The main aim of this study was to examine the effect of accessing a supported wellbeing centre on HCWs’ wellbeing, during the first wave of the COVID-19 pandemic in the UK. These centres comprised access to a high-quality rest space and peer-to-peer psychological first aid (hence ‘supported’); they were rapidly mobilised within weeks of COVID-19 being declared a pandemic, and were globally, the first wellbeing interventions of their kind [29]. This secondary analysis of COVID-Well data [29] shows that accessing a supported wellbeing centre was independently, and positively associated with wellbeing in HCWs. This demonstrates a clear benefit to the healthcare workforce, a population in which low wellbeing was evident before [49] and during the pandemic [5]. Our findings build on two prior COVID-Well studies showing that (a) the wellbeing centres were highly accessed by HCWs [29] and, (b) that the existence of centres as high-quality break spaces, together with the provision of peer-to-peer psychological first aid, was valued by the workforce [1]. Nonetheless, further research is needed to establish the effectiveness of psychological first aid for HCWs on wellbeing outcomes, the evidence for which has recently been defined as low-certainty [26].
When exploring predictors of wellbeing, we corroborated previous evidence showing a negative relationship between job stress and wellbeing [15, 16], a negative relationship between presenteeism and wellbeing [17, 18, 19], and a positive relationship between job satisfaction and wellbeing in HCWs [20, 21, 22]. Wellbeing was lower in younger workers - this aligns with other research showing lower wellbeing and/or higher prevalence of adverse mental health outcomes in younger HCWs [9, 50, 51, 52, 53, 54, 55, 56]. Similar age-related patterns have been observed in general population samples [57, 58]. This disproportionate impact of the pandemic on mental wellbeing of younger workers could reflect caregiving responsibilities for many (e.g., managing childcare around work and social restrictions and associated fear of disease transmission), shorter time in their job role, less experience of coping with difficult, complex, or life-threatening situations, concerns relating to fewer work or education opportunities, job insecurity, and financial insecurity from lower income [59].
Job stress was prevalent in HCWs, before [60] and during [5, 29, 61] the COVID-19 pandemic, and has implications for individual health and wellbeing, effectiveness of healthcare organisations and care quality [62]. This has been observed globally; during the first wave of the pandemic, Couarrazze and colleagues [63] described stress in HCWs across occupational groups and geographical regions (n = 13,537, 44 countries). Pre-pandemic, interventions targeting stress were found to have positive outcomes for nurses' health and/or wellbeing [24]. During the pandemic, a review highlighted the paucity and heterogeneity of organisational psychological support intervention protocols for HCWs aimed at mitigating the impact of occupational stressors associated with COVID-19 [64]. Emerging individual-level interventions to mitigate stress and the mental health impacts of COVID-19 include an e-support package, psychoeducation, mental health promotion, mindfulness and talking therapies [27, 65, 66, 67, 68]. Here, we did not identify any moderating effect of wellbeing centre access on the relationship between job stressfulness and wellbeing, despite qualitative research showing stress reduction and positive impacts on wellbeing through enabling opportunities to take work breaks and having access to social and psychological support within the centres [1]. Research conducted prior to the pandemic also suggested that rest breaks and the quality of break areas benefit HCWs (and the patients they serve) [69]. The lack of moderating effect here could potentially be explained by the use of a single-item measure of job stressfulness which may not have picked up on specific, acute stressors and complex relationships between them, that may influence the stress/wellbeing relationship in the context of a crisis (e.g., escalating global pandemic context, uncertainty and lack of job control, problems with access to personal protective equipment (PPE), rapidly changing roles, excessive workload, etc.). Alternatively, it may reflect the value of wellbeing centres in improving wellbeing, albeit alongside a certain level of unmodifiable stress that is naturally present in healthcare professional’s job roles, particularly during crisis situations, such as a pandemic.
Presenteeism is high in healthcare workers, higher than pre-pandemic levels [70], and is known to increase with job stress [71, 72]. In the sample from which our data are drawn, 68% of respondent reported presenteeism during the first surge of COVID-19 [29], and higher rates have been observed in HCWs elsewhere (e.g., 82%, USA) [73]. Presenteeism carries a high economic burden due to negative impacts on productivity [74, 75] and in healthcare, it has been described as a ‘public health hazard’ due to risk of infectious disease transmission in vulnerable patient populations [76]. In our study, wellbeing centre use moderated the link between presenteeism and wellbeing. That is, HCWs who reported presenteeism and had not accessed the centres showed a significantly lower level of wellbeing than those reporting presenteeism but who accessed the wellbeing centres. This suggests that for those who were present at work despite feeling unwell, accessing the wellbeing centres appeared to have a protective influence on wellbeing – perhaps providing greater respite and restoration for those who were not in optimal health. Future research might explore what motivated some, but not all, of the HCWs that reported presenteeism to use the wellbeing centres. This may be related to known barriers to service access, such as proximity of work areas to the centres, promotion of centres to all occupational groups, managerial and team support for wellbeing, and the challenges surrounding taking work breaks alongside requirements for donning and doffing PPE [1].
Job satisfaction appeared to buffer the impact of stress on HCWs wellbeing. That is, job satisfaction appeared to weaken the negative effect of job stressfulness on wellbeing, with those reporting highest job satisfaction, demonstrating the weakest relationship between job stressfulness and wellbeing. Job satisfaction is important in healthcare professions since it is associated with work absenteeism [77], intentions to leave and turnover [78]. Implementing strategies to enhance job satisfaction are therefore of value and this aligns with the 2019 recommendations provided by the National Academies of Sciences, Engineering, and Medicine Studies [79: Recommendation 1B] which advocate for the prioritisation of interventions that have potential to promote clinicians sense of meaning in life and at work.
Our analysis confirms that accessing a wellbeing centre did not moderate the relationship between job satisfaction and wellbeing or influence turnover intentions. This is not unexpected since the centres were aimed at improving wellbeing (which was achieved), rather than job satisfaction or turnover intention, per se. Nonetheless, these variables are related, since low job satisfaction predicts turnover intention [80], particularly when wellbeing is low [81]. Almost one third of our sample reported intention to leave their job [29] which is broadly comparable to other studies with healthcare workers (e.g., 31.7%: [82]; 27.7%: [83]). Fear of COVID-19 has exacerbated turnover intentions in frontline HCWs [84]. The unexplained variance in our model of predictors of turnover intention, however, suggests that other factors may be salient here at individual level (e.g., emotional exhaustion, depression, job stress, fatigue, emotional labour, work engagement, job satisfaction, professional self-concept), unit level (e.g., work conditions, interpersonal relationships, and unit culture), and organisational level (e.g., organizational commitment, person − organization fit, job embeddedness, organizational justice, organizational socialization and internal marketing of the organization) [85]. Alternatively, intention to leave may simply reflect natural processes in people’s career pathways, such as anticipation of retirement or professional development into another job role.
However, our findings highlight the protective role of job satisfaction in buffering the impact of job stressfulness on wellbeing, and similarly, turnover intentions. This supports the need for strategies to enhance job satisfaction in HCWs. Many approaches have shown promise; studies have accentuated the influence of empowerment and transformational leadership [86] and emotional competence [87, 88] on job satisfaction among HCWs. Participation in ‘Compassion Rounds’ has shown to increase job satisfaction, by fostering emotional expression, teamwork, and communication [89]. Job satisfaction has also increased following structured ‘huddles’ and peer recognition schemes for HCWs [90] and yoga practice for nurse academicians [91]. A systematic review and meta-analysis of interventions developed to increase job satisfaction in nurses found that interventions were primarily educational and consisted of workshops, educational sessions, lessons, and training sessions [92]. Notably, this review showed that organisational strategies to foster the intrinsic motivation of employees (e.g., spiritual intelligence, professional identity, and awareness) were more effective in increasing job satisfaction than extrinsic factors (e.g., salary and rewards) [92], a finding echoed in earlier studies [93].
This study provides insights into the predictors of wellbeing in HCWs during the first surge of the COVID-19 pandemic in the UK. We provide insights into the value of supported wellbeing centres as one approach taken in an acute hospital setting, to mitigating the impact of COVID-19 pandemic on the psychological wellbeing of HCWs. While there were demonstrable benefits to this approach, it should be recognised that wellbeing support requires intervention at individual, unit-, and organisational-level. In the UK, whole-system approaches to improving the health and wellbeing of healthcare workers have been advocated [94]. This refers to approaches that include identification and response to local need, engagement of the whole workforce (staff at all levels), and the involvement, visible leadership from, and up-skilling of, management and board-level staff. COVID-19 exacerbated challenges that already existed for healthcare workers. Therefore, strategies and interventions that showed benefit for workforce wellbeing during the pandemic should extend beyond times of crisis and be available in the long-term. Key findings and recommendations are shown in Fig. 3.
Study Limitations
Cross-sectional data were collected from employees at a single NHS Trust in England, albeit survey participants could have been based on any of this Trust’s three hospital sites, accessing wellbeing centres available at two of those sites. Data collection took place during the first wave of COVID-19, in an uncertain and rapidly changing local and national context. The study design reduces the ability to determine causality. Longitudinal data would provide further insight into the predictive value of wellbeing centres for individual and organisational outcomes. Findings may not be directly generalisable to other geographical regions, or in a different context or time. To maximise survey completion rate during an exceptionally busy and challenging period for HCWs, we used single-item measures of job stressfulness, job satisfaction, presenteeism and turnover intentions.