“A slap in the face”: Institutional betrayal, burnout, and career choice regret among frontline health care workers serving COVID‐19 patients

Abstract

The COVID‐19 pandemic has exacted a physical and mental health toll on health care and hospital workers (HHWs). To provide COVID‐19 care, HHWs expected health care institutions to support equipment and resources, ensure safety for patients and providers, and advocate for employees’ needs. Failure to do these acts has been defined as institutional betrayal. Using a mixed‐methods approach, this study aimed to explore the experience of institutional betrayal in HHWs serving COVID‐19 patients and the associations between self‐reported institutional betrayal and both burnout and career choice regret. Between July 2020 and January 2021, HHWs working in an urban U.S. health care system participated in an online survey (n = 1,189) and semistructured interview (n = 67). Among 1,075 quantitative participants, 57.8% endorsed institutional betrayal. Qualitative participants described frustration when the institution did not prioritize their safety while reporting they perceived receiving inadequate compensation from the system and felt that leadership did not sufficiently respond to their needs. Participants who endorsed prolonged breaches of trust reported more burnout and stronger intent to quit their job. Quantitatively, institutional betrayal endorsement was associated with 3‐fold higher odds of burnout, aOR = 2.94, 95% CI [2.22, 3.89], and 4‐fold higher odds of career choice regret, aOR = 4.31, 95% CI [3.15, 5.89], compared to no endorsement. Developing strategies to prevent, address, and repair institutional betrayal in HHWs may be critical to prevent and reduce burnout and increase motivation to work during and after public health emergencies.

“When Can I Call Home?” Coercive Control, Structural Isolation, and Functional Isolation Among Attendees of Residential Behavioral Modification Programs

“…These institutional wrongdoings are prevalent in the testimonials that were analyzed and appear to occur both on an individual level and systematically across institutions. Institutional betrayal has been known to exacerbate negative mental health outcomes (Park et al, 2023;Gómez, 2021;Smith & Freyd, 2013, 2014, and this case is no different (Chatfield, 2019). Institutional betrayal and betrayal trauma can manifest through psychological symptoms, such as dissociation, anxiety, depression, and post-traumatic stress disorder (PTSD; Park et al, 2023;Gómez, 2021;Smith & Freyd, 2013, 2014.…”

“…Institutional betrayal has been known to exacerbate negative mental health outcomes (Park et al, 2023;Gómez, 2021;Smith & Freyd, 2013, 2014, and this case is no different (Chatfield, 2019). Institutional betrayal and betrayal trauma can manifest through psychological symptoms, such as dissociation, anxiety, depression, and post-traumatic stress disorder (PTSD; Park et al, 2023;Gómez, 2021;Smith & Freyd, 2013, 2014. Although not pertinent to the focus of this paper and difficult to systematically collect based on the nature of the data, 24 testimonials claimed to have been formally diagnosed with at least one mental health condition, including depression, anxiety, insomnia, and panic disorders (among others).…”

“…Such reports often reflect coercive control established and maintained through fear (Hamberger et al, 2017) including physical, sexual, or emotional abuse, intimidation, isolation, or deprivation of basic needs (Callaghan et al, 2018;Duron et al, 2021). As such, residential facilities may foster an atmosphere with an expectation of negative consequences for any act of perceived disobedience and exploits vulnerable attendees (Duron et al, 2021), reflecting themes of institutional betrayal (i.e., harms done by an institution to persons who are dependent on the institution; Park et al, 2023;Smith & Freyd, 2014).…”

When health care sickens the health care worker: Commentary on Park et al. (2023)

“…I congratulate Park and colleagues (2023) on their analysis of the critical working conditions of health care and hospital workers during the COVID‐19 pandemic. Observed institutional betrayal was defined as the failure to support equipment and resources, ensure the safety of patients and providers, and advocate for employees’ needs (Park et al., 2023).…”

“…I congratulate Park and colleagues (2023) on their analysis of the critical working conditions of health care and hospital workers during the COVID‐19 pandemic. Observed institutional betrayal was defined as the failure to support equipment and resources, ensure the safety of patients and providers, and advocate for employees’ needs (Park et al., 2023). Since the World Health Organization (WHO) officially announced the end of the COVID‐19 pandemic on May 5, 2023 (U. N. News, 2023), the gag order imposed on health workers, whether anticipated or mandated, seems to have ended too.…”