Real leaders leave a legacy. They capture the hearts and minds of their teams; their origin story puts the safety and well-being of their people first. Great companies ubiquitously have safe, yet productive operations. For those companies, safety is an investment, not a cost for the C-Suite. It’s a real topic of daily focus. This is The Safety Guru with your host Eric Michrowski, a globally recognized Ops and The Safety Guru public speaker and author. Are you ready to leave a safety legacy? Your legacy success story begins now.
Hi and welcome to The Safety Guru. I’m your host Eric Michrowski and very happy to have with me Stephanie Andel, who’s an assistant professor in Indianapolis with a significant background in safety, safety, culture and studied in industrial organizational psychology. So, Stephanie, welcome to the to the show and love to hear a little bit about some of the background, what got you into psychology. And some of the key here is that you’ve been focused on it from a research standpoint.
Sure. So, thank you so much for having me. Probably my degree is in industrial organizational psychology, as you said, which is an area of psychology that focuses upon human behavior in the workplace. So, within this large field of Io’s, psychology is a sort of specialty called Occupational Health Psychology, or OHIP, which focuses on understanding how work impacts health, well-being and, of course, the safety of employees. My research falls squarely within OHIP, so I generally study work stress, particularly in high risk helping professions such as nursing and emergency medical services, and understanding how work stress influences health and well-being of those folks.
So lately my work has really started to pivot to focus on the current pandemic course. Right. So, for instance, one of my current research studies considers the toll of the coronavirus pandemic on health and safety of nurses who are working on the front lines of the crisis.
That’s really interesting and very timely piece of research. Love to hear a little bit more about it and what got you interested in this topic, because it’s such an important theme in the in these times.
Sure. So, as you know, the virus is continuing to grow exponentially across the United States and the world. And more and more are really coming out in the popular press about the plight of health care workers who are on the front lines. So, we hear things like there’s a lack of personal protective equipment or PPE, inconsistent covid protocols and hospitals, health care providers, health care providers are living in an RV in their driveway and aligning themselves. Right.
So, they don’t have. Right. They’re worried that they’re going to infect their family. So, the list really goes on. Right. So, we’ve also seen some evidence of the physical and psychological toll that this is having on folks. There’s a number of safety issues. It’s also leading to psychological outcomes like post-traumatic stress symptoms and sometimes even instances of suicide in the front lines. The situation is really quite dire. So, we decided something clearly needs to be done to help these individuals, but the question is, where do we start?
So that got me and my collaborators are Marianna Arbon or Chanta Down. And when he said interested in hearing directly from the nurses on the front line. So, we wanted to understand what are their biggest challenges that they’re facing during these times and what is the impact that this crisis is having on both their psychological as well as physical health and safety?
This fascinating piece of work, I know I started being interested in this when I started seeing the crisis expand into Italy. And there were some really early reports of the impact and also physicians, nurses losing best friends and seeing them kind of exhausted day in and day out. So, tell me a little bit about how you got to doing this and what did the study look like?
Yeah, so we conducted a two-month long study of about one hundred and sixteen registered nurses. So, in order to be eligible for this study, we wanted to make sure we were really hearing from the nurses who are working on the front lines. So, they had to be working front lines in hospitals in the United States. And we recruited these participants through all different kinds of ways. For instance, we got in touch with many of them through Reddit and other social media websites, really trying to get those folks who were right on the front lines.
And we ended up getting participants from 32 states across our final sample in terms of the study design. Every other week for two months, our nurses received a survey in their email that asked that about a variety of workplace stressors they’d encountered that are related to the pandemic. So, we also asked them to describe the biggest challenges that they’ve dealt with or encountered during this time. And also, we had them just tell us what are their hospitals doing and we’re not doing to support that during this challenging time.
So, this this really started the survey launched in May and during this of the heart of the pandemic and data collection just wrapped up pretty recently. So, we’ve just scratched the surface in terms of data analysis. But our preliminary results are really interesting and we’ll continue to analyze that data over the next few weeks to gain even more insights.
So, so really interesting. What did you find out so far?
Yeah, so preliminary analysis really unveiled four key challenges or concerns that our nurses were consistently encountering at work during the crisis. These challenges are related to issues such as understaffing, insufficient communication, inadequate safety protocols, and, of course, as you might imagine, extensive emotional demands.
OK, so tell me a little bit more about these key challenges of the nurses have been facing this during this pandemic. And let’s start with the first one you mentioned the understaffing one.
Sure. As much as nurses were consistently reporting that their units were understaffed. So, in fact, over half of fifty nine percent of our nurses stated that their work unit needed more employees just to adequately fulfill their work tasks related to the pandemic. So, one thing that we were actually quite surprised about and we learned through the responses, is that many hospitals have had to cut hours of many nurses at the same time that the pandemic was growing. So, when we were conducting when we started this study, we just thought all nurses there had been so many nurses, there was so much work that everybody would be overburdened.
Right. It actually turned out that folks were overburdened and overworked, but it was just a few because the hospital had to cut the hours and many others largely because the freezing of elective surgeries influenced hospital finances. So, the hospitals don’t have the finances to pay everybody, even though there’s so much work related to the pandemic. So, this puts ICU nurses and other nurses who are working with the patients in very difficult positions. So, for instance, our ICU nurses reported that they frequently were assigned a patient to provide a ratio that’s much higher than normal.
So usually, it’s one provider to one patient or maybe two patients to a provider. So sure. So, thank you so much for having me. Probably my degree is in industrial organizational psychology, as you said, which is an area of psychology that focuses upon human behavior in the workplace. So, within this large field of Io’s, psychology is a sort of specialty called Occupational Health Psychology, or OHIP, which focuses on understanding how work impacts health, well-being and, of course, the safety of employees. My research falls squarely within OHIP, so I generally study work stress, particularly in high risk helping professions such as nursing and emergency medical services, and understanding how work stress influences health and well-being of those folks.
o one to one to two to one. But they were saying it might be three patients to every provider, maybe even more. And that’s likely to be getting worse as the pandemic continues to grow. Right. Because keep in mind, this was started in May and the pandemic is continuing to grow.
It’s continuing to and the ICU and a lot of states, ICU beds are at capacity, near capacity. So, I would assume this is getting even worse if they’re not increasing the staff.
Exactly, and of course, this has major implications not only for the health and well-being of patients, but also for the providers themselves.
Wow, OK, that’s a that’s something I had not heard of before, so it’s actually fascinating but incredibly disturbing in terms of the impact. I don’t know if your research looked outside. You talked to us about the states because I thought that in other places, they had put all hands-on deck to move people from elective to other areas. Do you know if that’s the case or obviously you’ve studied only the US side?
Yeah. So, we really focused on the US here. But I would suspect that given the other the way that health care systems are different. And of course, in other countries, I would imagine that they’d be able to maybe more easily put everybody on deck, all hands-on deck right away, probably easier. So very interesting. So, what was the second key concern that showed up in the survey responses?
Sure. The second key concern related to insufficient communication, self-esteem or concern arose in a couple of different ways. So first, the vast majority of nurses reported there was a lack of consistent and effective communication from upper management so that that is there was insufficient downward communication. So, for instance, many of our nurses said the hospital was constantly changing policies with short notice. One person, for instance, said they found out or one person also. Suddenly they found out from a newspaper rather than a hospital that another nurse contracted Colgan work.
Right. So, oh, my goodness. Not a lot of good communication from upper management. Second, nurses reported a lack of support for upward communication. That is when employees tried to speak up about their concerns or make suggestions for improvement. They felt that they were being consistently shut down or ignored by management. So, for instance, we had one participant who said they wrote a long evidence-based proposal to overhaul their unsafe covid ICU environment, and that was met with no response from their management.
Others said that when they tried to speak up, their supervisors basically told them that they had to have to deal with it. So given this lack of communication, it’s perhaps not surprising that the vast majority are actually two thirds of our nurses reported that they actually they weren’t confident in the way that their hospital was handling the pandemic. They also felt that these concerns were not being validated by upper management.
That’s scary because everything I’ve ever read, I mean, I’ve been in the safety space in a very long time, not specifically in the health care, but both upward and downward communication is such a critical component to the safety outcomes in any industry.
Absolutely. And more important now than ever. Are you?
No kidding. Especially if you’ve got everything else. You’ve got our understanding, all these issues happening at the same time. It’s even more critical. OK, really disturbing. Tell me a little bit more about some of the other key concerns that came up.
Sure. So, we had two others. So, the third concern that came up were reports of inadequate safety protocols to protect employees themselves. Right. So, most of our nurses were concerned about the availability of safety equipment and effective protocols. Interestingly, they were less concerned about the availability of resources that were patient focused, such as ventilators and ICU beds, which is good. However, there’s a caveat there. The study took place in May and June when the second national surgeon cases didn’t start up yet.
So, I just want to mention, however, at this time, employees were most concerned about the availability of resources to protect their own health. So, things like clear safety protocols for the employees themselves, covid tests for employees themselves and of course, the personal protective equipment or the PPE, which we’ve also heard a lot about in the news. So, in terms of inconsistent or inadequate safety protocols, one nurse, for instance, who happened to be taking she shared that she was taking fertility treatments, reported that her hospital system was still requiring that pregnant staff have to care for covid patients because it was incredibly stressful for her.
Another nurse reported that they were initially told they weren’t allowed to wear masks because of how it made the hospital look. So, of course, this varied across hospitals. There were some folks who felt their hospitals were very supportive, but I thought it was quite concerning reading some of these notes from participants saying that they didn’t feel that there was a lot of attention on their own safety and that they weren’t being prioritized, which is really scary. I mean, is the analogy that people often use around if you’re flying in the cabin, pressure depressurizes, put your own oxygen mask first.
You can’t take care of other patients if you’re not healthy yourself, which is really the so, so critical that nurses and doctors have the right level of PPE and know how to use it.
Absolutely. I think the key here is we need to make sure that we’re helping the helpers. That’s what I like to say.
And. The final theme is the sense of emotional demands that these folks have been exposed to during this time. When we asked participants about the emotional experiences they’ve had at work, about three quarters or 72 percent reported that their work was often or always emotionally demanding during the crisis. And of course, I think it’s important to mention that these emotional demands really don’t just stop at work when they’re at the hospital. So, nurses reported that the impact of these demands are also spilling over to impact their family lives as well.
You know, they said things like their family members and children were constantly worrying that they would contract the virus.
I would imagine, you know, and they also they themselves were exhausted because they were worrying so much about their getting their family members sick. So, it’s really the emotional demands have a lot of impacts and a little bit like you talked about at the beginning, people living in RVs and so forth. There are cases where a nurse could be taking care of somebody who’s at risk patient normally right at home. Right. So, a parent or and having to live completely quarantined from the rest of the family.
So, it’s really alarming, especially when you think about the amount of sleep you need to have when you’ve got such an impact emotionally and physically in terms of work demands.
So, what are the implications of these covid related work stressors on nurses, their health and well-being and overall safety?
Sure. So, we found these work stresses are really associated with a wide array of negative outcomes. For instance, we found that they were linked to physical health outcomes such as reduced life quality care to mentioned psychological health outcomes such as post-traumatic stress disorder symptoms or PTSD symptoms, as well as what we call emotional exhaustion. Yep, safety outcomes such as near accidents, near misses and of course, covid related covid exposures and family outcomes. So, it’s even impacting marital satisfaction or family conflict.
So, the pressure that these folks are under is incredible. And the data shows that this is having a major impact, impact on really virtually every aspect of their lives right now.
And we don’t even know the long-term toll of this. Right, because we’re too soon into it. But the concern that I was reflecting is if there’s multiple waves, which is what most expect will happen, will you still want to do this next wave, the third wave, fourth wave, whatever the number of waves that come back to hit or do you eventually say can’t do this anymore? But then the other part is even new. Will it impact the recruitment of new nurses?
Will people want to become nurses? Will go to learn to become a nurse after hearing what has happened, which can have a long, long term consequences in terms of health care, access to health care. If nobody wants to do the work, that’s a challenge. Same as I know when this was certain to hit in Italy and the death toll among doctor was actually quite high initially from what I understand was, was how do you replace that expertise in the amount of time that may be needed for a following wave that comes around.
And so, given these key findings that you outlined, where do we go from here? What do you recommend that hospital leaders do to better support nurses during the current pandemic?
So that’s a great question. First of all, I want to mention that, you know, it’s absolutely imperative that hospitals provide their employees with the adequate people. And of course, it pains me to have to say that. But our most priority, right next, hospital leaders need to make sure that they support and really actively solicit employee feedback from employees on the front. Lines are going to be their best resources for learning what’s missing and what’s not working.
They’re also going to have informed ideas about how to improve current protocols in order to make sure that the workplace is more efficient, safer and less stressful. So, it’s also important to note that providing opportunities for employees to get that feedback can empower them and enhance unit morale as long as leadership actually responds and tries to take into account that feedback. Right. You don’t want to fall on deaf ears, right.
So those are important. I mean, we know that from the field of safety, the whole element of safety, participation, huge, huge people need to feel like there’s an unless they felt heard, something happens with it. I agree. So, I go on. Sorry. And third, I would recommend the hospital leaders. I’m sure they’re providing consistent and clear and regular updates to employees, not just when there’s major changes, but really schedule a consistent communication is key.
This, of course, ensures that everybody is on the same page so that. Processes run more smoothly and that everyone is kept as safe as possible, but also constant communication can help, at least to a degree, and reducing feelings of loneliness and isolation that these folks might be experiencing during this crisis. This is really a profoundly isolating time. So, anything that leaders can do to build a sense of community and connection is really more important now than ever out are, you know.
And the last thing I would recommend is, in addition to supporting employees, physical health through proper safety protocols and equipment availability is I would say it’s important that hospitals make concerted efforts to promote employee’s psychological health as well. So, they could do things like, well, research shows that psychological detachment, which is the ability to disconnect from work-Related thoughts once the workday is over. That’s important for reducing the negative impact of work stressors on psychological help so employers can promote detachment and a few different ways.
They could provide consistent regular work breaks. They could promote detachment after work by ensuring that employees are not contacted or preferably maybe not on call after the workday is over. And they also can promote psychological health in other ways. They could acknowledge employees hard work and efforts, and they could also try to limit the excessive emotional demands as much as possible. Of course, during this time, you’re never going to completely eliminate that. But if there’s any way for employees to go to work and share the burden, I think that is helpful to kind of protect every employee.
And so, one participant in our study actually mentioned that their unit allowed them to take a break from the covid unit and swap for a shift with a regular medical unit, which I really thought was a great way to kind of spread these most emotional demands. And it’s not pulling on one specific person, which I think is quite important.
I think it’s that’s brilliant because it really gives you a chance to recharge your batteries in some ways with something that’s less draining, I would assume.
Do you think the findings from this research will be helpful even after the pandemic subsides?
I really do. So, although we unveiled a number of key challenges that are top of mind for health care employees right now, these issues aren’t and are not necessarily new. Right. They’re just intensified right now due to the current pandemic. So therefore, while I would argue that all the recommendations, I gave are especially important to implement right now, it’s important to note that organizations are really always strived to incorporate these best practices, whether there’s a pandemic or not.
Ultimately, it’s my hope that this study will help to inform possible decision makers and even policymakers once the crisis is over to make the work environment safe, safer, healthier and better prepared in the years to come.
No doubt, because I think, like you said, the pandemic magnified the issues. But chances are some of the issues are in communication and so forth. Were there before. It just now becomes more acute. Exactly. So, besides health care, what other occupational groups or occupation groups do you think will be affected by this this pandemic?
Yeah, so quite honestly, it’s difficult for me to imagine occupational groups that would not be affected by the pandemic, but I think they’ll be affected in different ways. So, one group that comes to mind right now is teachers, given the pressure that’s on them, as many states are pushing to open schools back to in-person learning. Right. Right. So, I would imagine that these folks will unfortunately have your safety equipment, resources at their disposal in comparison to the health care professionals in our study.
So that, of course, has the potential to impact both their physical and psychological health. Additionally, those in the service industry who work with the public are also going to be dealing with a number of similar challenges as these pandemic rages on. But I also want to note, even folks who are not working directly with the public are going to continue experiencing numerous challenges as this crisis continues to unfold. So, for instance, many are working remotely with a lack of communication from employers.
Others are dealing with the stress of job insecurity. Others are trying to balance their work responsibilities with family responsibilities. Needless to say, these are really quite difficult times and therefore more important than ever that organizations will step up to support their employees physical and psychological health and safety.
Very, very well said, because I’ve seen this in the early days of the pandemic, a lot that worked for progressive employees that really enabled very quickly working as an example. Employees were, for the most part, incredibly grateful, and it showed very strong levels of active care for the organizations that did this really well. But as it goes on and on, the stress of trying to balance all the different things, like you said, family and so forth, it’s a lot for people to tackle.
So, I really thank you for coming on the show. But I think more importantly, thank you for doing this research, because this is this is raising like in terms of just the impact of it, I thought. Through a lot of the components that you brought, but not the depth and the breadth of issues, I don’t really think about the initial pieces in terms of long-term impact on a profession even. But I think you’ve brought some of a really, really interesting but also, I would say rather disturbing themes that are emerging as organizations are working through.
Obviously, some are doing this really well, but unfortunately, some probably haven’t been prepared, haven’t really been thinking about safety of the workforce in the same way in the health care space because they weren’t thinking the hazard was probably as dangerous as, say, in mining or in construction or in utilities.
Right, right. Yeah.
So, thank you very much for your work and for coming on the show.
Thank you so much.
Thank you for listening to The Safety Guru on C-Suite radio. Leave a legacy, distinguish yourself from the pack, grow your success, capture the hearts and minds of your team’s. Fuel your future. come back in two weeks for the next episode or listen to our sister show with the Ops guru Eric Michrowski.