BACKGROUND
During COVID-19 pandemic surges, many hospitals addressed staffing shortages with redeployment of healthcare workers (HCWs), which increases the number of employees able to care for surging numbers of patients. However, redeployed HCWs may face challenges from working in unfamiliar settings or lack of social support in new clinical environments. Trainees redeployed during the COVID-19 pandemic experienced a negative impact on their education and morale.1 However, few studies have reported on anxiety, depression, and insomnia in redeployed clinicians. We aimed to assess these conditions in HCWs redeployed during the COVID-19 pandemic.
METHODS
From August 31 to September 15, 2020, HCWs were recruited via public Facebook, Twitter, and Instagram accounts to complete an online survey. Self-selection and “healthcare worker” definitions were contingent upon an affirmative answer to, “Have you worked in the clinical setting during the COVID-19 pandemic?” Participants were from all areas of healthcare and training levels. Respondents were asked to consider the “most recent month of greatest clinical intensity and risk of SARS-CoV-2 transmission.” Outcomes included insomnia [Insomnia Severity Index (ISI)2 score of > 14], and anxiety and depression [Patient Health Questionnaire-4 (PHQ-4)3 score ≥ 3]. “Redeployment” was defined as being assigned to a new unit/department or returning to work from retirement. Chi-squared analysis tested for associations of redeployment with age, sex, relationship status, race, ethnicity, profession, career stage, and positive SARS-CoV-2 test with our outcomes. Multivariable logistic regression was used to test for independent association of each outcome with “redeployment” controlling for demographics and preexisting sleep, anxiety, and depressive disorders. p values less than 0.05 were considered statistically significant. All analyses were performed using StataCorp. 2019, Stata Statistical Software: Release 16, College Station, TX: StataCorp LLC.
RESULTS
Of the 1176 respondents who clicked the survey link, 963 (82%) submitted and 931 (79%) reported their redeployment status. Of these, 208 (22.3%) reported “redeployment.” Common redeployment sites included ICU (22.1%), other inpatient (25.0%), outpatient (21.2%), or ER (17.8%). Groups more likely to be redeployed included age < 30 (25.5% vs. 13.0%), single (41.8% vs. 18.3%), Black (17.3% vs. 4.6%), Hispanic (23.1% vs. 10.2%), trainees (24.0% vs. 15.9%), non-physicians (40.9% vs. 28.9%), and those from a rural area (5.4% vs. 4.2%) or town (28.9% vs. 12.2%) (Table 1). Among redeployed HCWs, non-physicians were more likely to have insomnia (63% vs. 36%), anxiety (70% vs. 43%), and depression (68% vs. 35%). Those with positive COVID test were more likely to have insomnia (49% vs. 30%) and anxiety (54% vs. 38%). All were statistically significant at p < 0.05. Being a trainee was not significantly associated with any of the outcomes.
Table 1.
Sample Characteristics
| Total N (%) |
Redeployed N (%) |
Not redeployed N (%) |
p value* | |
|---|---|---|---|---|
| Total | 931 (100) | 208 (22.3) | 723 (77.7) | |
| Age group | ||||
| 18–29 | 147 (15.8) | 53 (25.5) | 94 (13.0) | < 0.001 |
| 30–49 | 690 (74.1) | 140 (67.3) | 550 (76.1) | |
| 50 + | 86 (9.2) | 14 (6.7) | 72 (10.0) | |
| Did not answer | 8 (0.9) | 1 (0.5) | 7 (1.0) | |
| Gender | ||||
| Male | 218 (23.4) | 60 (28.9) | 158 (21.9) | 0.06 |
| Female | 705 (75.7) | 145 (69.7) | 560 (77.5) | |
| Did not answer | 8 (0.9) | 3 (1.4) | 5 (0.7) | |
| Race | ||||
| Non-Black | 862 (92.6) | 172 (82.7) | 690 (95.4) | < 0.001 |
| Black | 69 (7.4) | 36 (17.3) | 33 (4.6) | |
| Ethnicity | ||||
| Non-Hispanic | 757 (81.3) | 152 (73.1) | 605 (83.7) | < 0.001 |
| Hispanic | 122 (13.1) | 48 (23.1) | 74 (10.2) | |
| Did not answer | 52 (5.6) | 8 (3.4) | 44 (6.1) | |
| Significant other | ||||
| Yes | 697 (72.7) | 117 (56.3) | 580 (80.2) | < 0.001 |
| No | 219 (22.9) | 87 (41.8) | 132 (18.3) | |
| Did not answer | 15 (4.5) | 4 (1.9) | 11 (1.5) | |
| Profession | ||||
| Physician | 599 (64.3) | 123 (59.1) | 514 (71.1) | < 0.001 |
| Non-physician† | 332 (35.7) | 85 (40.9) | 209 (28.9) | |
| Career stage | ||||
| Trainee | 167 (17.3) | 50 (24.0) | 115 (15.9) | < 0.001 |
| Non-trainee | 760 (78.9) | 156 (75.0) | 600 (82.1) | |
| Did not answer | 36 (3.74) | 2 (1.0) | 8 (1.1) | |
| Location | ||||
| Rural | 40 (4.4) | 11 (5.4) | 29 (4.2) | < 0.001 |
| Town | 146 (16.2) | 59 (28.9) | 85 (12.2) | |
| Suburban | 202 (22.4) | 43 (21.1) | 157 (22.6) | |
| City/metro | 515 (57.0) | 91 (44.6) | 424 (61.0) |
ICU intensive care unit, CCU coronary care unit, ER emergency room
*Chi-squared analysis
†Non-physicians included physicians’ assistants, nurse practitioners, registered nurses, physical/occupational/respiratory therapists, and allied healthcare workers, i.e., medical technicians and certified nursing assistants
In multivariate analyses, redeployment was independently associated with higher odds of insomnia (2.00 [95% CI 1.29, 3.09], p < 0.001), anxiety (2.37 [95% CI 1.67, 3.37], p < 0.001), and depression (2.57 [95% CI 1.80, 3.68], p < 0.001) (Table 2).
Table 2.
Risk for Poor Sleep Quality, Insomnia, Anxiety, and Depression Among HCWs Redeployed Vs. Not Redeployed During August 31, 2020–September 15, 2020
| Redeployed (OR, 95% CI) |
p value | |
|---|---|---|
| Insomnia* | 2.00 (1.29, 3.09) | < 0.001 |
| Anxiety† | 2.37 (1.67, 3.37) | < 0.001 |
| Depression‡ | 2.57 (1.80, 3.68) | < 0.001 |
Odds ratios were from logistic regression models used to test the effect of redeployment on the likelihood of developing one of the outcomes of interest controlling for age, sex, race, ethnicity, career stage, and profession, relationship status, and preexisting sleep disorders, anxiety disorder, or depressive disorder
OR odds ratio, CI confidence interval
*As measured by the Insomnia Severity Index (ISI); insomnia defined as ISI scores in the moderate to severe range (15–28)
†Presence of anxiety was defined by a PHQ4 score of ≥ 3 for anxiety-specific questions
‡Presence of depression was defined by a PHQ4 score of ≥ 3 for depression-specific questions
DISCUSSION
Our results suggest that redeployment during the COVID-19 pandemic is associated with significant risk for insomnia, anxiety, and depression among healthcare workers even after controlling for many demographic factors. Given the chronic and relapsing nature of these conditions,4,5 it is important to consider that some health challenges of redeployment may have long-lasting consequences.
Limitations of this study include the dynamic nature of the healthcare workforce during this period. Many clinicians chose to switch jobs, including taking positions as traveling clinicians, or leaving healthcare altogether, and more left after our study period. Anxiety, depression, and insomnia may have influenced these decisions, which could limit generalizability. Although social media is widely utilized, using it as a means of recruitment may be considered a limitation. To combat time period bias, we asked participants to consider the month they were most clinically active caring for COVID-19 patients. While this may lead to bias, we felt it would be most representative of serving on the frontlines during the pandemic.
This is one of the first analyses of sleep and mental health effects of HCW redeployment. Considering our findings, future research should examine anxiety, depression, and insomnia in HCWs working outside of their scope of practice or in unfamiliar settings. Specifically, psychological and sleep hygiene support for these workers warrants examination. Positive leadership support6 and reserving redeployment as a last resort may be particularly important first steps for mitigating stress.
Funding
Dr. Vineet Arora is funded by National Heart, Lung and Blood Institute (NHLBI Grant K24HL136859).
Declarations
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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