COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers

Abstract

Objective: To evaluate relationships between coronavirus disease 2019 (COVID-19)-related stress and work intentions in a sample of US health care workers.

Patients and methods: Between July 1 and December 31, 2020, health care workers were surveyed for fear of viral exposure or transmission, COVID-19-related anxiety or depression, work overload, burnout, and intentions to reduce hours or leave their jobs.

Results: Among 20,665 respondents at 124 institutions (median organizational response rate, 34%), intention to reduce hours was highest among nurses (33.7%; n=776), physicians (31.4%; n=2914), and advanced practice providers (APPs; 28.9%; n=608) while lowest among clerical staff (13.6%; n=242) and administrators (6.8%; n=50; all P<.001). Burnout (odds ratio [OR], 2.15; 95% CI, 1.93 to 2.38), fear of exposure, COVID-19-related anxiety/depression, and workload were independently related to intent to reduce work hours within 12 months (all P<.01). Intention to leave one's practice within 2 years was highest among nurses (40.0%; n=921), APPs (33.0%; n=694), other clinical staff (29.4%; n=718), and physicians (23.8%; n=2204) while lowest among administrators (12.6%; n=93; all P<.001). Burnout (OR, 2.57; 95% CI, 2.29 to 2.88), fear of exposure, COVID-19-related anxiety/depression, and workload were predictors of intent to leave. Feeling valued by one's organization was protective of reducing hours (OR, 0.65; 95% CI, 0.59 to 0.72) and intending to leave (OR, 0.40; 95% CI, 0.36 to 0.45; all P<.01).

Conclusion: Approximately 1 in 3 physicians, APPs, and nurses surveyed intend to reduce work hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether. Reducing burnout and improving a sense of feeling valued may allow health care organizations to better maintain their workforces postpandemic.

Keywords: AMA, American Medical Association; APP, advanced practice provider; IRB, Institutional Review Board; MAR/MCAR, missing at random vs missing completely at random; OR, odds ratio.

Figure 1

Work intentions of US health care workers by role and presence or absence of burnout (N=20,665). APP, advanced practice provider.

Figure 2

Relationship between burnout, feeling valued by one’s organization, and work intentions of US physicians, advanced practice providers (APPs), and nurses (N = 11,306). No burnout = “enjoy my work, no symptoms of burnout,” “under stress, less energy, but I don’t feel burned out.” Yes burnout = “beginning to burn out,” symptoms won’t go away,” “completely burned out.” No “feeling valued” = “not at all” or “somewhat.” Yes “feeling valued” = “moderately” or “to a great extent.”