Pandemic has had emotional, financial impact on cath lab workers
A survey of nurses and technologists who work in cardiac catheterization laboratories found high rates of decreased morale, mental distress and financial adversity as a result of the COVID-19 pandemic.
At the height of the pandemic in the spring, hospitals stopped performing elective procedures, including many nonurgent cath lab procedures such as PCI and transcatheter aortic valve replacement. In the current peak of the pandemic, hospitals have not stopped such procedures, but are trying to balance COVID-related safety considerations with the need to perform certain CV procedures.
“Rather than abruptly cease operations in the cath lab, we are trying to have a phased institution of cath lab volume based on the census of COVID,” Srihari S. Naidu, MD, director of the cath lab at Westchester Medical Center, professor of medicine at New York Medical College and president-elect of the New York chapter of the American College of Cardiology, told Healio. “The idea is to maintain elective volume in a safe fashion. We have learned that by halting all the operations in the cath lab, there is an increase in cardiovascular mortality because of our inability to take care of these patients in the real world.”
The researchers conducted a national online survey of 450 cath lab nurses and technologists (63% nurses; 78% women; mean age range, 41 to 50 years; 50% urban; 35% suburban; 15% rural) to determine whether the pandemic-induced changes to cath lab operations in the spring affected their workflow, responsibilities, financial status and mental health. They published their findings in the Journal of Invasive Cardiology.
The survey arose out of a commentary written by Bailey Ann Estes, BSN, registered nurse – first assistant in the cardiac cath lab at Hendrick Medical Center in Abilene, Texas, and communications chair of the Cardiovascular Teams Section of the ACC, on the impact of COVID-19 in the cath lab.
“It was important to provide perspective on how the pandemic has changed how we practice,” Estes told Healio. “Dr. Naidu wanted to bring a more personal nursing perspective into the discussion and to dive deeper into those issues, so we decided to construct a national survey to see what is going on at different labs across the country.”
Naidu told Healio that it was clear cath labs were handling the pandemic differently, “but it wasn’t clear which ways were going to be ideal. I had also seen there was a lot of depression and angst among all the workforce, but there had been nothing written about nurses and other workers in the cath lab, so I wanted to see if the changes implemented in the cath lab for COVID-19 impacted our front-line workers on a financial and emotional level, and whether there are ways to improve that.”
Among the cohort, 68% were the primary financial provider for their families and 74% worked in a cath lab that experienced a case volume decrease of more than 75% since the onset of the pandemic. The decrease in volume occurred despite many of the respondents working in institutions with a low percentage of patients with COVID-19; 54% of respondents said their institution’s inpatient COVID-19 census was less than 10%.
“I was not aware that the majority of workers in the cath lab were the primary breadwinner for their family, so any financial implications of COVID are going to hit them much harder,” Naidu said in an interview.
In other findings:
- 47% of respondents said they cared for patients with COVID-19;
- 45% of respondents said they were relocated;
- 42% of respondents who were part time or per diem said they were laid off or furloughed;
- 12% of respondents who were full time said they were laid off; and
- 65% of respondents said their work hours decreased.
“The majority had a decrease in work hours, which means the majority had a decrease in pay,” Naidu told Healio.
In addition, 96% of respondents reported a decline in morale in the cath lab during the pandemic, 53% said they felt they had inadequate support from hospital leadership/administration, 43% said they were concerned about exposure to COVID-19 and putting their families at risk, and 33% said they were concerned about job and financial loss.
Among emotional parameters, 80% of respondents reported they had anxiety/stress, 39% reported fear, 36% reported depression and 38% reported anger.
The researchers found the following were among the independent predictors of depression:
- relocation to provide care to patients with COVID-19 (OR = 4.71; 95% CI, 1.76-12.63; P < .01);
- increased stress/anxiety outside of work (OR = 3.42; 95% CI, 1.27-9.19; P = .02);
- working in an urban/metropolitan area (OR = 2.41; 95% CI, 1.15-5.02; P = .02);
- feeling scared to go to work (OR = 1.84; 95% CI, 1.07-3.17; P = .03);
- not feeling confident in ability to care for patients with COVID-19 (OR = 0.44; 95% CI, 0.24-0.81; P < .01);
- not feeling supported by administration/leadership (OR = 0.29; 95% CI, 0.176-0.5; P < .001); and
- per diem employment status (OR = 0.1; 95% CI, 0.01-0.95; P = .04.)
“Based on learning the predictors of depression, we have come up with a variety of things that make a lot of common sense,” Naidu told Healio. “If you don’t relocate people and you don’t decrease work hours, they are less depressed and less stressed. If you have them more prepared, give them more personal protective equipment and communicate with them, they are less depressed and less stressed. We also need to have services in place to recognize that there is an increase in anxiety, and maybe we should be putting more effort into mental health services at this time.”
Estes told Healio that from the nurses’ perspective, “the main problem has been inadequate communication between the staff and leadership. There is uncertainty about what is going on with work hours and relocation. There were a surprising number relocated to take care of patients with COVID-19 directly. We are a highly specialized staff that is not necessarily adequately trained or prepared to jump in and take care of infectious diseases.”
In the spring, no one was prepared for the pandemic, but now, applying lessons from the survey “can help hospitals prepare for spikes and do it in a healthy fashion,” Naidu said.
“There are ways to do elective procedures during the pandemic. We have been dipping our toes into same-day discharge and it is now becoming routine. Pretty much all PCIs should go home. Some TAVRs and patent foramen ovale closures should go home the same day. We make the same revenue whether we keep them one night or not, and we can pay our staff because we are doing these procedures. And of course, we need to let people know that we are still doing urgent cases, so they should come on in if they are having a heart attack.”
In addition, Naidu said, “all cath lab directors should have a meeting with their staffs after they read this paper, to say they recognize this is happening and to confirm we need better communication going forward about concerns and how to assuage them before another wave hits.”
For more information:
Bailey Ann Estes, BSN, can be reached at firstname.lastname@example.org.
Srihari S. Naidu, MD, can be reached at email@example.com.