The responsibility to care: lessons learned from emergency department workers’ perspectives during the first wave of the COVID-19 pandemic in Canada

Abstract

Background This study’s objective was to examine emergency department (ED) workers’ perspectives during the Canadian COVID-19 first wave. Methods This qualitative study included workers from nine Canadian EDs who participated in 3 monthly video focus groups between April and July 2020 to explore (1) personal/professional experiences, (2) patient care and ED work, (3) relationships with teams, institutions and governing bodies. Framework analysis informed data collection and analysis. Results Thirty-six focus groups and 15 interviews were conducted with 53 participants (including 24 physicians, 16 nurses). Median age was 37.5 years, 51% were female, 79% had more than 5 years’ experience. Three main themes emerged. (1) Early in this pandemic, participants felt a responsibility to provide care to patients and solidarity toward their ED colleagues and team, while balancing many risks with their personal protection. (2) ED teams wanted to be engaged in decision-making, based on the best available scientific knowledge. Institutional decisions and clinical guidelines needed to be adapted to the specificity of each ED environment. (3) Working during the pandemic created new sources of moral distress and fatigue, including difficult clinical practices, distance with patients and families, frequent changes in information and added sources of fatigue. Although participants quickly adapted to a “new normal”, they were concerned about long-term burnout. Participants who experienced high numbers of patient deaths felt especially unprepared. Interpretation ED workers believe they have a responsibility to provide care through a pandemic. Trust in leadership is supported by managers who are present and responsive, transparent in their communication, and involve ED staff in the development and practice of policies and procedures. Such practices will help protect from burnout and ensure the workforce’s long-term sustainability. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00306-z.

“The Cost in the Individual”

“…This supports previous research, which found that organization-directed interventions were more impactful compared with individual-directed interventions. 33,34 Targeting burnout at the individual level was inadequate: only 5% of physicians who had negative emotions related to work sought mental health support, 19 and significant cultural barriers existed. 35 Organizational structure and lack of organizational support were key drivers of burnout.…”

Frontline Physician Perspectives on Their Experiences Working During the First Wave of the COVID-19 Pandemic

“…Others have reported significant increases in morale because of a sense that safety and physical and mental well-being is a priority in their department and institution. 23 Effective communication is a factor within the control of institutional leaders, and can enhance trust, 24 which is directly related to employee compliance. 25 Open, honest, frequent communication has been shown to enhance morale, 22,25,26 and is corroborated by our study in the context of a catastrophic pandemic.…”

“…Effective communication is bi-directional 22 ; clinical teams want to be engaged in decision-making. 6,24 Engagement of stakeholders during the COVID pandemic has contributed to bioethics policy for scarce resource allocation, 27 and successful program initiatives for healthcare delivery and community engagement within this crisis. 26 Intentional consideration of stakeholders from all specialties affected is important as well.…”

The Emergency Medicine Resident Retreat: Creating and Sustaining a Transformative and Reflective Experience

“…In a recent survey, emergency medicine has shifted to become the specialty with the highest degree of burnout [13]. Many healthcare leaders attribute such a high rate to the working conditions and risks of the COVID-19 pandemic [14][15][16], which has undoubtedly also impacted the experience and wellness of trainees. This sustainable retreat program has demonstrated success with resident satisfaction and is the first report in the literature for emergency medicine.…”