Hearing the voices of Australian healthcare workers during the COVID-19 pandemic

  1. Michelle Ananda-Rajah
  2. Benjamin Veness
  3. Danielle Berkovic
  4. Catriona Parker
  5. Greg Kelly
  6. Darshini Ayton

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Abstract

The statistics of healthcare worker (HCW) COVID-19 infections do not convey the lived experience of HCWs during the pandemic. This study explores the working conditions and issues faced by Australian HCWs.

Methods

Qualitative analysis of free-text responses from Australian HCWs from 3 August to 26 October 2020 from an open letter calling for better respiratory protection for HCWs, transparent reporting of HCW COVID-19 infections and diversity in national infection control policy development. The open letter was sent to an email list of 23 000 HCWs from a previous campaign and promoted on social media.

Results

Among 3587 HCWs who signed the open letter during the study period, 569 free-text responses were analysed. Doctors and nurses accounted for 58% and 33% of respondents, respectively. Most respondents came from Victoria (48%), New South Wales (20%), Queensland (12%) or Western Australia (11%). Dominant themes included concerns about: work health and safety standards; guidelines on respiratory protection including the omission of fit-testing of P2/N95 respirators; deficiencies in the availability, quality, appropriateness and training of personal protective equipment; and a command-and-control culture that enabled bullying in response to concerns about safety that culminated a loss of trust in leadership, self-reported COVID-19 infections in some respondents and moral injury.

Conclusion

Deficiencies in work health and safety, respiratory protection, personal protective equipment and workplace culture have resulted in a loss of psychological and physical safety at work associated with an occupational moral injury. The challenge for healthcare leaders is to repair trust by addressing HCW concerns and fast track solutions in collaboration with them.

Article activity feed

  1. Version published to 10.1136/leader-2020-000386
  2. ScreenIT

    SciScore for 10.1101/2020.09.25.20197061: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableIn-house fit-testing was occurring, with alarming results, where “around 40% of women failed a quantitative fit test on the disposable P2/N95 masks” (Anaesthetist, NSW), noting that “women and non-Caucasian faces appear at greatest risk of failure.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several limitations. The purpose of the open letter was primarily to advocate for increased protection for HCWs, and thus the methodology was not designed to optimally probe HCW perspectives. The study may not be representative of all HCWs as the response rate was 12% at 48 hours and it did not capture all types of HCWs including a large sample of nurses, administrative or support staff. Occupational moral injury has not been well described in healthcare and deserves further research to better understand its root causes, preventative strategies and evidence based remediation. Response and non-response bias common to survey methodology may be operating and these findings require confirmation in studies from other jurisdictions. Finally, there was no ‘check’ to ensure that respondents were indeed HCWs, however the consistency of themes would argue otherwise. Constructive engagement with HCWs that also addresses their moral injury presents the challenge for healthcare leaders during this pandemic and beyond. This process should be seen as an opportunity to harness the resourcefulness of HCWs that many respondents felt had been sidelined, with the wealth of governance and operational experience among healthcare leaders, policy makers and government in order to fast track solutions. Achieving shared goals necessarily starts with better consultation and a dose of courage in all actors. Not doing so risks the contagion described in this report spreading throughout Aus...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.09.25.20197061v1 on medRxiv