Healthcare Social Workers' Trifecta of Distress: COVID-19, Health Disparity, and Social Justice

Background and Purpose:

In their positions within hospitals, hospices, skilled nursing facilities, and outpatient clinics, social workers have served as essential frontline workers during the COVID-19 pandemic. Their daily lives and roles have shifted dramatically, exposing them to new responsibilities, health risks, and professional and personal grief and loss. Healthcare social workers have witnessed an exacerbation of inequalities that permeate the micro, mezzo, and macro levels of human health and well-being. Historical disparities in access to medical care, and mental health became more divergent during the pandemic, forcing social workers into many ethical and moral dilemmas. Thus, increasing the risk for social workers exposure and embodiment of secondary trauma. The purpose of this mixed method study was to explore how serving as a healthcare social worker during COVID-19, amidst the individual and collective loss, health disparities, and injustices, impacted their personal and professional well-being

Methods:

Participants were recruited through social media platforms of healthcare social work professional organizations from September-November 2020. Data collection included an online survey and an optional individual interview. Each participant filled out an online survey that captured sociodemographic variables, including social work education and professional experiences. Additional survey items measured complicated grief, emotional distress, and resilience. The interview explored shifts in work roles, patient/caregiver care, and personal experiences of grief, loss, and resiliency. Quantitative analyses included descriptive statistics of sociodemographic and social work variables, bivariate correlations, and multiple regressions to assess the extent of predictors of grief, emotional distress, and resiliency. Interpretive phenomenology informed the methods for qualitative data analysis.

Results:

Of the 246 survey respondents, most were White (89%), aged between 35 and 64 (75%), non-Hispanic (93%), female (98%), married (66.3%), with a graduate degree (93%), and advanced level social worker license (70%). The majority performed clinical work (69%) and continued to work outside the home in health settings during COVID-19 (72%). About one-third of participants met the criteria for complicated grief symptoms and mental distress. Participants reported a lower level of resilience (M=75.5, SD=12.4) compared with the U.S. general population (M=80.4). Qualitative findings reveal four essences of being a health social worker during COVID-19: going up a roller coaster with a blindfold on; all-consuming moral distress; searching for creative solutions; and championing for our relevance. The pandemic showcased social workers’ ability to creatively tackle continuously changing responsibilities, an increase in patient/caregiver physical and psychosocial acuity of needs, health disparities, and the mounting social and political unrest. Those with limited administrative support fought for personal protective equipment, patient and caregiver rights, and their own well-being. Social workers partnered with community agencies to address social justice issues and health inequities such as access to healthcare, transportation, housing, and food.

Conclusions and Implications:

Pandemic-related grief emerged within daily clinical practice, as well as within social workers’ own personal lives and communities. This collective and pervasive grief impacted social workers’ resilience and their perceived ability to effectively navigate multiple roles and ethical dilemmas that emerged within a setting that was plagued with uncertainty.