Willingness to work questioned amid PPE shortage

Difficulty accessing personal protective equipment (PPE) is forcing healthcare workers on the front line to question their willingness to work during the COVID-19 pandemic, according to ongoing research conducted by Edith Cowan University (ECU).

Associate Professor Erin Smith and Dr Brennen Mills from ECU’s School of Medical and Health Sciences have released preliminary data from a national survey asking healthcare workers about the issues they are confronting while trying to do their jobs on the front line.

More than 350 doctors, nurses and paramedics have completed the survey, with around half of all participants reporting a lack of access to the PPE needed to do their jobs safely.

“Doctors were more likely to report lack of access to PPE compared to paramedics and nurses,” Assoc Prof Smith said, “with face masks, face shields, gowns and hand sanitiser being the types of PPE most often in short supply.”

PPE in short supply

Nearly 70% of participants reported that they had been asked to ration their use of PPE and around 30% said that colleagues had resorted to using non-traditional or non-vetted forms of PPE in order to protect themselves.

“Just over 20% of all participants reported being tested for COVID-19 and 30% have chosen to physically isolate themselves from other members of their household, including sleeping in different bedrooms or moving out of the family home in an attempt to protect loved ones,” Assoc Prof Smith said.

“We found 17% of participants had undergone a period of self-isolation due to work-based exposure to COVID-19. Doctors were more likely to do this than paramedics or nurses.”

Concern for others

Survey participants were more concerned about being exposed to COVID-19 at work compared with outside of work and 61% were concerned that they would personally become infected with COVID-19. Frontline healthcare workers were also very concerned about their colleagues, with 77% reporting they were concerned that their colleagues would be infected.

Nurses were more concerned than paramedics about personally being infected, more concerned that their colleagues would be infected, and more concerned that they would expose their patients to the virus. Doctors were also more concerned than paramedics that they would expose their patients to COVID-19.

The survey highlights that one of the biggest concerns for frontline healthcare workers is the health and wellbeing of their loved ones, particularly those within their immediate households.

“81% of participants suggested they were concerned about exposing their family members to the virus. For 41%, this concern was rated as ‘extreme’,” Assoc Prof Smith said.

“They are worried that by doing their jobs, they could potentially go home and infect their loved ones. And they have every right to be concerned, with the thousands of healthcare workers around the world infected and hundreds dead.”

A difficult choice

Assoc Prof Smith said the findings highlight an ethical dilemma — at what point does the risk to personal safety and concern for loved ones begin to outweigh the desire to work? It appears that for many on the front line, this difficult decision is already being considered.

Almost 80% of participants have started weighing their professional obligation (‘I should work’) with personal risk (‘I could get infected, I could infect my family’) and around 60% said they were less willing to work now than usual.

Doctors and nurses were more likely to report an impact on willingness to work at this time compared with paramedics, potentially reflecting the greater difficulties experienced within hospitals and general practice clinics in accessing PPE compared with the emergency pre-hospital environment.

The lack of access to PPE was strongly associated with levels of anxiety and stress, particularly for doctors and nurses. It was also directly related to how safe they felt doing their job, with 80% of healthcare workers feeling less safe at work than before COVID-19.

“Along with feeling unsafe, healthcare workers are also worried that their workplace has insufficient PPE to protect staff, especially if there were to be a surge in patients,” said Assoc Prof Smith.

“Three quarters of participants were concerned about this, and we saw this reported across doctors, nurses and paramedics.”

Communication is key

In terms of support for frontline healthcare workers, around half of all participants believed that their workplace was failing to do everything possible to protect them at the present time. Doctors were more concerned in this regard than nurses and paramedics.

Communication was a major contributing factor, with 40% being dissatisfied with the way employers had communicated to date.

“There were clear concerns regarding the perceived transparency and timeliness of communications from employers, particularly around PPE,” Assoc Prof Smith said.

“Our frontline workers need to know how much PPE there is and when they are likely to run out, and what we are hearing is that this clear information is not coming.”

Paramedics were more likely to be dissatisfied with communication from their employers than doctors and nurses but were less likely than doctors and nurses to report that access to PPE had negatively impacted their willingness to work.

“These results are important as they paint a clear picture of frontline troops in the war against COVID-19 [that] are struggling to access the PPE they need to protect themselves,” Assoc Prof Smith said.

“This is ultimately forcing them to make the difficult decision about whether they continue working or not.”

Healthcare workers across Australia are invited to share their experiences through the ongoing survey.

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