15 June 2020 – Policy Brief
Epidemics and pandemics have enormous implications on healthcare systems, particularly on the healthcare workforce (1). While the SARS-CoV-2 pandemic poses a significant challenge for the entire healthcare workforce worldwide nursing staff (i.e. nurses, midwives, licensed practical nurses, nursing assistants, nursing students) are especially affected as they represent the largest group of frontline healthcare workers providing extended working hours in close proximity to patients. In all settings (e.g. hospitals, nursing homes and community care) SARS-CoV-2 poses unique occupational health challenges not only to provide a rapid and sustainable response but also to continue providing care to vulnerable populations (e.g. chronically ill, older or frail persons) irrespective of their SARS-CoV-2 status.
To maintain the healthcare workforce during this and future crises, it is crucial to provide healthcare worker’s with the right equipmentand appropriate training and to protect their physical and mental health. Healthcare workers are threatened not only by exposure to infectious diseases, but also by long working hours and reduced rest periods. As theyfall ill, their absence further exacerbates their colleagues’workloads consequently increasing their risks of infection. Moreover, staff shortages negatively impactquality of care, reduce patient safety and increase incidence of adverse events (e.g. medication errors).
Close surveillance and monitoring by testing for viral status is consequently of importance to keep the healthcare workforce safe. Another aspect is to provide enough and appropriate personal protective equipment (PPE). Swiss healthcare workers have reported inter-setting disparities in PPE availability with acute care hospitals havingmore stock, while community and long-term care facilities seem to be less well prepared. This does not only apply to equipment shortages but also a lack of knowledge in how to use the equipment properly or how to maintain standard infection prevention precautions. A recent study in Swiss nursing homes showed that only 52% of the institutions provided regular hand hygiene training (2). Access to infection control and expert knowledge is instrumental in implementing adequate measures into daily clinical practice and while this is available in larger Swiss hospitals, smaller hospitals, community and long-term care settings do not have adequateaccess to this expertise. Experiences during thefirst months of the disease outbreak in Switzerland have shown that not all healthcare workers had appropriate access to PPE and that not all had sufficient know-how to respond to an emerging infectious disease, such as SARS-CoV-2. This know-how is rapidly evolving and available at Swiss university hospitals. Currently, resources, particularly in cantonal public health units, university hospitals, larger hospitals and in higher education organisations, are not yet sufficient to disseminate and implement this know-how rapidly across all 281 hospitals, 1’566 nursing homes and more than 600 home care organisations. Cantons and the Federal Office of Public Health are responsible not only to coordinate, but also to seek ways to provide resources for hospitals and higher education organisations to distribute this highly specialised know-how and to provide training opportunities in appropriate volume.
It needs to be highlighted that the SARS-CoV-2 pandemic does not only threaten the physical but also the psychosocial health of the healthcare workforce. For example, a recent online survey of 553 nurses and 857 physicians in Switzerland found that less perceived support by the employer was associated with higher anxiety and burnout (3). Thisstudy is in line with previous evidence showing serious implications for the workforce and on the health care systems ability to deliver care at a time of heightened need and thereafter (4). Psychosocial health issues are associated with physical health risks of pandemics and thus contribute to the vicious cycle of sickness absence, workforce shortages, and risks of adverse events, as described above. Supporting not only the physical but also the psychosocial health of healthcare workers and developing appropriate multilevel measures to support them are thus essential for policymakers, executive managers and nurse leaders.
Recommendations (on the federal, cantonal level):
- Take responsibility – including organizational and financiallysupport – to ensure that all healthcare workers are proactively informed about the latest infection control practices and necessary measures of the SARS-CoV-2 outbreak. Cantons provide the financial means, decide on the organization and structure responsible for roling out such measures.
- Aligned with recommendations of centers of expertise, provide PPE and additional specialized staff resources for infection control training and consultations for all healthcare settings according to legal requirements (EpG Art.35-3) and the needs of the different settings.
- Closely monitor Covid-19 and mortality rates among healthcare workers in all health care settings
- Monitor healthcare workers’mental health and develop appropriate support
- Involve community and long-term care representatives systematically in pandemic emergency task forces of cantons and communities