The understanding of frontline HCPs’ experiences of balancing work life and family life during the COVID-19 pandemic are described in three themes: 1) Readiness for change, 2) A sense of being abandoned among family, and 3) Opposing feelings about being a part of something bigger. In the following, these themes will be illuminated in-depth one by one.
Readiness for change
The participating HCPs described how they were forced by the acute outbreak to be ready for changes. A sense of having a say as well as having the opportunity of choosing to work in COVID-19 wards was crucial for their readiness for change and motivation to work at short notice. While some HCPs found it natural to be part of the frontline, others felt pressured to do so and described feelings of being deprived of the right to choose whether they wanted to work in a specialized COVID-19 ward or not.
I have not signed up to work in the COVID ward…. She [the boss] called and said that she had been instructed to find three [HCPs for the COVID-19 ward], and she had half an hour to do that. She was a little panicked and I could hear the hidden: “we are counting on you” in her voice. She also said that two others already had agreed to the task, so they just needed me.
This involuntary pressure experienced by the HCPs pushed them to be ready for changes. For some HCPs this push meant they were growing and felt important and ready for the changes while for others it had a negative impact on their professional identity and job satisfaction. Not only a readiness for changing working environments and physical sites were expressed by the HCPs but also a readiness for facing a novel and unknown coronavirus was dominating their narratives. They described how they had to be ready for something they did not know about and as such did not know how to prepare for. To be ready for something unknown was approached with a certain variation in motivation from the HCPs. An important factor for the individual’s motivation and readiness to face the more or less unknown working conditions was highlighted as being involved in decisions about expected tasks and responsibilities. Furthermore, perceptions of being heard and invited to reflect on possible consequences of agreeing to be caring for and treating patients with COVID-19 infection was expressed as paramount for the participating HCPs’ readiness for changes.
I received an email from my manager late at night, where she asked if I wanted to join
[the COVID contingency], but I did not see it [the e-mail]. So, when I came to work the next morning, she [the manager] was ready before I even met and asked if she could count on me.
The consequences of not being able to reflect and discuss possible interventions and potential fears related to one’s own family life filled the HCPs with mixed feelings of, on the one hand, an obligation to be ready while it, on the other hand, was difficult to see and think through the possible interferences in one’s own life and family. A prominent described threat to the HCPs’ readiness for changes was the potential threat to their own as well as their family’s health. The participating HCPs expressed their experiences of a previously unknown uncertainty in how to balance their working obligations and readiness to be on the front in the care and treatment of patients with COVID-19 and their family life. Suddenly they feared for their own health but also extensive concerns about bringing COVID-19 home to their families was illuminated. This fear was for some of the HCPs faced and placed in the background of their consciousness; while others carried the fear with them as a burden, influencing their readiness. These HCPs did, however, try to divert the fear and do their job: “I try not to stress over things that I can’t influence. If it comes [being infected and bringing illness home], then I will do my best”.
From being an expert in one’s own field to a novice in a new department was associated with uncertainties with having to balance a new way of being a professional. Despite uncertainty about caring for and treating patients with COVID-19, cohesion among the HCPs was highlighted. They described how every HCP contributed with their knowledge and skills leading to a sense of professional pride and common goals and direction. A strong metaphor of being in a war together and stepping in when your help was needed was pervasive in the HCPs’ narratives: ”It was like being at war ... You could say that we were the soldiers that were going to be in the front”. This readiness for stepping in did, however, have consequences and required changes and flexibility at home. Changes in working hours and variety of shifts had a substantial impact on family life and, thereby, the work life balance. Despite these challenges in balancing working life and family life, experiences of this very special team spirit providing an extraordinary effort in the fight against COVID-19 were pointed out as being worth it. Although it was mentally exhausting being surrounded by colleagues you did not know in advance, it was also experienced as a great strength to work with colleagues from different specialties with a mutual goal of making an effort of helping out in a situation associated with multiple challenges for the involved individuals: "This has been the best thing I have experienced in my career. Seeing nurses who stopped working three, five and ten years ago come in and say: I want to help”. This perceived community and the experience that everyone contributed with each their professionalism and enthusiasm was of great importance for the individual HCPs’ readiness for change: “The best thing about being part of this process was those people…, they ignored the obstacles that there usually are… It was people that just made things happen”.
A sense of being abandoned among family
HCPs working frontline taking care of and treating patients with COVID-19 described ambiguous experiences of being abandoned among family and friends due to the risk of infection through their work. The very real possibility of the HCPs becoming infected and catching COVID-19 due to close contact with infected patients raised concerns from their families who began regarding them as potentially poisonous from whom one should distance themselves.
He [son] didn’t want to be near me; not only because he himself could be infected, but he was also afraid of infecting others. He wished that his mother could be without it [the frontline care and treatment for COVID-19 patients].
Experiences of family members keeping extra distance thus permeated the stories of the HCPs and such experiences became ordinary daily events when meeting others. In the HCPs’ daily life and surroundings, they felt isolated from usual social contact with close family and descriptions of relatives moving out of the shared home in fear of being infected were illuminated.
My sister, her husband and my two-year-old niece said they were isolating themselves from me. My boyfriend lived with others and said I should not visit him there while working so closely with corona patients. There were several who withdrew from me [in social surroundings].
The consequences for the family life of HCPs working forefront in the COVID-19 departments thus led to feelings of being abandoned. Further consequences concerning the children of the HCPs were also described. All of a sudden, their children did not get invited to playdates and some of their usual friends were not allowed to play with children of HCPs. The social consequences for the HCPs’ children was expressed as a very high price to pay in order to meet their obligations of caring for and treating patients with COVID-19 and experiences of stigma was also expressed in the stories.
The HCPs did, however, also take precautions and distanced themselves from their family where possible: “I was not nervous for myself [as a HCP] getting infected, but for me to infect my family. That is why we [HCP and spouse] kept our distance from our family. We were completely isolated; we were only being with ourselves”. This contrast between being abandoned by one’s family and the voluntary distancing and isolation from friends and family was expressed as an important factor in the work life and family life balance. This balance could easily be disturbed if feelings of being abandoned by family and friends dominated, leading to a sense of doubt about if the frontline work and obligations were worth it. However, the voluntary distance to their family contributed to the HCPs’ working identity and helped maintain the balance between work and family in a way that felt trustworthy for themselves.
Although the feeling of being distanced from the family could either be characterized by fear and stigma from the social environment, the HCPs understood very well this distance. Uncertainties about the novel coronavirus contributed to awareness among the HCPs about selecting when and with whom to interact socially. Likewise, the participating HCPs experienced a great deal of concern from their loved ones due to their potential risk of getting infected with COVID-19 combined with respect towards them due to working in the forefront in the care and treatment of patients with COVID-19 and thereby risking their own safety.
Opposing feelings about being a part of something bigger
The HCPs described how they experienced a tension marked by opposing feelings that could be difficult to deal with. On the one hand, they talked about how they wanted to be part of the fight against COVID-19 and make a difference for the sick patients in the worldwide pandemic, while at the same time experiencing a work life full of insecurity. Their stories illuminated how thinking about being a part of something bigger contributed to a fighting spirit and professional pride. These feelings did, however, for some HCPs, fade away when actually working in the department caring for and treating the COVID-19 patients.
In contrast to the imagined expectations of being part of a bigger contingency - namely a team of professionals fighting an unknown virus - insecurity and ambivalent feelings of not wanting to quit their usual jobs and letting something unfamiliar and unknown impact their family life was illuminated in the HCPs’ narratives.
It was frustrating to quit my regular job and then suddenly have to do something completely different. At the same time, it was an extraordinary situation that no one had tried before. So of course, I also felt that I had to step in and help. But I had an ambivalent feeling about it. Basically, I would probably have preferred not to be a part of it.
An overwhelming sense of frustration due to putting their own work on hold with an uncertain time horizon without knowing when to resume was described as particularly important for the HCPs’ adaptability of working frontline caring and treating for patients with COVID-19. The fact that the participating HCPs did not know when to resume their regular job had an impact on their motivation for doing their work and participating in the COVID-19 contingency. The HCPs also described how conditions such as working hours and shifts as well as tasks constantly changed leading to a sense of unpredictability and exhaustion. Tasks that exceeded one’s competencies proved especially discouraging. Such challenges were difficult to deal with and the HCPs had an urgent need for sharing these with someone. When the HCPs experienced being listened to by a colleague or their closest manager, they described how they felt a relief. This relief was expressed if the listening led to a balance between what expectations were placed on them and the skills they had, but also when the flexibility that the individual HCP had in relation to their family life was recognized. So, when sharing frustrations and uncertainties about working life, a balance with family life could be maintained for the HCPs, however, experiences of being left to oneself had a negative impact on their family life in which the HCPs had to place their frustrations.
Despite the possible overwhelming experience of being on the front in a pandemic, the HCPs also described how being part of a professional setup that really worked and where everyone took an active part and were responsible, dedicated and motivated gave a feeling of being part of something bigger. The participating HCPs related how everyone helped where they could and did their very best and how being a part of this big picture gave a sense of professional pride: “As a nurse, I should not sit in my PhD office. You became a nurse, because you want to help when there is a need, and there was a need, and therefore I liked to join”. This relief was about balancing the expectations they had and the skills they had, but also the flexibility that the individual had in relation to their family life. A sense of agreement among the HCPs was illuminated in their narratives and they described how they experienced almost never being denied help from colleagues and how everybody focused on helping each other. This helping community was particularly significant for performing in this extraordinary situation. Furthermore, this community and feelings of being part of something bigger led to a special vigilance among the HCPs and their well-being which was important for balancing work life and family life. Feelings of being part of something bigger thus outweighed the possible negative consequences for the family life.
Although the HCPs described the importance of being part of something bigger, they also talked about opposing feelings on the way to their first day of work when they had to meet, care for and treat their first patient with COVID-19. Their stories illuminated how their motivation to contribute with their knowledge and skills could be overshadowed by fear of the uncertain and unknown, and how the risk of getting infected themselves or infecting their family and friends were in the foreground of their consciousness in the beginning.
Before the first shift I was sitting in the car wondering if I was scared, even though I knew the isolation regimen. We [as HCPs] end up getting infected ourselves… So, I had such a thought on the way into [the hospital] about what this [COVID-19] was, for nobody knew what it was and how dangerous it really was.
These thoughts of how dangerous the disease might be was most prevalent in the beginning of the individual HCPs’ meeting with infected patients, however, such thoughts continued to lie as a shadow both in the HCPs’ working life as well as in their family life witnessing the seriousness of the situation.