Our analyses focused on open-ended questions 2 through 6 (see Online Resource 1). Themes emerging from Questions 1 and 7 were much more general and respondents interpreted these as unrelated to the current pandemic. (See Online Resource 2 for example responses).
Preliminary Chi-Square and ANOVA analyses determined that missing responses/skipped questions did not occur in any systematic pattern based on any of the demographic variables we queried (all p’s > 0.05). In other words, any skipped questions were the result of random variation among participants.
Demographics
Our final sample consisted of 72 participants, yielding a response rate of 24%. Among the participants, 66% (n=48) were women, 81% (n=58) worked predominantly daytime shifts, and 83% (n=60) worked on weekdays. Of note, 91% (n=65) did not test positive for COVID-19, but 83% (n=60) knew a colleague who did. A variety of professional roles was represented, with physicians and nurses each accounting for 14% of our sample (n=10 for each group; see Table 1). Table 2 illustrates the length of MSK tenure among participants, with one third having been at MSK for 3 years or less. Two-thirds of the respondants (n=48) also indicated that they interacted in person with cancer patients diagnosed with COVID-19 (see Table 3).
Overall Themes
Across the open-ended questions, staff narratives of their experiences during COVID-19 coalesced into four major themes:
Theme 1: Concerns about exposure and infection for self and others
Exposure to the virus emerged as the primary concern and stressor for staff working during the COVID-19 pandemic. Across all questions, participants reflected on the tension between balancing their responsibilities to patients with personal fears of infection – compounded by concerns over the availability of effective personal protective equipment (PPE). These fears were magnified by the novelty of the virus: information about COVID-19 changed in real time, making it difficult for participants to assess their own safety and exposure risks, and heightening their concerns over becoming virus vectors and infecting their loved ones. When asked to describe the “most difficult” part of their work during the pandemic (Question 3), 80% (40/50) of responses were related to concern about their own, their colleagues’ and their families’ exposure to COVID-19:
- “I was constantly worried though that I would get COVID, and that even if I didn't show symptoms that I would have it and pass it on to my elderly parents”
- “I had nightmares of being infected or potentially infecting others, I prone myself every night as a result of fear of contracting this virus.”
Theme 2: Patient care as a source of both meaning and stress
A positive sense of responsibility towards patients framed participants’ answers about their experiences. When asked to describe the “most gratifying” part of their work during the pandemic (Question 4), 87% (41/47) wrote about seeing or helping patients. Participants wrote that providing patient care and support helped them feel that they were making a difference and gave them a sense of direction, meaning and fulfillment during a time that felt out-of-control. Multiple participants also described the gratifying experiences of seeing patients recover from COVID-19. Additionally, in Question 4, 60% (28/47) of participants expressed gratitude for their employment, including statements of pride and professional satisfaction in being able to contribute to the pandemic response. Other responses conveyed appreciation for having a job during such an economically tumultuous period.
- “The most gratifying part of work during the pandemic is making sure the patients have a clean room.”
- “Seeing patients recover in the ICU and facetiming their families so they could see their loved ones off the ventilator.”
However, caring for patients was also described as a source of stress, frustration and sorrow. For example, when asked to describe the “most difficult” part of their work during the pandemic (Question 3), 48% (24/50) of respondents focused on the challenges of patient care. Many expressed helplessness in trying to manage patients infected with SARS-CoV-2, guilt in enforcing restricted visitor policies combined with difficulties in communicating with families, and frustration in trying to provide high-quality care remotely.
- “The most difficult part of work during this difficult time was the lost [sic] of patients.
- “It's been difficult to be unable to perform an in-person assessment…you call a patient and they sound unwell, yet they do not want to go into UCC or seek escalated care.”
- “The most difficult part of my work during the pandemic was explaining to family members they could not see their gravely ill mother, father, child, etc.”
Theme 3: Coping with Unknowns, Uncertainties, and Disruptions to their Lives.
Respondents experienced constant stress and anxiety as they attempted to navigate COVID-19-related professional and personal uncertainties. When asked to discuss the “weight of the COVID-19 pandemic on you, personally” (Question 2), 59% (30/51) of participants related concerns about their families - including virus exposure, their children’s physical and emotional health, and the ability to provide financial support. These stressors were compounded by the disruption of familiar routines and coping mechanisms. Across questions, many participants expressed the tension between their increased reliance on family for social and emotional support (especially as physical/social distancing increased) and the need to protect their loved ones from virus exposure. For some, work life and home life began to blend, making it increasingly difficult to juggle competing responsibilities. As a corollary, participants whose direct exposure to COVID-19 patients compelled them to quarantine away from loved ones described the difficulty and sacrifices they experienced.
- “I would distance myself from family member's as everyday I feared bringing home Covid [sic].”
- “The most difficult part was dealing with the unknown, which generated a high level of fear. It took a lot of energy to stay calm and mentally sharp.”
- “There were changes in practice happening every day or sometimes by the hour…”
Theme 4: Importance of Institutional & Professional Support:
Despite challenges, participants emphasized that professional collaborations were vital to helping them get through this difficult period. When asked what they found “the most helpful,” (Question 5), 70% (33/47) described positive interactions with colleagues, staff, and managers who were invested in both protecting co-workers from unnecessary exposure and providing meaningful social support.
- “I am also grateful for [my supervisor’s] support. When I recovered from COVID, I was…given a remote assignment which allowed me to work from home. The stress of commuting into the city during the crisis was gone.”
- “Co-workers and MSK staff worked collectively and diligently in navigating through the difficult times while providing quality patient care.”
Responders further expressed gratitude towards MSK for helping them feel valued and supported. They enumerated the institution-wide actions and policies (such as transportation assistance) that MSK implemented at the beginning and throughout the pandemic to mitigate the crisis-related stressors they were facing. When asked “What could MSK have done or do now to make this stressful period easier or more manageable for you?” (Question 6), 37% (16/43) responded that they believed there was nothing the institution could have done better to handle the pandemic and mitigate its effects on staff:
- “I talk to friends and ex-colleagues and I know that our organization did everything it possible [sic] could for the comfort of its employees.”
- “MSK out did [sic] themselves by offering so may support to the staff in terms of transportation, housing, financial assistance, etc.”
Participants also described stressors regarding timely communication from leadership, particularly at the onset of the pandemic, when information about COVID-19 and related safety protocols were rapidly evolving. Some perceived that new information was not communicated simultaneously to all staff, leading to a sense that team members “were not always on the same page.” A few statements referred to respondents’ direct leadership/supervisor and institutional leadership. Several participants offered suggestions, which included clearer communication around staffing decisions and protocols, and adjustments to benefits and perks during the COVID-19 pandemic, such as instituting hazard pay (53%, 23/43):
- “The first couple of weeks MSK was following CDC recommendations which were clearly behind what data had shown in other countries …The communication and protocols improved with time.”
- “I felt at the beginning of the pandemic the hospital was slow to provide PPE to staff even those who had valid concerns.”
- “Hazard pay would have been a major benefit…. It would also show a greater sense of appreciation.”