Understanding the Burnout of Low-Paid Health Care Workers during Covid-19

Background and Purpose: Health care workers (HCWs) are experiencing burnout from the increased stress caused by the COVID-19 pandemic. A national US survey found that over 60% of HCWs reported that stress associated with COVID-19 had impacted their mental health, and 55% felt burned out. Although burnout was a prominent issue before the pandemic, it has become worse. In the current literature on HCWs, low-paid HCWs such as hospital service, clerical, and technical workers (SCTWs) have received scant attention compared to doctors and nurses or HCWs in non-hospital settings. Our study sought to fill this gap in current understandings by investigating the rates and factors related to burnout among SCTWs and comparing them to those of nurses.

Methods: Data are drawn from a cross-sectional survey conducted in April 2021, which collected job quality, mental health and well-being, and sociodemographic information. This convenience sample includes 538 unionized HCWs employed in four hospitals in Pittsburgh: 308 nurses and 238 SCTWs. Although both nurses and SCTWs were predominantly female, nurses’ demographic characteristics differed significantly from those of SCTWs in terms of race/ethnicity, age, education, and wage. Multivariate logistic regression was used to analyze how different factors, including organization (hospital and union support), individual job (concern about contacting covid), and social context of healthcare jobs (financial insecurity and stigmatization), were associated with burnout among nurses and SCTWs, controlling for sociodemographic variables (age, gender, race, education, tenure, and wage).

Results: Despite the demographic differences between nurses and SCTWs, high proportions of both groups experienced personal (58% of nurses and 55% of SCTWs) as well as work-related burnout (66% of nurses and 51% of SCTWs). Multivariate logistic regression identifying factors associated with burnout among the two groups revealed that hospital support was the significant protective factor against both personal and work-related burnout among the two groups. Meanwhile, financial insecurity was the significant risk factor for both personal and work-related burnout among nurses as well as for personal burnout among SCTWs.

Conclusions and Implications: The prolonged battle against the COVID-19 pandemic has left many HCWs physically, mentally, and emotionally exhausted, exacerbating burnout that was already endemic in the healthcare sector. Consistent with national data, most HCWs, both nurses and SCTWs, in our sample experienced personal and work-related burnout, which adversely affects their physical and mental health as well as their ability to provide quality care. The common factors contributing to burnout suggest that both nurses and SCTWs have similar needs and experiences. This work highlights how COVID-19 and labor conditions intersected to affect the mental health of HCWs in a major employment sector. These findings are particularly relevant for social workers in the healthcare sector and those working with burnt-out HCWs to work at individual and organizational levels to prevent and treat burnout. Given that women of color are disproportionately represented in low-paying healthcare jobs, future research is warranted to explore in more depth how the intersections of race, class, and gender shape the work lives and mental health of these workers.