By Melinda Young
Healthcare workers (HCWs) experienced institutional betrayal and high rates of burnout during the COVID-19 pandemic from July 2020 to January 2021, according to the authors of a new study.1
Nearly three in five HCWs believed their institution betrayed them. They experienced stress, fear, anxiety, and concerns about their work environments.
Research from more than 1,000 studies about HCWs during the pandemic revealed high levels of anxiety and depressive symptoms among health system staff.2,3
While fewer studies focus on non-frontline staff and their emotional burden, there is evidence the pandemic introduced acute fears and stressors for healthcare workers across roles in hospitals. Recent research showed that healthcare workers with higher levels of stress tended to be younger and more frequently female, with fewer years of occupational experience. They also were less likely to have caregiving responsibilities at home, and they were more commonly concerned about their finances and becoming infected.2
The pandemic exacerbated pre-existing stressors, including larger workloads and staff shortages that contribute to physical and emotional exhaustion, investigators found.2
This suggests that health systems and leaders should do more to mitigate these factors by giving ample physical and emotional support to staff to prevent burnout and quitting.
“Building and maintaining trust would help healthcare workers to have more motivation to work and less regret to be a healthcare worker,” says Soim Park, PhD, lead study author and a research associate in the department of international health at Johns Hopkins Bloomberg School of Public Health. “If you have institutional betrayal, you have four times higher regret that you’re a healthcare worker. If you want to maintain your staff and healthcare workers, then establish trust and [prevent] feelings of institutional betrayal.”
Healthcare leaders can do this by paying attention to their workplace atmosphere and by taking proactive steps that make employees feel like valued members of the team, Park says.
Sixty percent of HCWs surveyed said they experienced at least one of five questions related to institutional betrayal. A large proportion also noted burnout. Park and colleagues found that employees who experienced burnout during the pandemic reported compromised physical or psychological health.
“This study was conducted in the beginning of the pandemic when everything was chaotic,” Park adds. “If you did a study later on in 2022, the percentage could be a lot less than this.”
Employees cited the personal protective equipment (PPE) shortage as a factor. They also expressed frustration that the hospital had not prepared for the pandemic as well as they had expected.
The notion that hospitals did not stock enough PPE because they found the expense unwarranted led HCWs to believe the institution did not prioritize their safety. This eroded their trust in the hospital.
“The other thing is they didn’t get recognition,” Park notes. “The institution did not provide enough heartfelt thank you messages to healthcare workers, and they didn’t provide hazard pay in the beginning of the pandemic.”
Frontline workers also noted that some of their supervisors were working at home while their staff had to be on the floor, facing COVID-19 patients. For instance, some physical therapists said physicians avoided biocontainment units, which led them to question the solidarity they expected in the hospital.
One person described a manager who displayed a level of support that made a positive difference in their unit. “My boss got down and dirty with the rest of us. Whatever we would need, he would make it work. I think he provided a lot of support to get us through [the pandemic]. Just being there and rolling up a sleeve and working as hard as we did — that meant a lot.”1
HCWs also noted colleagues who left their jobs during the pandemic because they felt unsupported and insufficiently protected and recognized. Other reasons for leaving were related to insufficient compensation, burnout, child care issues, mental distress, and greater workload. Some nurses quit to become traveling nurses for higher pay.1
“Thinking of these messages, I think what hospitals can do is make an atmosphere where healthcare workers can report their experiences and share their concerns,” Park says. “Some participants said that they reported problems to the upper level, but they were not heard.”
HCWs said their concerns were never solved or addressed, and the hospital did not take corrective actions to prevent problems related to what they experienced on the frontline.
While most people said they understood why PPE was in short supply, they also were concerned about how this issue was communicated to them by management.
“Some people reported they got emails that said, ‘Don’t steal PPEs for your home,’ and they said [the administration] perceived them as thieves,” Park says. “Creating an environment where workers feel like a valued member is one thing hospitals can do even if they don’t have enough PPE. Prioritizing healthcare workers’ safety makes them a valued member.”
Even if a health system does not give frontline workers extra pay for working long hours under hazardous conditions, they could at least provide emotional compensation.
“There are quotes that healthcare workers received a lot of thank you messages from the community, and we all know that from the news,” Park adds. “But they did not get enough heartfelt thank you messages from the leadership.”
Because the pandemic was a new crisis for most hospital leaders, it is understandable they did not know what to do — especially in the beginning — to best support their staff.
“Everything was chaotic and new, and it’s difficult to apply one simple guideline to healthcare workers,” Park says. “Some reported the guidelines were too frequently changed.”
If the hospital cannot afford hazard pay during a period when most of their work is diverted because of a pandemic or crisis, then perhaps they could tell staff that they have a plan to pay hazard pay the next year when their revenues return to normal, Park suggests.
“Give them a deadline, and say, ‘We’ll visit it again,’” Park says. “Leadership could be more frank, saying, ‘We don’t have those resources right now, but later on, we’ll make a plan.’”
Health systems also might need to update and improve their mental health resources for staff. The traditional support was not enough during a time when workers felt institutional betrayal. Their outreach should extend beyond frontline staff, since many other workers, including those in food service, registration, security, and nonclinical roles, also experienced stress and burnout.
“In one study, we didn’t see a difference between clinical and nonclinical staff — they had the same problems,” Park says.
Those researchers found that HCWs’ vulnerability to severe psychological distress during the pandemic was embedded within the broader work environment and the health system’s work environment before the crisis. Employees who experienced daily stress at work before 2020 said they experienced enhanced stress, burnout, and emotional exhaustion during the pandemic.2
“We see a significantly positive association between feelings of betrayal and mental distress and post-traumatic stress disorder,” Park says.
REFERENCES
- Park S, Closser S, Cooney EE, et al. “A slap in the face”: Institutional betrayal, burnout, and career choice regret among frontline health care workers servicing COVID-19 patients. J Trauma Stress 2023;36:980-992.
- Atkins K, Cooney EE, Park S, et al. Day to day and environmental risk factors for psychological distress among healthcare workers: A mixed methods analysis. J Occup Environ Med 2023;65:e593-e603.
- Dragioti E, Tsartsalis D, Mentis M, et al. Impact of COVID-19 pandemic on the mental health of hospital staff: An umbrella review of 44 meta-analyses. Int J Nurs Stud 2022;131:104272.
HCWs experienced institutional betrayal and high rates of burnout during the COVID-19 pandemic from July 2020 to January 2021, according to the authors of a new study. Nearly three in five HCWs believed their institution betrayed them. They experienced stress, fear, anxiety, and concerns about their work environments.
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