Katelyn N. Hedrick, MA, Clemson University; Phoebe Xoxakos, MS, Clemson University; Riley L. McCallus, MA, Clemson University; Jordan G. Smith, MS, Clemson University; Emily L. Hirsh, MD, FACEP, Department of Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville; Zachary Klinefelter, PhD, Clemson University; William H. Jackson, MD, MBA, Department of Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville; Ronald G. Pirrallo, MD, MHSA, Department of Emergency Medicine, Prisma Health, Clemson University School of Health Research, University of South Carolina School of Medicine Greenville; Cassie B. Mueller, MSN, Department of Emergency Medicine, Prisma Health; Thomas W. Britt, PhD, Clemson University; Marissa L. Shuffler, PhD, Clemson University
Purpose/Objectives
Our research seeks to broadly understand the job demands that attending physicians and registered nurses are experiencing during the COVID-19 pandemic. Once we have developed a deeper understanding of these job demands, we will examine whether there are specific job demands faced by only attendings or registered nurses and what these role specific job demands are. Next our research seeks to understand the specific organizational resources that attendings and registered nurses need inside the workplace to combat increased job demands and whether they differ on needed resources.
Background
During times of crisis such as COVID-19, it is important to understand the job demands and specific organizational resources that various roles require within the hospital. According to the 2017 National Nursing Workforce Survey, there are over 3.8 million registered nurses in the United States (Rosseter, 2019; Smiley et al., 2017), with a projected 200,000 jobs opening yearly between 2016 and 2026 (Torpey, 2018). Furthermore, nurses represent the largest percentage of healthcare workers in the industry. Despite this, there is little research to the authors’ knowledge on the resources and support that can best assist nurses during times of crises (French et al., 2002; Liu et al., 2018). It is essential that we begin bridging this gap, as prior research has demonstrated that various medical specialties suffer from burnout at different rates due to different job demands and resources (West et al., 2018). As such, our research seeks to longitudinally examine qualitative responses from attending physicians and registered nurses to develop recommendations on how hospital leadership can best assist both physicians and registered nurses during times of crises.
Methods
Emergency Department clinicians (i.e., attendings and RNs) currently employed by a hospital system located within the southeastern United States were invited to participate in this study. Specifically, the survey was sent to six hospitals and their associated urgent care facilities within this system. The first survey was distributed in March 2020, as COVID-19 began to impact the southeastern United States. Hospital leadership and the research team decided to survey clinicians weekly for the first six weeks and then met to reevaluate the frequency of the survey. After April 2020, leadership and researchers decided to switch to monthly data collection in response to the stabilization of patient numbers and to reduce participant fatigue. Monthly data collection began in May 2020 and is ongoing. To recruit participants, an email was sent to the Emergency Department clinicians on Tuesday with a reminder email sent on Thursday or when a lag in responses was noticed by the lead researcher. The survey was open for 4 days to provide clinicians with enough time to complete the survey despite their busy work schedules. Attending physicians were invited to participate throughout the entire study, while registered nurses were invited during the 9th wave (July 2020) of data collection. Currently, we have collected over 7,000 open-ended responses from 129 attending physicians and 258 registered nurses.
An adaptive survey technique was used for the qualitative response questions to allow the researchers to better understand and respond to the rapidly changing clinical environment during COVID-19. To accomplish this, each month the research team met with hospital leadership to discuss necessary survey changes. These decisions were informed both by previous waves of data collection and leadership’s technical expertise of the clinical work environment. While an extensive list of questions is outside of the scope of this abstract, topics for questions typically include personal concerns, coping strategies, support needed from leadership, and work-related concerns (e.g., scheduling, staffing, medication shortages, and supply shortages).
Findings
The research team utilized an iterative process to develop a coding scheme of job demands and resources to present survey results to hospital leadership after each wave of data collection. Preliminary analyses have identified several job demands that are shared across clinicians, including but not limited to a shortage of staff, schedule issues, high patient volume and acuity, and bed holds. If this submission is accepted, further details will be provided on the job demands and resources needed for support. Furthermore, we will provide recommendations based on (1) the final results, (2) the in-depth literature review, and (3) further conversations with subject matter experts.
Discussion
This research has the opportunity to bridge the gap in the hospital industry’s understanding of how to best assist registered nurses, a historically underrepresented group during times of crisis (French et al., 2002; Liu et al., 2018).
Conclusions
Future research should continue to examine the resources that can best support registered nurses and other historically under researched groups.