Unique stressors in a global pandemic: a mixed methods study about unique causes of distress among healthcare team members during COVID-19

Abstract

Background: Amid the COVID-19 pandemic, healthcare systems experienced significant challenges, including lower revenues from elective procedures, limited supplies, a massive influx of patients and psychologically distressed employees. National reports of well-being showed striking rates of burnout among healthcare workers. Prior research depicted how the pandemic affected all categories of healthcare workers, yet there is little evidence showing what specific factors hinder each type of employee. Methods: Employees from a large medical center in the Southeastern United States (US) (n=1,130) participated in an online survey, responding to a series of questions about their daily stressors, working conditions, and distress as measured by a 9-item Well-Being Index (WBI), and providing open-ended responses about additional stressors and positive changes in their work. With an analytic sample of 1,037, we used stepwise analysis for each employee group to identify which stressors have a significant association with their overall distress. Using a convergent mixed methods approach, we corroborate our quantitative findings with qualitative themes from the open-ended responses. Results: Among all types of employees i.e., physicians, nurses, Advanced Practice Providers (APPs), Clinical support staff and Non-clinical staff, moral distress was associated with higher WBI distress. Qualitative themes showed employees were mainly concerned with quality of and access to care for patients. Stress triggered by heavy workload in the setting of increased pandemic-related responsibilities and decreased personnel was associated with a high level of WBI distress among all types of employees, whereas other significant stressors differed by role. Conclusions: The COVID-19 pandemic created a myriad of work and non-work-related stressors hindering all healthcare workers' psychological well-being differently. Working conditions and responsibilities for each role are unique. Institutional policies must contemplate the distinctiveness of stressors and distress across employee sub-groups to properly mitigate psychological distress.