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Mental Health and Social Support for Healthcare and Hospital Workers During the COVID-19 Pandemic

Mental Health and Social Support for Healthcare and Hospital Workers During the COVID-19 Pandemic
Veenema TG, Closser S, Thrul J, et al.
Date posted:
September 23, 2021
Publication type:
The Johns Hopkins Center for Health Security
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Healthcare and hospital workers providing care and support to infected patients during a pandemic are at increased risk for mental distress. Factors impacting their mental health include high risk of exposure and infection, financial insecurity due to furloughs, separation from and worries about loved ones, a stressful work environment due to surge conditions with scarce supplies, traumatic experiences due to witnessing the deaths of patients and colleagues, and other acute stressors. Finding ways for institutions to support the mental wellbeing of healthcare and hospital workers in an acute pandemic-related crisis situation is of critical importance. The factors affecting mental health are deeply connected to work-related motivation and attendance. Willingness to come to work is multifactorial and is dependent upon an individual’s self-perception of risk, as well as having the skills and resources necessary to perform work tasks given the nature of the public health emergency. Social and material support for healthcare workers in a variety of high-stress and high-risk settings is important for supporting workers’ mental health and in maintaining their commitment in challenging conditions.

The impact of the COVID-19 pandemic on healthcare workers has been profound, characterized by death, disability, and an untenable burden on mental health and wellbeing. Lost on the Frontline, a report published by The Guardian and Kaiser Health Network in April 2021, revealed that more than 3,600 healthcare workers in the United States had died of COVID-19. While the median age of death due to COVID-19 was 78 years, in healthcare workers, it was 59. Two-thirds of deceased healthcare workers were people of color, revealing the deep inequities tied to race, ethnicity, and economic status in America’s healthcare workforce. Lower-paid workers who handled everyday patient care, including nurses, support staff, and nursing home employees, were far more likely to die in the pandemic than physicians. Only 30% of the deaths were among hospital workers, with few employed by well-funded academic medical centers. Healthcare workers were 3 times more likely to contract COVID-19 than the general public. Detrimental effects also experienced by healthcare and hospital workers included financial hardship, stress related to known and unknown information, and fear of the uncertainty regarding continued progression of the pandemic. As of August 2021, the COVID-19 pandemic is far from over and its full impact upon hospital and healthcare workers remains unknown.

The Johns Hopkins Health System (JHHS) operates in 2 states and the District of Columbia. Johns Hopkins Medicine (JHM) is the robust partnership between JHHS and the Johns Hopkins University School of Medicine, with a workforce of approximately 53,000 employees and a very limited number of contract workers. JHHS and JHM have played a leadership role during the COVID-19 response both nationally, by producing and sharing data to inform decisionmaking and evidence-based guidelines for response, and regionally, in accepting large numbers of patients during the surge. Prior to the onset of the pandemic, JHHS and JHM leadership had established a commitment to employee mental health and wellbeing through substantial investments and the implementation of numerous programs to support employees. However, even with the presence of these dedicated resources, clinical and nonclinical staff have reported high levels of stress, anxiety, and burnout.

To identify the issues most critical to healthcare workers’ mental health, wellbeing, and motivation during the COVID-19 pandemic, we conducted a cross-sectional survey (1,189 responses) and 73 semistructured interviews with individuals currently employed at JHHS and JHM hospitals located in Maryland and the District of Columbia. Our study population included healthcare providers and direct support services staff, including workers in frontline environmental services, food services, and security.

The responses from our survey and interviews revealed that the trauma of witnessing COVID-19 death was exacerbated by the general stress of working during the pandemic and that the significant mental health burden created by the pandemic/infectious disease environment itself was characterized by the ongoing uncertainty and ambiguity about the scientific understanding of the virus. Additionally, stressors negatively impacting employee mental health stemmed from the workplace, resulting in reduced trust of and increased perceptions of betrayal in the institution.

Although our findings are specific to one academic health system, they may be relevant to other hospitals and health systems. Studies such as this offer an important window into learning more about employee health from the unique stress and trauma of the COVID-19 pandemic and can facilitate progress toward a health system that communicates value and prioritizes safety for all staff.



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