The Toll Of The Coronavirus Pandemic On Health Care Workers

The report, based on findings from the KFF/Washington Post Frontline Health Care Workers Survey, explores the coronavirus pandemic through the lens of a frontline health care worker in the U.S.. This survey is the 35th in a series of surveys dating back to 1995 that have been conducted as a part of The Washington Post/Kaiser Family Foundation Survey Project and includes interviews with a nationally representative sample of 1,327 frontline health care workers (those with direct contact with patients and their bodily fluids), representing people working in hospitals, doctors’ offices, outpatient clinics, nursing homes and assisted care facilities, and those working in home health care. The sample includes workers who work in many, and multiple, aspects of patient care. The survey also included a comparison survey of 971 U.S. adults not working in health care. See Appendix A for the demographic profile of the frontline health care workers included in this project.

More than one year after COVID-19 overwhelmed the U.S. health care system, the Frontline Health Care Workers Survey finds that some health care workers are now seeing the light at the end of the tunnel as the vaccine roll-out continues. But with less than half of health care workers reporting receiving a COVID-19 vaccine and majorities of frontline health care workers saying they have experienced adverse mental health impacts from the pandemic, this analysis also finds that there may be some longer term impacts on those who were at the forefront during this global pandemic.

  • The coronavirus pandemic has had a major impact on the mental health of frontline health care workers. A majority of frontline health care workers (62%) say worry or stress related to COVID-19 has a negative impact on their mental health. In addition, more than half (56%) of all frontline health care workers say that worry or stress related to COVID-19 has caused them to experience trouble with sleeping or sleeping too much (47%), frequent headaches or stomachaches (31%), or increased alcohol or drug use (16%). In addition, 13% of health care workers say they have received mental health services or medication specifically due to worry or stress related to COVID-19 and an additional one in five (18%) say they thought they might need such services, but did not get them.
  • The youngest health care workers (18-29 years old) seem to have been hit hardest by working during a global pandemic. Three-fourths of younger frontline health care workers report worry or stress related to COVID-19 has had a negative impact on their mental health and seven in ten say they feel “burned out” about work. These feelings may be directly tied to their work experiences during the COVID-19 pandemic as four in ten of these youngest workers are working in a hospital setting and nearly half (45%) report assisting with patient care such as bathing, cleaning, and housekeeping. And, almost one in eight (13%) of 18-29 year old frontline health care workers say they had at least 10 patients in their direct care who died as a result of COVID-19.
  • Throughout the past year, news reports have told of hospitals running low on personal protective equipment (PPE) and at over-capacity for the intensive care units. This experience seems relatively common among the hardest hit frontline health care workers. Over half (56%) of health care workers in hospitals say that their workplace reached over-capacity of ICU beds to treat critical patients, and one third (34%) of health care workers working in either hospitals or nursing homes say that at some point during the pandemic, their workplace ran out of PPE for its employees. And while most health care workers say their employer is “doing about the right amount” or “going above and beyond” when it comes to providing sick leave to employees who had COVID-19 or ensuring employees have the ability to get vaccinated, more than half of health care workers – including a majority of health care workers across different types of health care settings including hospitals (59%), office or clinic (52%), nursing home or assisted care facility (58%), and those who work in patient homes (56%) – say their employer is “falling short” when it comes to providing additional pay for employees who are working in the most high-risk situations.
  • The survey also finds some optimism among frontline health care workers with most health care workers across workplaces and across race and ethnicity saying that the COVID-19 outbreak in the U.S. is at least “somewhat under control” including one fourth who say it is “mostly under control” or “completely under control.” Nearly six in ten frontline health care workers also say they anticipate the COVID-19 pandemic in the U.S. to be controlled enough so that people can resume normal life by early 2022 or later, while 47% say normal life can resume by mid-fall or sooner—including 5% who say life can safely resume in the U.S. now.
Majorities Of Health Care workers Report feeling hopeful, But significant shares also report negative feelings

More than one year into a global pandemic, the KFF/Washington Post Frontline Health Care Workers Survey finds three-fourths (76%) of frontline health care workers saying they feel “hopeful” when going to work these days. Majorities also say they feel “optimistic” (67%) and motivated (63%). Yet, about half also say they feel “ burned out” (55%) or “anxious” (49%). About one in five (21%) say they feel “angry” when they go to work these days.

The share of frontline health care workers who report feeling these emotions does not vary drastically across places where they work (hospital, nursing home, office or clinic, or providing in-home care), but there are some differences depending on their direct experience with the coronavirus. Nearly one-third of frontline health care workers who had a patient die as a result of COVID-19 (32%) or they themselves tested positive for COVID-19 (29%) report feeling “angry.”

Younger health care workers are more likely to report negative emotions than their older counterparts. Seven in ten (69%) frontline health care workers between the ages of 18 and 29 say they feel “burned out” compared to 59% of health care workers between the ages of 30 and 49, 43% of those ages 50 to 64 years, and 27% of health care workers who are ages 65 and older. Three in ten frontline health care workers ages 18-29 also report feeling “angry” about going into work these days. A smaller share of younger health care workers (49 years and younger) also report feeling positive emotions, such as hopeful, optimistic or motivated about going to work than their older counterparts (50 and older).

Young Health Care Workers Report Feeling COVID-19 Burden The Hardest

The youngest group of frontline health care workers are more likely to report feeling negative emotions about their work, but this may be directly tied to their work experiences during the COVID-19 pandemic. Four in ten 18-29 year old adults (41%) report working in a hospital setting (which saw the most severe COVID-19 cases) and nearly half (45%) worked directly assisting with patient care such as bathing, cleaning, and housekeeping, while a smaller share reporting being responsible for patient diagnosis (37%) or administrative tasks (27%).Seven in ten 18-29 year old frontline health care workers say they have had to work more hours or work harder as a result of the COVID-19 pandemic, compared to 59% of 50-64 year olds, and half of those ages 65 and older (49%). A larger share of 18 to 29 year olds also report directly caring for the sickest patients suffering from COVID-19. Six in ten 18-29 year old frontline health care workers (61%) say they worked directly with COVID-19 patients during the past year, including three in ten who treated patients who died as a result of COVID-19. Thirteen percent of 18-29 year old frontline health care workers say they had at least 10 patients in their direct care who died as a result of COVID-19.

How would you describe the work that you do?
(% of 18-29 year old frontline health care workers)

Responsible for administrative duties like a nursing home manager/front desk clerk: 27%
Responsible for patient diagnosis and treatment like a doctor or a nurse: 37%
Responsible for assisting with patient care like bathing, eating, housekeeping: 45%

The Mental health Burden

A majority of frontline health care workers (62%) say worry or stress related to COVID-19 has a negative impact on their mental health. A smaller share, but still at least four in ten say the same about their physical health (49%), relationships with family members (42%), and relationships with coworkers (41%). While the share of frontline health care workers who say their mental health has been negatively impacted is similar to the share of the public overall, there are some key groups that report disproportionate impacts.

Once again, the burden seems to be hardest hit on the youngest group of frontline health care workers. Four in ten 65 and older frontline health care workers report that worry or stress related to COVID-19 has had a negative impact on their mental health, as do a majority of 50-64 year olds (51%) and 30-49 year olds (65%); yet an even larger share of 18-29 year olds report the same (75%).

More than half (56%) of all frontline health care workers say that worry or stress related to COVID-19 has caused them to experience trouble with sleeping or sleeping too much (47%), frequent headaches or stomachaches (31%), or increased alcohol or drug use (16%). In addition, 13% of health care workers say they have received mental health services or medication due to worry or stress related to COVID-19 and an additional one in five (20%) say they thought they might need such services but did not get them. Among those who felt they needed but didn’t get mental health care , the most commonly cited reasons are because they were too busy (27%), they were afraid or embarrassed about seeking care (17%), they couldn’t afford it (16%), or they couldn’t get time off work (14%).

The Hardest Part Of The Pandemic? Concerns Over Safety For Both Themselves And Their Family Members

When asked to say in their own words, one in five frontline health care workers say the hardest part of working during the COVID-19 pandemic was their worry about getting exposed to the coronavirus or getting sick from the virus themselves or exposing their family members (21%). This is closely followed by 16% who say having to wear personal protective equipment (PPE) was the hardest part of work. Fewer offer responses like precautionary measures/safety protocols (8%),  long hours and lack of time off (7%), not enough PPE or other supplies (5%), patients being isolated (5%), or dealing with stress, anxiety, or fear (5%) as the hardest part of working during the COVID-19 pandemic.

IN THEIR OWN WORDS: Thinking about your work in health care delivery settings, what has been the hardest part of working during the COVID-19 pandemic?“Dealing with people that are positive or suspected positive and wearing all the PPE layers can take a burden on your mind.” –59 year old man, responsible for assisting with patient care in a nursing home or assisted living facility, Wisconsin

“Coming in contact with it and not knowing who came into contact with it so we weren’t protected.” –59 year old woman, responsible for assisting with patient care in a nursing home or assisted living facility, Michigan

“I work in the Emergency Department and at the height of the pandemic – December, January – we couldn’t keep up with the capacity of patients, both Covid and not, that were coming into the hospital. The staff was overwhelmed, the resources were running out, and our exposure to Covid was extremely high. It was terrible, honestly, and scary.” –38 year old woman, responsible for administrative duties in a hospital, Pennsylvania

“Trying not to get infected [and] covid 19 skeptics. It’s very irritating to have people come in and downplay the importance of masks.” –65 year old woman, responsible for patient treatment and diagnosis at a doctor’s office and outpatient clinic, Montana

“Entering covid positive rooms. My patients aren’t in the hospital for covid but are tested for it. It’s difficult to do my job effectively with all the PPE on though I am thankful for it. It is also stressful to have to enter a Covid positive room.” –53 year old woman, responsible for patient treatment and diagnosis in a hospital, Ohio

“The extra steps needed when I come home from working with Covid patients. [I] have to undress in the garage and straight to the shower. Sometimes making my son sleep overnight at his grandmas when I have seen Covid patients that day.” –33 year old woman, responsible for patient treatment and diagnosis, in-home patient care, Missouri

“Stress and anxiety levels to do work and help keep patients calm. Extra workload.” –59 year old woman, responsible for patient treatment and diagnosis in an outpatient clinic, Minnesota

“Trying to stay protected and protect patients without supportive management.” –31 year old woman, responsible for patient treatment and diagnosis in a doctor’s office, Texas

Many health care workers report that they did get sick from coronavirus in the past year, but few experienced major symptoms. One in six frontline health care workers say they tested positive for COVID-19, including 8% who say both they and someone else in their household tested positive. An additional 11% say someone in their household tested positive but they did not. One-fourth of frontline health care workers working in nursing homes or assisted care facilities say they tested positive for COVID-19 (24%) compared to less than one in five working in hospitals (18%), doctor’s offices or clinics (14%), or providing in-home care (8%).

Among health care workers who tested positive, one-fourth (4% of all health care workers) say they experienced “major symptoms” while most say they experienced “minor symptoms” (72% of those who tested positive and 12% of all health care workers). One in twenty say they tested positive but didn’t experience any symptoms (1% of all health care workers).

About eight in ten frontline health care workers say that concern about being exposed to COVID-19 at work and exposing others in their household has been sources of stress during the past year, including at least four in ten who say these concerns were a “major source of stress.” A smaller share, but still a majority (63%), say concern about having enough personal protective equipment (PPE) has been a source of stress.

While there are no differences in sources of stress across the different types of work or places they work with majorities all saying these were all at least minor sources of stress, there is a connection between mental health and sources of stress. Among frontline health care workers who reported experiencing adverse mental health impacts from the pandemic (six in ten of total frontline health care workers), about nine in ten say concerns about being exposed to COVID-19 at work or concern about exposing others in their household to COVID-19 were sources of stress.

Views Of their Employers

Throughout the past year, news reports have told of hospitals running low on personal protective equipment (PPE) and surpassing their capacity in intensive care units.  This experience is common among the hardest hit frontline health care workers. Over half (56%) of health care workers in hospitals say that their workplace reached over-capacity of ICU beds of places to treat critical patients, and one third (34%) of health care workers in either hospitals or nursing homes say that at some point during the pandemic, their workplace ran out of PPE for its employees.

And while most health care workers say their employer is “doing about the right amount” or “going above and beyond” when it comes to providing sick leave to employees who had COVID-19 (66%) or ensuring employees have the ability to get vaccinated (88%), more than half of health care workers who are not self-employed say their employer is “falling short” when it comes to providing additional pay for employees who are working in the most high-risk situations (56%).

A majority of health care workers across different types of health care settings including hospitals (59%), office or clinic (53%), nursing home or assisted care facility (58%), and those who work in patient homes (56%) say their employer is “falling short” in providing additional pay for employees working in high-risk situations.

Despite these issues, eight in ten health care workers say that they think the general public has shown a great deal (28%) or a fair amount (52%) of respect for health care workers like them throughout this time. Nine in ten say that the patients they interact with have a great deal (35%) or a fair amount (52%) of respect for them.

Frontline health Care Workers Are optimistic About the current status of the vaccine, say life will return to normal relatively soon

Majorities of health care workers across workplaces and race and ethnicity say that the COVID-19 outbreak in the U.S. is at least “somewhat under control” including one fourth who say it is “mostly under control” or “completely under control.” The view of the status of the pandemic is similar across demographic groups but notably, while about one-fourth of White health care workers say that the outbreak is either “completely” (4%) or “mostly under control” (19%), only about one in ten Black health care workers say the same. Three in ten (31%) of Black health care workers say the COVID-19 outbreak is “not at all under control.” While majorities across workplaces say that the COVID-19 is at least somewhat under control, one-fourth of those working in in-home patient care (27%) say that it is “not at all under control.”

About four in ten frontline health care workers say they anticipate the COVID-19 pandemic in the U.S. to be controlled enough so that people can resume normal life by mid-fall or sooner – including 6% who say life can safely resume in the U.S. now. However, most frontline health care workers think the pandemic will only be under control enough for normal life to resume in early 2022 or later (58%). The general public has similar expectations about when they expect normal life to resume, with one quarter (27%) saying by mid-summer or sooner, 17% saying mid-fall, four in ten (38%) saying by early 2022 and an additional 17% saying later than that.

About one in four in-home health care workers saying they expect a return to normal later than early 2022. This is similar to the share of those working in nursing homes and assisted care facilities. These groups are also less likely to say they have received at least one dose of a COVID-19 vaccine, due to both concerns about getting it and a lack of access.

Six in ten (61%) frontline health care workers say that most Americans are not taking enough precautions to prevent the spread of COVID-19, similar to the share of the general population who say the same about their peers. Seven in ten (68%) Black health care workers, younger health care workers ages 18-29 (68%) and health care workers who are Democrats and Democratic leaning independents (73%) say Americans are not taking enough precautions, while a majority of health care workers who are Republicans or Republican leaning independents (56%) say Americans are taking enough precautions to prevent the spread of COVID-19.

Vaccine Intentions Methodology

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