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Healthcare workers enter their profession with a deep commitment to serving others. From emergency department nurses to medical specialists to disability support workers, there is a shared commitment to caring for people in times of need. Yet healthcare workers also experience high workplace demands and stressors in their day-to-day lives. The work can be unpredictable and unrelenting. Despite every effort to preserve life and health, some patients will never fully recover and some will die. Healthcare workers go to work each day, hoping to make a positive difference, in the face of financial constraints, staffing shortages, heavy expectations, and strong emotions.
Given all these issues, it is unsurprising that working in healthcare takes its toll. Doctors and nurses, in particular, are known to suffer from higher rates of burnout, anxiety, depression, and suicide than other occupations. The wellbeing of healthcare workers matters to individual workers and their families and, more broadly, affects the quality of care, patient safety, and workforce retention.
While healthcare workers in Australia are used to responding to crises such as bushfires, floods, mass casualty accidents, and outbreaks of disease, the current COVID-19 pandemic is a crisis of a scale not seen since the Spanish Influenza that followed World War I. In countries around the world, COVID-19 has interrupted daily life, made normal work practices and routines impossible, and given rise to fear and uncertainty. Indeed, our very language has changed to include new phrases such as āsocial distancingā and āCOVID-normalā. Unsurprisingly, the pandemic has had a profound effect on the physical, emotional, economic, and social wellbeing of populations globally.
For healthcare workers, this situation has been no different, except that work cannot suddenly stop and there have been multiple new challenges. Around the world, people providing patient care in hospitals and the community have had to respond quickly to heavy workloads, large volumes of new information, new work practices and roles, redeployment or job insecurity, separation from loved ones, and increased risks to their own lives and the lives of family members.
The Australian COVID-19 Frontline Healthcare Workers study
After earlier pandemics, such the 2003 outbreak of severe acute respiratory syndrome (SARS), research showed that the mental health of many healthcare workers suffered, with potentially long-lasting effects. Similarly, a growing body of evidenceāfrom around the worldāis finding high rates of anxiety, depression, post-traumatic stress, and burnout among healthcare workers during the COVID-19 pandemic. Importantly, some healthcare workers are more vulnerable to these harms, and both personal and workplace factors can contribute to this risk.
With this knowledge, our research team believed it was vital to understand the psychosocial, workplace, and financial effects of the COVID-19 pandemic on healthcare workers in Australia. We hoped that this knowledge would help with recognising their needs, developing practical solutions, and supporting the health workforce during crises now and in the future. And so, the āAustralian COVID-19 Frontline Healthcare Workers studyā was born.
The survey was a voluntary, anonymous, online survey of healthcare workers in hospitals, general practice, and community care across Australia. We invited workers from all health roles (doctors, nurses, allied health, medical laboratory, administrative, and other support staff) to take part. The survey was shared by leaders at hospitals and community organisations, professional colleges, societies and associations, universities, government health departments, newspapers, television, radio, and social media.
The survey ran from August to October 2020, which coincided with the second wave of the pandemic in Australia. Throughout this time, international arrivals into Australia and interstate travel were largely halted. Severe lockdown restrictions were in place in the state of Victoria including: mandatory mask-wearing, travel limited to five kilometres from home, an evening curfew, a one-hour daily limit for outdoor exercise, working from home for all but essential workers, home-schooling, restrictions on seeing extended family, the closure of most shops, hospitality and entertainment venues, and shutting of interstate and international borders. During the second wave, around 20,000 people in Australia were infected with COVID-19 and around 800 died. These numbers were many times lower than similar countries overseas. Nevertheless, healthcare workers were disproportionately affected, with thousands of healthcare workers becoming infected with COVID-19 at work. It would be another four months before the first vaccine against COVID-19 was provisionally approved for use in Australia.
It was in this context that healthcare workers were invited to contribute to our survey. Healthcare workers generally are reluctant to participate in surveys for many reasons, including lack of time. However, within eight weeks we had received almost 10,000 responses from healthcare workers across Australia, which was a truly incredible response. We heard from people working in all roles and areas of the health sector, ranging from aged care nurses to hospital cleaners to intensive care specialists. This made our study the largest multi-professional, health workforce survey in the world on this topic.
Of the respondents, half (52%) were aged under 40 years and most (81%) were women, which reflects the predominantly female health workforce in Australia. Most participants were nurses (39%), doctors (31%), or allied health staff (17%) with the remainder working in other health roles. Few healthcare workers (2%) had been infected with COVID-19, but three-quarters (76%) were worried or very worried that their role could lead to them transmitting COVID-19 to their families. The survey found worryingly high levels of psychological distress among healthcare workers during the pandemic. Over half of the healthcare workers who responded to our survey reported significant levels of burnout (71%), severe anxiety (60%), and/or depression (57%). Additionally, many experienced significant changes to social relationships, workplace roles, and finances. More detailed results from the survey, including the demographic and workplace factors associated with mental illness, coping strategies, and organisational change have been published elsewhere.
In addition to measuring mental health, social, financial, and workplace changes, we wanted to understand healthcare workersā experiences, so we included four questions where people could write freely and tell us more. The last question was: āIs there anything else you want to tell us?ā Normally these are the questions that we all skip over and leave blank in surveys. Yet, once again this survey was unusual as the healthcare workers did not race past these open questions. We received thousands of free-text responses, many of which were long and detailed. Indeed, we received over 250,000 words of heartfelt free text. We read stories of grief, fear, anger, hope, gratitude, and much more. Healthcare workers from every part of the Australian healthcare system shared their personal experiences of, and reflections on, the COVID-19 pandemic and its effect on their families, their work, and their health.
The origins of this book
Some of the healthcare workers who completed our survey expressed little hope that others would ever hear their voices. And indeed, this book was not part of our original research plan. However, as we read the unfiltered emotions and experiences that these healthcare workers offered up to us, we understood that their stories needed to be shared. And it was clear from their responses that healthcare workers wanted other people to hear their words, to understand what they had been through and to bear witness to what they experienced in their work and home livesāboth good and bad. These healthcare workers also wanted their narratives and experiences to drive change for the better.
What to expect as you read this book
In this book, we recognise that healthcare workers are the experts in their own lives and that the best way to understand, and learn from their experiences, is to let them speak for themselves. Apart from this introduction, and brief contextual comments introducing each chapter and theme, the words in this book are those of healthcare workers themselves. All of the quotes are free-text responses to the Frontline Healthcare Workers survey, with most drawn from the final question which simply asked: āIs there anything else you want to tell us?ā Survey responses are grouped by theme, with light editing for clarity and flow. We have provided brief demographic detailsāprofession, area of work, gender, and age rangeāfor each person quoted in this book. Minor details have been changed to protect their anonymity, such as removing the names of hospitals or changing the ages of children.
In compiling this book, we hope to achieve four things. First, to allow healthcare workers to share their stories, and hear from others, as a way of giving words to their experience and finding a sense of shared meaning. Second, we hope to nurture a deeper understanding within the community and among healthcare leaders of how the pandemic affected those providing care. Healthcare workers told us it was sometimes hard to find the words to communicate their experiences with others. We hope that this book will help. Third, we want to shine a light on what these experiences mean for creating a stronger, kinder, and fairer health system for our future. And finally, we wish to create a record of the extraordinary contribution of healthcare workers during the COVID-19 pandemic, as a way of honouring and remembering their contributions.
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Emotions matter, they make us human. They shape our thoughts, actions, and how we understand and connect with others. The uncertainty and challenges thrown up by the COVID-19 pandemic fuelled a firestorm of emotions among healthcare workers. This chapter presents the array of feelings described by healthcare workers as they navigated the pandemic. As you will read below, healthcare workers felt a full spectrum of emotions, from the positiveāenjoying a slower pace of lifeāto the deeply painful, such as the distress of patients dying and fears for their own lives. The emotional experiences of healthcare workers were complexāchanging day-to-day, moment-to-moment, and the depth and breadth of these emotions are evident in the accounts presented here.
Shock
For people around the world, the scale and impact of the pandemic were shocking, and healthcare workers were no different.
Some healthcare workers wrote about the unfamiliarity of living or working in a pandemic.
The feeling of shock was sometimes accompanied by a sense of disbelief.
