2.9 Theme: adequate resourcing for the role
Critical HCPs requested the provision of basic resources for them to safely fulfil their roles. The words ‘adequate’ and ‘sufficient’ particularly in relation to PPE and training were consistently used. HCPs were clear they did not expect the ‘best’ or to be overresourced, although they did want ‘adequate’ access to PPE, information, knowledge and training, breaks and food, appropriate rostering, and support to ensure they could safely perform their role physically and emotionally. Many HCPs suggested that the pandemic was an opportunity to correct perceived existing deficiencies with regards to pay, leave entitlements, and compensation. The primary request in this theme however was for ‘adequate PPE and PPE training’ as exemplified by an intensive care nurse: “Adequate PPE and a no-tolerance policy for inadequate PPE, especially in emergency situations” (ID 1360, Australia); an anaesthetist: “Adequate PPE and consistent guidance” (ID 3788, UK); and another intensive care nurse:
“Knowing we will be supplied with adequate PPE, I believe a gown, eye shield and mask are not enough. Even airline cleaners get hazmat suits, and they don't come into direct contact with patients.” (ID 1462, Australia).
HCPs wanted to be safe. Furthermore, they wanted to have the knowledge, resources, leadership, autonomy, and support to enable them to effectively respond to the pandemic. This was illustrated by a clinical ICU nurse:
“reassurance that we are safe and up to date in our practice on the day - it is constantly changing [which is understandable] but therefore disconcerting when yesterdays practice is now not considered safe” ( ID 2020, Australia).
Another related aspect for this theme was the need for access to COVID-19 testing and the timely return of results as reported by a speech therapist:
“Access to testing for COVID-19 with a quicker turnaround time to getting results. I worry most about whether I may have COVID-19 or whether I am overreacting and imagining/exaggerating symptoms. If there was a quicker test then I would feel more confident to be able to test my symptoms”, (ID 3593, Ireland).
Many respondents identified the pandemic as an opportunity to improve remuneration, increase compensation for risk, and address perceived flaws in current attitudes to the risk posed for HCPs, particularly nurses. This was clearly articulated by intensive care nurses, for example: “…… ….If your work exposes you to something that makes you unable to attend work it is industrial sickness which should be covered by your employer …… …” (ID 205, Australia), “I think the possibility of higher pay during the high-risk period should be considered.” (ID 54, Australia) and “Hazard pay” [single suggestion from respondent] (ID 2769, New Zealand).
Increased provision for leave and compensation for risk was also a suggestion made by other HCPs, for example, an intensive care physiotherapist, “Improved leave provisions for when we get sick and/or catch COVID and not use up our current normal sick leave ± rec leave”. (ID 3239, Australia).
It was evident that HCPs perceived an urgent need for frequent access to education and training including simulation. Many identified that this was key to their ‘survival’ during the pandemic. For those who were asked to act outside their normal roles, education and clinical support was perceived as critical. An emergency nurse and medical trainer highlighted the need for skills training through “simulation scenarios for training [and this would result in]- less anxiety when you are trained how to manage e.g., intubation without manual ventilation pre ETT etc in your own workplace” (ID 1004, Australia). This was reiterated by many respondents, for example, an acute care nurse identified the need for: “Ensuring adequate training supervision if changing nursing role e.g. stepping up to HDU” (ID 1289, Australia) and an emergency nurse recommending: “Clinically, much more training on whatever information is available regarding the pathophysiology and treatment options of COVID19” (ID 1382, Australia). Concern was expressed by a consultant anaesthetist about missing essential training during her maternity leave:
“…. I am not stressed by long hours or patient exposure. But I am stressed by not being present. To help or get PPE training and simulation [training]. So, I do not feel at all prepared for returning to work …. I would like to attend training sessions even when on leave.” (ID 410, Australia).
Many respondents requested stronger consideration for healthier rostering, for example, ‘adequate’ time between shifts to recover and recuperate. This was illustrated by an intensive care nurse: “Adequate down time to recover and avoid COVID-19 fatigue” (ID 3156, Australia) and a consultant anaesthetist: “Adequate rest days in between shifts” (ID 3617, UK).
There were also requests for shorter shifts as HCPs found PPE restrictive and exhausting physically and emotionally. An emergency paramedic suggested: “Shorter shifts. Working in PPE is exhausting” (ID 3526, UK) and an emergency nurse practitioner: “Shorter shifts, working in teams (same roster for 3months etc) and more days off to prevent transmission of COVID19” (ID 1107, Australia).
HCPs, particularly nurses, repeatedly requested ‘adequate staffing levels’ primarily to provide clinical support with PPE and to cover breaks. This intensive care nurse provided a detailed response:
“… actually getting proper breaks as described in our policy when caring for COVID patients for example the policy says a 15 minute break every hour that is not happening and I've been looking after these critically sick COVID patients in an isolation room for 3 + hrs without breaks ” (ID 1485, Australia).
Nurses also requested shifts in which they were not caring for patients with COVID-19 as a means of maintaining their wellbeing, as articulated by an intensive care nurse: “Access to exercise equipment, shower facilities and rotation to non-COVID19 patients” (ID 3119, Australia).
HCPs requested practical resources to assist with their wellbeing. These included facilities to shower at work and the provision of hospital supplied ‘scrubs’ (work clothes) to minimise the perceived risk of infection to their family and friends. An intensive care nurse identified that: “Being provided with scrubs to wear at work so I reduce the risk of transmitted COVID to my family at home”. (ID 3213, Australia) was needed, which was supported by an intensive care medical resident: “Ability to use hospital laundered scrubs, shower at work to prevent transmission to home. ….” (ID 3631, US ).
Provision for their physiological needs was a plea among respondents. Physiological needs fell into the categories of sleep, food, hydration, accommodation, and exercise. Sleep hygiene and time to rest was a major request. This was one of several suggestions for wellbeing made by intensive care nurses: “Using apps to help sleep/relax” (ID 3521, UK) and “adequate sleep and rest” (ID 302, Australia). The need for a place to sleep was also premised with the requirement to physically isolate and protect others as exemplified by a nurse educator:
“sleeping arrangements for healthcare staff if they do not [have] enough space to do proper social distancing at home - it's hard to have mental wellbeing when the physical stuff feels impossible to achieve.” (ID 3850, UK).
And an emergency nurse suggested: “Having hotels available for staff to self-isolate if needed, so they don't have the worry of taking it home to their family/children.” (ID 1169, Australia).
Respondents wanted easy access to nutritious and healthy food and hydration when working clinically. For example, a consultant anaesthetist suggested: “Hospital provision of food and drink” (ID 3685, UK). A more extensive list of provisions was offered by an emergency paramedic:
“Access to healthy nutritious food, ability to work out, shifts that allow for adequate rest, separate staff quarters for those that need separate accommodations from susceptible family members” (ID 3648, US).
Another physiological need identified was the time and space to exercise. Exercise was a common suggestion to enhance wellbeing across disciplines and often made in combination with other strategies, as exemplified by an emergency medical consultant: “Healthy eating, exercise [our emphasis] and fresh air where possible. Meditation” (ID 1895, Australia).
HCPs suggested that vulnerable HCPs should be ‘shielded’ and not expected to do frontline clinical work. This was exemplified by a rural emergency doctor: “Take the vulnerable staff off the floor don't leave it to their line managers” (ID 372, Australia).
2.11 Theme: the need for genuine kindness and provision of support for HCP wellbeing
Many respondents offered suggestions about what could practically be implemented to assist their wellbeing as evidenced in the previous theme. Additional suggestions included the provision of regular debriefing and psychological support from people with specialised skills and an understanding of the clinical areas. These responses were framed with a need for authenticity, that is, actions not just words. There were requests for opportunities to debrief HCPs working in the clinically, for example:
“Formal debriefing for healthcare staff where necessary - not just the reminder of free counselling sessions through [state governance] - Actual debriefing with doctors, nurses etc. to unpack issues and learn, and to support each other” (ID 1360, intensive care nurse, Australia), and
“A space to share how scared I am on a personal level without having to be a Doctor who is supposed to be on the “frontlines” “fighting” this” (ID 3528, medical fellow intensive care, UK).
There was a strong emphasis on the importance of a healthy supportive team, for example: “A positive work culture, staff being supportive and kind to one another during times of stress” (ID 3073, intensive care nurse, Australia). There was also a level of skepticism about the term ‘wellbeing’. This was expressed in a single response by an intensive care social worker: “Stop using the word wellbeing - it's at saturation” (ID 834, Australia). HCPs required evidence of genuine concern from both health and political leaders. For example, an emergency medical consultant emphasised, “Honest employers/hospital admit showing concern to staff wellbeing and providing PPE that WE feel we need to work safely” (ID 2845, Australia).
Medical trainees requested more support to manage unique additional pressures related to the disruption of their training and uncertainty about their future careers as exemplified by an anaesthetic registrar:
“For the college to be more empathetic to the strain they are putting on trainees by delaying our VIVAs to some distant, non-committal date. For them to express something resembling human empathy and not the cold robotic tone ….” (ID 3079, Australia).
And an emergency registrar stated that:
“More genuine support from ACEM and ED staff specialists within our department; not just in regards to health and wellness surrounding COVID-19, but also regarding the cancellation of exams and the impact this has had on trainees.” (ID 460, Australia).