significantly higher pandemic-related fear levels (work infection: p = 0.0115, general: p = 0.0025) and lower perceived personal protective equipment (PPE) supply (p = 0.0103). Between pre-pandemic and pandemic periods, both groups had significantly increased night shift assignments and decreased sleep hours, but the prison group had increased work hours. Although not statistically significant, both groups had high occupational stress and prevalence of post-traumatic stress symptoms. Our results indicate that prison nurses experienced work and wellbeing challenges during the pandemic. Future research and practice ought to address nurses' workload, PPE, and psychological resources in correctional facilities and healthcare organizations.

Digitization in Everyday Nursing Care: A Vignette Study in German Hospitals

(1) Background: Digitization in hospital nursing promises to transform the organization of care processes and, therefore, provide relief to nurse staffing shortages. While technological solutions are advanced and application fields numerous, comprehensive implementation remains challenging. Nursing leadership is crucial to digital change processes. This vignette study examined the effects of the motives and values on nurses' motivation to use innovative technologies. (2) Methods: We asked hospital nurses in an online vignette study to assess a fictitious situation about the introduction of digital technology. We varied the devices on the degree of novelty (tablet/smart glasses), addressed motives (intrinsic/extrinsic), and values (efficiency/patient orientation). (3) Results: The analysis included 299 responses. The tablet vignettes caused more motivation than those of the smart glasses (Z = -6.653, p < 0.001). The dataset did not show significant differences between intrinsic and extrinsic motives. The nursing leader was more motivating when emphasizing efficiency rather than patient orientation (Z = -2.995, p = 0.003). (4) Conclusions: The results suggest efficiency as a motive for using known digital technologies. The nursing staff's willingness to use digital technology is generally high. Management actions can provide a structural framework and training so that nursing leaders can ensure their staff's engagement in using also unknown devices.

Mental health problems and needs of frontline healthcare workers during the COVID-19 pandemic in Spain: A qualitative analysis

Background

Healthcare workers (HCWs) from COVID-19 hotspots worldwide have reported poor mental health outcomes since the pandemic's beginning. The virulence of the initial COVID-19 surge in Spain and the urgency for rapid evidence constrained early studies in their capacity to inform mental health programs accurately. Here, we used a qualitative research design to describe relevant mental health problems among frontline HCWs and explore their association with determinants and consequences and their implications for the design and implementation of mental health programs.

Materials and methods

Following the Programme Design, Implementation, Monitoring, and Evaluation (DIME) protocol, we used a two-step qualitative research design to interview frontline HCWs, mental health experts, administrators, and service planners in Spain. We used Free List (FL) interviews to identify problems experienced by frontline HCWs and Key informant (KI) interviews to describe them and explore their determinants and consequences, as well as the strategies considered useful to overcome these problems. We used a thematic analysis approach to analyze the interview outputs and framed our results into a five-level social-ecological model (intrapersonal, interpersonal, organizational, community, and public health).

Results

We recruited 75 FL and 22 KI interviewees, roughly balanced in age and gender. We detected 56 themes during the FL interviews and explored the following themes in the KI interviews: fear of infection, psychological distress, stress, moral distress, and interpersonal conflicts among coworkers. We found that interviewees reported perceived causes and consequences across problems at all levels (intrapersonal to public health). Although several mental health strategies were implemented (especially at an intrapersonal and interpersonal level), most mental health needs remained unmet, especially at the organizational, community, and public policy levels.

Conclusions

In keeping with available quantitative evidence, our findings show that mental health problems are still relevant for frontline HCWs 1 year after the COVID-19 pandemic and that many reported causes of these problems are modifiable. Based on this, we offer specific recommendations to design and implement mental health strategies and recommend using transdiagnostic, low-intensity, scalable psychological interventions contextually adapted and tailored for HCWs.

Perceived Risk of COVID-19 and Employee Decision-Making: How Psychological Distress during the Pandemic Increases Negative Performance Outcomes among Healthcare Workers

In this research, we examined how COVID-19 impacts employee decision-making and performance, knowing that this virus has negatively affected public health, crippled economies, and transformed social and business environments across the globe. To quantitatively test our specific hypotheses regarding the effects of employees’ perceived risk of COVID-19 and psychological distress on negative performance outcomes, we surveyed 443 healthcare workers who were employed by a group of private hospitals in Zimbabwe. These essential workers were delivering day-to-day frontline services with high exposure to COVID-19 during the pandemic. We find that employees’ perceived risk of COVID-19 increases their disengagement, turnover intention, burnout, and low morale at a p < 0.05 significance level. These latter relationships are mediated by employees’ psychological distress at a p < 0.05 significance level. Our findings shed light on how the COVID-19 pandemic is affecting the cognitions and behaviors of the frontline workers who are vulnerable to this contagious disease. Turnover intentions are amplified among healthcare employees, due to their perceived risk of COVID-19 and the resulting psychological distress. Similarly, burnout becomes predominant as these workers worry about contracting the coronavirus due to the poor working conditions they face. As such, our research confirms that the pandemic has intensified the precariousness of work and challenge of managing employee performance, especially for frontline healthcare workers.