The Wellbeing of Healthcare Workers during COVID-19 Era in Primary Public Health Facilities in Johannesburg, South Africa

3.2.1. Unsafe Workplace Environment

HCWs narrated unsafe work environment characterized by increased workload; staff shortage; insufficient personal protective equipment (PPE) and compensation allowance; poor health services outcomes; and death of colleagues. These issues came across as compromised work policies, which led to HCWs concerns of unsafety at work during COVID-19. Several issues mentioned above such as increased workload, staff shortage, and lack of support from the employer were also implicated.

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On increased workload, participants said:

‘The workload was too much.’

(40 years old, female, enrolled nurse, 14 years of work experience)

‘The workload was too much, it was heavy…’

(27 years old, female, professional nurse, 5 years of work experience)

‘There was a time where a lot of staff were infected, and they didn’t come to work so it increased the workload to the ones that were left to work at the facility. It makes one to have a heavy workload because we must reallocate and must cover every service.’

(50 years old, female, professional nurse, 24 years of work experience)

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On staff shortage, participants said:

‘Shortage of staff was an issue, staff was sick.’

(35 years old, female, enrolled nurse, 6 years of work experience)

‘We were always short staffed, which meant those that were in the workplace now they must compensate for those who are absent.’

(39 years old, female, medical doctor,14 years of work experience)

‘I think the number one, shortage of staff…because we would never go for a week without one of us getting sick with COVID-19…’

(37 years old, female, professional nurse, 17 years of work experience)

‘Most of workers here had COVID-19 so it obviously had a strain because you find that maybe about four people or so are off sick or on quarantine for that seven or fourteen days so that obviously puts a lot of strain on ones that are on duty on that time because they must stretch to see all these patients.’

(33 years old, female, professional nurse, 14 years of work experience)

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On deaths of colleagues, one participant said:

‘We’ve lost colleagues to the pandemic… Therefore, we constantly felt unsafe…’

(39 years old, female, medical doctor, 14 years of work experience)

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On insufficient resources and poor policies, one participant said,

‘I think we were demotivated because at some point you would find that there is no PPE, it’s out of stock. And they didn’t want to give COVID-19 allowance, danger allowance and that is demotivating…’

(27 years old, female, Professional Nurse, 5 years of work experience)

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On poor quality service, some HCWs indicated that increased workload, staff shortage and low morale translated into poor quality of service HCWs rendered to the patients. They said:

‘We try and push harder. At times you feel that you are not giving proper nursing care… It was a disaster. There was a time that a patients consulted with me, and I realize that I will go to prison here because I was not offering good services. But what can you do, because at the end of the day all these patients must be seen.’

(36 years old, female, professional nurse, 9 years of work experience)

‘It was difficult because in my team I could see seventy patients a day. Already I was not providing quality service, I was doing quantity.’

(36 years old, female, professional nurse, 11 years work experience)

‘… Sometimes you are not rendering quality service to the patients because you get exhausted, there was no quality of care’

(40 years old, female, professional nurse, 5 years of work experience)

Collectively, the wellbeing of HCWs was negatively aggravated by the above-mentioned sub-themes, and collectively led to their low morale, as well as potentially compromised the quality of healthcare service during the COVID-19 era. Most of the participants said:

‘Staff morale was low, because there was too much workload and most of the time, we had shortage of staff because part of our staff had to go in isolation.’

(30 years old, female, professional nurse, 7 years of work experience)

‘The mood was very low. People were not motivated.’

(39 years old, female, medical doctor, 14 years of work experience)

‘You get demotivated, your morale goes down, you lack ability to wake up every morning… Your colleagues are sick, you are even afraid that maybe next is me…’

(37 years old, male, professional nurse, 10 years of work experience)

‘…we were demotivated because at some point you would find that there is no Personal Protective Equipment, it’s out of stock. And they didn’t want to give us COVID-19 pandemic allowance, danger allowance and that is demotivating. Your morale will be low.’

(27 years old, female, professional nurse, 5 years of work experience)

‘… Already I was not providing quality service, I was doing quantity.’

(36 years old, female, professional nurse, 11 years work experience)

3.2.2. Poor Health Outcomes

Regarding poor health outcomes, HCWs reported that their emotional and physical wellbeing were strained. Emotionally, they experienced psychological distresses of fear of dying, stress, and mental exhaustion, accompanied by emotional roller coaster of sadness, depression, anxiety, temper, frustration, worriedness, insomnia, and trauma. While, physically, they reported fever, asthma, recurring bronchitis, fatigue, and unending physical exhaustion.

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On emotional wellbeing, some participants said:

‘The situation was emotional unstable, next again, stable, and then unstable. One minute you are over thinking, one minute you are fine, one minute you are scared, one minute you are okay.’

(34 years old, female, professional nurse, 10 years of work experience)

‘I was feeling anxious as well because we didn’t know this pandemic. I was anxious…’

(37 years old, male, professional nurse, 10 years of work experience)

‘There were times I wanted to call the hotline for psychiatric because I felt like I was feeling sad and depressed. Waking up was a mission, asking myself if I really want to go there, especially if you are working at the COVID-19 tent because everybody who is coughing will be coming to you.’

(28 years old, female, professional nurse, 10 years work experience)

‘I was short tempered, … I was frustrated, you don’t know what’s going to happen.’

(36 years old, female, professional nurse, 9 years of work experience)

‘I used to worry a lot, like what if I get infected and I don’t survive…’

(40 years old, female, enrolled nurse, 14 years of work experience)

‘… I ended up drinking sleeping pills so that I can sleep for me to forget what was happening, … I couldn’t sleep…’

(35 years old, female, enrolled nurse, 6 years of work experience)

‘You don’t understand, I was always traumatized… It affected me in so many ways, and I don’t want to go back there’

(40 years old, female, enrolled nurse, 14 years of work experience)

Emotional wellbeing was described as stress during the COVID-19 pandemic trying not to get infected, while at the same time providing health service. Participants said:

‘It was a very stressful time. Very, very stressful. I ended up being admitted at a psychiatric hospital because of stress you know. You know you get stressed.’

(60 years old, female, professional nurse, 37 years of work experience)

‘It’s been a stressful moment because every time you feel like you are trying to avoid being infected with COVID-19, at the same time you try to provide service as expected, and that is exhausting.’

(33 years old, female, professional nurse,14 years of work experience)

‘It was a time that was quite stressful for all of us. It was something that we have never experienced.’

(39 years old, female, medical doctor,14 years of work experience)

Fear for their lives, being infected, hospitalized and/or dying were other points HCWs raised that affected their emotional wellbeing. Some said:

‘…We were fearing for our health …’

(60 years old, female, professional nurse, 37 years of work experience)

‘It was hectic, fearing for our lives. People were dying, and you are thinking am I going to die. There was a time where I personally was infected with COVID-19, and I thought I am dying.’

(36 years old, female, professional nurse, 9 years of work experience)

‘I was afraid of dying due to COVID-19 infection.’

(40 years old, female, Professional Nurse, 5 years of work experience)

‘It was just scary because every day you hear that someone somewhere has passed away, you become scared, am I going to make it end of the week? end of the month? You become scared.’

(37 years old, female, professional nurse, 17 years of work experience)

‘…I was scared to get COVID-19 and complicate, get hospitalized and even die.’

(39 years old, female, professional nurse, 12 years of work experience)

Further HCWs’ expressions entailed mental exhaustion, which led to a feeling of not wanting to come to work. Participants said:

‘My mental exhaustion was all over the place… My mind will tell me that if I go home what if I am taking COVID-19 home, what if I give my family COVID-19…’

(27 years old, female, professional nurse, 5 years of work experience)

‘…I ended up drinking sleeping pills so that I can sleep for me to forget what was happening, so I was not okay mentally… My mind was not well’

(35 years old, female, enrolled nurse, 6 years of work experience)

‘I got exhausted number one, so once you get exhausted it means emotionally you are not okay, so you find that even when you get home you don’t have time to do things that are personal to you because you are exhausted emotionally… Social life was just on the low because we were always tired’

(33 years old, female, professional nurse,14 years of work experience)

‘Just tiredness, like mentally I can say I am tired’

(39 years old, female, enrolled nursing assistant, 9 years of work experience)

‘It really exhausted me emotionally. Sometimes when I wake up in the morning, I snooze the alarm hundred times thinking oh my God I am going to that place’

(35 years old, female, Enrolled Nurse, 6 years of work experience)

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On physical wellbeing, HCWs reported suffering from fever, asthma, recurring bronchitis, fatigue, and unending physical exhaustion. This is what some of them said:

‘When you get home, you feel so tired, … physically, I just feel exhausted.’

(30 years old, female, professional nurse, 7 years of work experience)

‘I am still exhausted, but I think the exhaustion is more from the COVID-19 pandemic more than anything. Since then, I am just physically exhausted, I come to work and go home but I can feel I am exhausted.’

(36 years old, female, professional nurse, 9 years of work experience)

‘Sometimes you end up shouting at patients only because you are physically exhausted, which I have been more since COVID-19.’

(40 years old, female, enrolled nurse, 14 years of work experience)

‘Remember there are some of us who had COVID-19 and recovered, but we got the post COVID syndrome. We don’t have our full pre COVID physical health. Some of us are getting recurrent bronchitis, others are now borderline asthma, others are weak. Others have diabetes because of their COVID-19 infection.’

(39 years old, female, medical doctor, 14 years of work experience)

‘There are those colleagues who were directly infected by COVID-19, they will tell you even today some of them are still having post COVID-19 fatigue. Some of them will tell you that ever since I had COVID-19 it’s like my immune system is no longer the same, I feel like I get feverish more often, my body is no longer physically strong as before.’

(30 years old, female, professional nurse, 7 years of work experience)

3.2.3. Impacted Home and Community Environments

HCWs narrated impacted home and community environments manifested through interruption of relationships with family and friends, and experiences of deaths of loved ones. This was due to social distancing and quarantine from family members and friends because of fear to infect their loved ones with COVID-19, while some of the loved ones died due to COVID-19 infection.

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On social distancing and quarantine, they said:

‘Not being able to go to your children and husband is draining while you are sick, and you don’t have anyone to take care of you, only yourself… My husband had COVID-19, he moved out of the house and left the kids, so I had to look for someone to come and take care of the kids because I am this side working and not staying. with them.’

(40 years old, female, enrolled nurse, 14 years of work experience)

‘I had to be separated from my son during COVID-19 pandemic because he couldn’t go to school so that for me was just not right because I was used to staying with him every day, I had to take him home to granny.’

(33 years old, female, Professional Nurse,14 years of work experience)

‘The condition at home changed, we were talking over the phone with my siblings, there were no visits because I am a health care worker, so socially we were affected. I remember we could not even do a birthday party for my mom and my siblings had to video call her on her birthday. They were afraid because they said I am a nurse I am going to give them COVID-19. Most of the things were done via the phone…’

(49 years old, female, professional nurse, 12 years work experience)

‘My partner was pregnant at that time of COVID-19. So, we were sleeping in two separate bedrooms trying to protect her, and the relationship was affected.’

(47 years old, male, professional nurse,15 years work experience)

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On losing family and friends, they said:

‘I lost my mother.’ (Participant burst into tears)

(49 years old, female, professional nurse, 12 years work experience)

‘I lost my father, uncle and a colleague.’ (Participant had teary eyes)

(35 years old, female, enrolled nurse, 6 years of work experience)

‘I lost nine cousins and one nephew within a space of two months.’

(60 years old, female, professional nurse, 37 years of work experience)

‘…some of my friends died of COVID-19…’

(35 years old, female, enrolled nurse, 6 years of work experience)

‘…we’ve lost family members. We’ve lost friends… I lost my aunt and cousin’

(39 years old, female, medical doctor, 14 years of work experience)

‘I know a colleague of mine who lost a mother, who lost a grandmother to COVID-19 so you can understand she lost her support system.’

(30 years old, female, professional nurse, 7 years of work experience)