Introduction
“In a medical crisis, my job is to manage a clinical team, problem-solve and be in control. It is hard to admit that I feel vulnerable and scared…But I am admitting it because you need to know how close health care workers are to breaking.”Emergency Medicine Physician, Arizona
Materials and methods
Study sample and data collection
Statistical analysis
Results
Descriptive statistics of sample
Full Sample (n = 288) | Sample of providers affected by feelings of stress, anxiety or depression (n = 187) | χ2 comparison of sample that did versus did not report increased stress/anxiety/depression | |||
---|---|---|---|---|---|
n | % | n | % | ||
Sex, n (%) | |||||
Female | 251 | 94 | 168 | 92 | χ2 = 3.10 |
Male | 14 | 5 | 12 | 7 | p = 0.21 |
Other/non-binary | 2 | 1 | 2 | 1 | |
Age (mean ± SD) | 46.4 ± 11.5 | 46.0 ± 11.4 | t-stat = 0.92, p=0.36 | ||
Race/ethnicity, n (%) | |||||
White | 165 | 62 | 113 | 62 | χ2 = 8.38 |
Black | 29 | 11 | 14 | 8 | p = 0.14 |
Hispanic/Latinx | 40 | 15 | 30 | 16 | |
Asian/Pacific Islander | 26 | 10 | 19 | 10 | |
Native American | 4 | 2 | 4 | 2 | |
Other | 3 | 1 | 2 | 1 | |
Provider type, n (%) | |||||
Physician | 44 | 16 | 32 | 18 | χ2 = 16.39 |
Physician’s Assistant | 14 | 5 | 8 | 4 | p = 0.06 |
Nurse Practitioner/ Certified Nurse Midwife | 82 | 30 | 53 | 29 | |
Registered Nurse | 61 | 23 | 34 | 19 | |
Other Nurse | 7 | 3 | 6 | 3 | |
Medical Assistant | 11 | 4 | 7 | 4 | |
Health Educator/Social worker | 7 | 3 | 6 | 3 | |
Manager/Director | 24 | 9 | 20 | 11 | |
Administrative staff | 17 | 6 | 15 | 8 | |
Student | 3 | 1 | 1 | 1 | |
Education, n (%) | |||||
High school, GED, technical or vocational | 13 | 5 | 9 | 5 | χ2 = 0.40 |
Two-year college degree | 21 | 8 | 13 | 7 | p = 0.98 |
Four-year college degree | 61 | 23 | 43 | 24 | |
Graduate or professional | 163 | 61 | 111 | 61 | |
Other | 8 | 3 | 6 | 3 | |
Practice setting, n (%) | |||||
Primary care/Heath department | 123 | 43 | 83 | 45 | χ2 = 1.52 |
Family planning/abortion clinics | 97 | 34 | 58 | 32 | p = 0.68 |
Youth/student clinics | 52 | 18 | 35 | 19 | |
Hospital/Other | 16 | 6 | 9 | 5 | |
Region, n (%) | |||||
Northeast | 35 | 12 | 21 | 11 | χ2 = 5.2723 |
Midwest | 26 | 9 | 17 | 9 | p = 0.260 |
Southeast | 90 | 31 | 49 | 26 | |
Southwest | 76 | 26 | 38 | 26 | |
West | 69 | 23 | 52 | 28 |
n | % | |
---|---|---|
Sample = all providers (n = 288) | ||
In what ways have you as a provider been affected by COVID-19? | ||
Stress | 184 | 66 |
Anxiety or depression | 96 | 35 |
Fear of going to clinic or getting sick | 110 | 40 |
Shift towards providing COVID-19 related care | 113 | 41 |
Shift towards administrative work (adjusting protocols, time in meetings) | 114 | 41 |
Shift away from sexual and reproductive health services | 72 | 26 |
Absenteeism (due to own illness, family illness, school closures) | 43 | 16 |
Decreased staff hours | 72 | 26 |
Increased staff hours | 36 | 13 |
Sample = providers who were affected by stress, anxiety or depression (n = 187) | ||
Current status of clinic (at time of survey) | ||
Closed completely | 3 | 2 |
Closed on-site but providing services through telehealth | 35 | 19 |
Open on-site and providing services through telehealth | 109 | 58 |
Open on-site but not providing services through telehealth | 40 | 21 |
Current status of stay-at-home orders (at time of survey) | ||
Stay-at-home/ shelter-in-place order | 40 | 22 |
Re-opening with restrictions | 135 | 75 |
Completely open | 5 | 3 |
Patient care
“I hate for a client to not know [if] they can still come see or call us. We are here for them still.” Clinic Manager, Family Planning Clinic, Tennessee
“Concern for so much focus on COVID-19 leading to worsening of other health conditions.”Physician Assistant, County Health Department, North Carolina
Sudden increase in responsibilities due to COVID-19 related care
“Increased workload, little sleep, urgent changes, and ever-changing needs.”Clinic Manager, Family Planning Clinic, Virginia
“Majority of our staff are assisting at the COVID drive-thru testing centers but weekly we are testing approximately 300 people in a four-hour span. It is hot, we are worn out. Then [we] are calling all of the positive and also doing the contract tracing and mailing every person that gets tested a copy of their result, positive or negative…We no longer have volunteers assisting us…[W]e are managing our normal daily routines of answering the phone calls, rescheduling patients that were scheduled prior to COVID that have to be changed to telemedicine visits.”Registered Nurse, Family Planning Clinic, Louisiana
Changing clinical guidelines and protocols
“More worry and concern; the unknown. Changes daily. This is going to be the new ‘normal’. Not looking forward to how medicine will be done in future.”Nurse Practitioner, Youth/Student Health Center, Oregon
“I work in leadership, and I need to lead very unpopular changes that I myself don’t agree with.”Internal Medicine Physician, Primary Care Clinic, Minnesota
Telehealth visits
“Fear of missing diagnoses due to telehealth or attention distracted by COVID-19.”Physician Assistant, Primary Care Clinic, North Carolina
Anxiety about COVID-19 among patients and staff
“Responsibility to present a calm and supportive environment to patients and staff causes a repression of your own stress. This is exhausting… I have depleted my emotional reserves calming others.”Clinic Manager, Primary Care Clinic, New Mexico
Worry about COVID-19 infection and/or infecting family
“Always wondering if this is the day that I get the virus.”Counselor/Health Educator, Family Planning Clinic, Pennsylvania
Financial and employment concerns
“I feel that our administration does not care about patients or quality of care, and that my hard work is not valued in the least. I might be fired like many colleagues at any moment, by text or phone, and I have dedicated my career to serving others through health care, particularly to those marginalized.”Certified Nurse Midwife, Primary Care Clinic, New Mexico
Home-related concerns including childcare
“Home all the time working full time and homeschooling 3 children.”Family Practice Physician, Primary Care Clinic, California
Provider distress and burnout
“I can’t explain it- it’s horrible.”Registered Nurse, Family Planning Clinic, Tennessee
“Feeling overwhelmed, stressed, unsure of what is right or wrong. Don't want to come to work. Feeling down and don't feel like I have support.”Nurse Practitioner, School-based Health Center, Oregon
“I wake up in the middle of the night worrying about COVID.”Registered Nurse, Family Planning Clinic, Louisiana
“Stuck alone in an office all day with little to no patient interaction.”Registered Nurse, Family Planning Clinic, Georgia
Fear of the unknown
“The unknown always causes anxiety. When will our operations go back to normal? Will there be another spike and will we have to close again?”Clinic Manager/Director, Family Planning Clinic, Montana