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One year into COVID: How are healthcare employees holding up?

None of us will forget what it was like to live through the era of COVID-19. But the healthcare workforce has felt the strains of the pandemic much more acutely than the rest of us.

Long shifts, scarce resources, mortalities among the ranks—it all added up to the most distressing period of their careers. Ask many of them, even those with non-clinical roles, and they’ll say it felt like a war.

Such stressful times, however, are also precisely the moments when health organizations need their workers the most. Never in the last hundred years has it been more important to protect the welfare of healthcare employees, both physically and psychologically.

How can healthcare leaders do that? What does the data suggest about the best way to preserve staff morale, even in the midst of a crisis?

Nolan Miller, MISOP, NRC Health’s solutions expert on workforce engagement, is here to shed some light on these questions.

Here are a few important datapoints that Miller believes healthcare leadership should bear in mind.

Remarkable resilience at work

Miller draws his observations from a broad survey of nearly 90,000 healthcare workers, working with a host of NRC Health partners in a variety of care settings. He paid especially close attention to benchmark engagement measures taken in 2019, compared to 2020—giving us a reasonably accurate snapshot of employees’ sentiments before the pandemic began, and while they were in the thick of it.

His first observation? “Leaders might be surprised at the stability of employee morale over this period,” Miller says.

While some responses certainly declined—there was, naturally, a sharp drop in positive responses to items like, “I have fun at work”—many overall measures stayed the same, or even improved, from late 2019 to late 2020.

Employees who reported “having great pride in my job,” for example, hovered near the same benchmark—from 93% in 2019, to 92.5% in  2020.

Responses to the prompt, “I love coming to work every day” tell a similar story, holding steady at 71.9% through both 2019 and 2020.

I love coming to work every day. 71.9 71.9
I have great pride in my job. 93 92.5


Where 0 is the worst possible place to work and 10 is the best possible place to work, how would you rate this organization as a place to work? 34.4 34.6

These are promising indications for the industry at large. But Miller is careful to emphasize that these steady numbers are not universal.

“The stresses and impact of COVID were not evenly distributed across the country,” he says. “Some organizations were hit much harder than others. Nobody should feel like they’re doing something wrong if their positive responses are declining. Most of the time, that just reflects how the crisis unfolded in their communities.”

Being there for each other

At first blush, these figures might seem to contradict a mainstream narrative about the pandemic: that it is an exhausting trial, one that leaves healthcare workers depleted and demoralized. If these workers still “love coming to work every day,” can the damage be so severe?

Miller urges caution before coming to such a conclusion.

“It’s not that the pandemic isn’t profoundly affecting these workers,” he says. “Instead, what the data shows is that they have found effective tools to cope with it.”

This is most obvious when we consider which workforce engagement measures have improved over the course of the pandemic.

For instance, positive responses to the prompt, “Communication among the people that I work with is never a problem” went from 47.1% in 2019 to 48.9% in 2020.

Likewise, a greater proportion of workers agreed that they had good relationships with their coworkers: 85.8% said so in 2019, versus 86.8% in 2020.

The quality of relationships even extended beyond the four walls of the healthcare facility. In 2019, 62.7% of workers agreed with the statement, “I have friendships with my work colleagues outside of the workplace”—compared with 64.7% in 2020.

Finally, employees also reported an uptick in their own active support for their colleagues. Responses to, “I look for opportunities to support my coworkers” went from 94.2% in 2019 to 94.4% in 2020.

Together, these trends are very telling. They suggest that healthcare workers have found a social remedy for the travails of work in the time of COVID-19.

“The data’s pretty clear in showing how they’re taking support from each other,” Miller says. “That sense of social support is likely a huge driver of what’s keeping morale so stable.”

The affect shift phenomenon

According to Miller, however, there may also be another force at play.

“We can’t discount the possible effects of the affect shift phenomenon,” he says.

An affect shift can happen when a crisis event impacts the workplace. In such an environment, workers look to their organizations to set the tone for their response.

If an organization flounders, cynicism and detachment can assail the workforce. But if organizational leaders can find a constructive and supportive response to the crisis, workforce engagement tends to improve—becoming even better than if there were no crisis in the first place.

“Many organizations have found very empathic, thoughtful responses to life under the pandemic,” Miller says. “And our preliminary data suggests that these structural improvements have helped workers stay engaged.”

This is most visible in the ways that employees evaluate their overall workplace environment.

For instance, in 2019, 72.3% of employees agreed that “My work environment inspires me to perform at my very best.” That measure in 2020? 72.4%.

Similarly, more workers reported feeling well-equipped to handle their jobs. Responses to, “I have the equipment I need to provide the best possible patient care” went from 66.1% in 2019 to 66.8% in 2020.

“The most important place to watch for a positive affect shift is in employees’ relationships with their supervisors,” Miller says. “That is one of the most important correlations for overall workplace engagement.”

Here too, the data is heartening. Positive responses to, “I have benefited from a one-on-one relationship with my supervisor,” for example, ticked up from 70% in 2019 to 71.9% in 2020, as did responses to, “the person I report to creates opportunities for professional growth,” which increased from 66.3% in 2019 to 68.5% in 2020.

Always room to improve

In all, Miller believes that healthcare leaders should take pride in how well they’ve cared for their employees.

“None of this just happens,” he says. “It’s not an accident that these organizations have such positive cultures that can respond in such a helpful way to a really horrible crisis.”

That said, however, Miller is confident most leaders would agree that this is no time to rest on their laurels. The COVID-19 crisis is ongoing, and other stressful times may be ahead—so it’s always good to be prepared.

“Even if scores are going up, that doesn’t mean you’re completely insulated from burnout,” Miller says. “There’s always a risk. And every organization should be thinking about ways to support their exhausted staff members, regardless of the trend lines.”

To that end, taking the time to truly understand employees, using a data-based approach to engagement, will go a long way toward informing an effective engagement strategy.

“Long-term, it’s that understanding that’s going to keep healthcare workers in the fold,” Miller says.