Infectious Disease

The pandemic had an emotional and monetary impression on cath lab workers

December 15, 2020

5 min read

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A survey of nurses and technologists working in cardiac catheterization laboratories found that the COVID-19 pandemic greatly reduced morale, psychological distress, and financial hardship.

At the height of the spring pandemic, hospitals stopped performing elective procedures, including many non-urgent cath lab procedures such as PCI and transcatheter aortic valve replacement. At the current height of the pandemic, hospitals have not stopped such procedures, but are instead trying to balance COVID-related safety considerations with the need to conduct certain CV procedures.

Emotional Impact of the COVID-19 Pandemic on Health Workers

Srihari S. Naidu

“Instead of abruptly ceasing operations in the cath lab, we are trying to create a phased cath lab volume setup based on the COVID census.” Srihari S. Naidu, MD, The 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, said Healio. “The idea is to safely maintain voting volume. We learned that interrupting all operations in the cath lab increases cardiovascular mortality because we cannot care for these patients in the real world. ”

The researchers conducted a national online survey of 450 cath lab nurses and technologists (63% nurses; 78% women; median age range 41 to 50 years; 50% urban; 35% suburban; 15% rural) to see if the Pandemic The changes to catheter lab operations in the spring impacted workflow, responsibilities, financial status and mental health. They published their results in the Journal of Invasive Cardiology.

Bailey Ann Estes

The poll emerged from a comment by Bailey Ann Estes, BSN, Nurse – First assistant in the cardiac catheterization lab at Hendrick Medical Center in Abilene, Texas and chairman of communications for the ACC’s Department of Cardiovascular Teams on the effects of COVID-19 in the cath lab.

“It was important to provide an overview of how the pandemic has changed our practice,” Estes told Healio. “DR. Naidu wanted to bring a more personal nursing perspective into the discussion and dig deeper into these issues. So we decided to do a national survey to see what was going on in different laboratories across the country.”

Naidu told Healio that it was clear that cath labs were handling the pandemic differently, “but it wasn’t clear which avenues would be ideal. I had also seen there was a lot of depression and anxiety among all of the staff, but nothing had been written about nurses and other cath lab workers so I wanted to see if the cath lab changes for COVID-19 were being implemented on ours Frontline people financially and emotionally and whether there are ways to improve it. ”

In the cohort, 68% were the primary financial service providers for their families, and 74% worked in a cath lab that has seen case volume decrease by more than 75% since the pandemic started. The decrease in volume occurred even though many of the respondents worked in facilities with a low percentage of patients with COVID-19. 54% of respondents said their facility’s inpatient COVID-19 census was less than 10%.

“I didn’t realize that the majority of the cath lab workers were the main breadwinners for their families, so they will be much more affected by the financial impact of COVID,” Naidu said in an interview.

In other findings:

  • 47% of respondents said they care for patients with COVID-19;
  • 45% of respondents said they had been relocated;
  • 42% of respondents who were part-time or on a daily rate said they had been made redundant or on leave;
  • 12% of respondents who were full-time said they had been made redundant; and
  • 65% of the respondents said that their working hours had decreased.

“The majority had a reduction in hours, which means the majority had a reduction in pay,” Naidu told Healio.

In addition, 96% of respondents said that morale in the cath lab had deteriorated during the pandemic, 53% said they were not adequately supported by hospital management / administration, 43% said they were concerned about exposure to COVID 19 and their families at risk, and 33% said they were worried about jobs and financial losses.

Among the emotional parameters, 80% of respondents said they were afraid / stressed, 39% said they were afraid, 36% reported depression and 38% reported anger.

The researchers found that some of the independent predictors of depression include:

  • Relocation to care for patients with COVID-19 (OR = 4.71; 95% CI, 1.76-12.63; P <0.01);
  • increased stress / anxiety outside of work (OR = 3.42; 95% CI, 1.27-9.19; P = 0.02);
  • Working in an urban / urban area (OR = 2.41; 95% CI, 1.15-5.02; P = 0.02);
  • Fear of going to work (OR = 1.84; 95% CI, 1.07-3.17; P = 0.03);
  • feeling unsure whether patients can be cared for with COVID-19 (OR = 0.44; 95% CI, 0.24-0.81; P <0.01);
  • feel unsupported by the administration / leadership (OR = 0.29; 95% CI, 0.176-0.5; P <0.001); and
  • Daily rate (OR = 0.1; 95% CI, 0.01-0.95; P = 0.04)

“Based on learning the predictors of depression, we developed a number of things that made a lot of common sense,” Naidu told Healio. “If you don’t relocate people and you don’t cut working hours, you will be less depressed and less stressed. When you’ve prepared them better, given them more personal protective equipment, and communicated with them, they’ll be less depressed and less stressed out. We also need services to realize that anxiety is mounting, and perhaps we should look to the mental health services more at this point. “

Estes told Healio that, from the nurses point of view, “the main problem was inadequate communication between staff and management. There is uncertainty about what is going on with working hours and moving. There were a surprising number of resettlers who directly cared for patients with COVID-19. We are highly specialized staff who are not necessarily trained or prepared to treat infectious diseases. “

Nobody was prepared for the pandemic in the spring, but now applying lessons from the survey can “help hospitals prepare for spikes and do so in a healthy way,” Naidu said.

“During the pandemic, there are opportunities to have voting procedures. We dipped our toes in the discharge the same day and it is now becoming a routine. Pretty much all PCIs should go home. Some TAVRs and patented Foramen Ovale closures should go home on the same day. We make the same income whether we keep them one night or not, and we can pay our employees for doing these procedures. And of course we need to let people know that we are still working on urgent cases, so if they have a heart attack they should step in. ”

In addition, Naidu said, “All cath lab directors should meet with their staff after reading this paper to recognize this is happening and to confirm that we can better communicate about concerns and how we face them in the future another wave can calm hit. ”

Reference:

For more informations:

Bailey Ann Estes, BSN, can be reached at baileyann1123@gmail.com.

Srihari S. Naidu, MD, can be reached at srihari.naidu@wmchealth.org.

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