In their own words: Experiences of emergency health care workers during the COVID‐19 pandemic

Abstract

Background During the COVID‐19 pandemic, a substantial number of emergency HCWs have screened positive for anxiety, depression, risk of post‐traumatic stress disorder and burnout. The purpose of this qualitative study is to describe the impact of COVID‐19 on emergency care providers’ health and well‐being using personal perspectives. We conducted in‐depth interviews with emergency medicine (EM) physicians, EM nurses and emergency medical service providers at ten collaborating sites across the United States between September 21, 2020, and October 26, 2020. Methods We developed a conceptual framework that described the relationship between the work environment and employee health. We used qualitative content analysis to evaluate our interview transcripts classified the domains, themes and subthemes that emerged from the transcribed interviews. Results We interviewed 32 emergency HCWs. They described difficult working conditions, such as constrained physical space, inadequate personnel protective equipment and care protocols that kept changing. Organizational leadership was largely viewed as unprepared, distant, and unsupportive of employees. Providers expressed high moral distress caused by ethically challenging situations, such as the perception of not being able to provide the normal standard of care and emotional support to patients and their families at all times, being responsible for too many sick patients, relying on inexperienced staff to treat infected patients, and caring for patients that put their own health and the health of their families at risk. Moral distress was commonly experienced by emergency HCWs, exacerbated by an unsupportive organizational environment. Conclusion Future preparedness efforts should include mechanisms to support frontline health care workers when faced with ethical challenges in addition to an adverse working environment caused by a pandemic such as COVID‐19.

Frontline Physician Perspectives on Their Experiences Working During the First Wave of the COVID-19 Pandemic

“…Kuwahara et al suggest change at the level of the preparedness phase (of disaster/emergency/crisis management), including "multiple plans and measures to maintain social ties should be prepared at the individual level (e.g., family, friends, neighborhood), organizational or community levels, and societal levels to prevent or mitigate the negative impact of social isolation and its related problems. 37 " Finally, shortages of PPE were a prominent issue early in the pandemic 5,28,38 ; adequate PPE is an essential component to healthcare worker wellness in this crisis. 39,40 PPE has no longer become a critical issue for the majority of US hospitals, but the variation in hospital leadership's ability to address the health and safety of frontline workers affected morale and had downstream effects.…”

“…23 Failure to implement existing crisis care standards, when indicated, caused unnecessary moral distress. 5,29,30 Moral distress can affect everyone; it has been suggested that it be openly discussed given that it is a healthy, rather than a pathological, response. 41 Moral distress can be mitigated by systemic factors despite similar clinical exposures 42 ; this highlights the power of systemic decisions to minimize moral distress in addition to addressing it through individual physician wellness.…”

“…[1][2][3] Minimal research qualitatively explored frontline physicians' perspectives regarding novel policies and procedures in real time during the first wave of the pandemic in the USA. 4 As the pandemic progressed, more qualitative investigations were conducted exploring physician perspectives on working in subsequent waves of the pandemic, 5,6 the impact of COVID-19 on primary care, 7,8 integration of palliative medicine into intensive care units, 9 and telehealth. [10][11][12][13][14][15][16] To inform future efforts in the COVID-19 pandemic and prepare for future crises, we must understand frontline physicians' perspectives from the first wave of the pandemic, when the least was known about this crisis.…”

The Emergency Medicine Resident Retreat: Creating and Sustaining a Transformative and Reflective Experience

“…In a recent survey, emergency medicine has shifted to become the specialty with the highest degree of burnout [13]. Many healthcare leaders attribute such a high rate to the working conditions and risks of the COVID-19 pandemic [14][15][16], which has undoubtedly also impacted the experience and wellness of trainees. This sustainable retreat program has demonstrated success with resident satisfaction and is the first report in the literature for emergency medicine.…”

Job stressors and burnout among nurses and primary‐care physicians working at a dedicated outpatient respiratory center for patients with suspected or confirmed COVID‐19

“…The verbatim answers to each of these open-ended queries were assessed in a completely blinded manner vis-à-vis the quantitative data. The authors independently evaluated these answers using qualitative content analysis [44][45][46] and subsequently discussed the assessments until concordance was attained.…”