Building Community Power through Research to Understand How Healthcare Job Quality Harmed Workers' Mental Health and Contributed to the Great Resignation

Background: Healthcare has replaced manufacturing as a primary industry in many rust-belt cities. Though the ethos of healthcare advocates health and wellness, healthcare has long been one of the most unsafe U.S. industries for employees. COVID-19 has exacerbated these long-standing problems, with 60% of U.S. healthcare workers (HCWs) reporting COVID-19-related effects on their mental health, contributing to a national shortage of HCWs. The current study was requested by local policymakers to determine how to better support HCWs, initiating a university-community partnered survey. This presentation reports both process and product, highlighting how community-partnered research can support ongoing community organizing around important issues for social justice and policy change, through examining how job quality and wages interact to affect HCWs’ health.

Method: Researchers and HCWs developed the survey through an iterative process of discussion, proposals, and feedback. Eligible participants included city hospital workers and those who left in the preceding year. The sample (N=1,458) is majority White and female. Sixty percent of respondents were nurses and 64% had at least a bachelor’s degree. To understand differences in wage and type of work, the current study divides the sample into low-paid service workers (<$20/hour, n=233), higher-paid service workers ($20-$30/hour, n=438), and nurses and other highly paid specialist workers (>$30/hour, n=787). Multivariate analyses were used to examine how job quality factors, including pay, paid time off (PTO), and working conditions (staffing, workplace safety, discrimination, and harassment) were associated with burnout, secondary traumatic stress, and compassion satisfaction for each wage-level group, accounting for worker age, race, gender, education, and household income.

Results: Feeling unsafe at work was associated with burnout, secondary traumatic stress, and reduced compassion satisfaction for all wage groups. Additionally, inadequate staffing and workplace discrimination were associated with burnout and secondary traumatic stress for all wage groups. Insufficient PTO was associated with burnout and harassment from patients and visitors with secondary traumatic stress for all wage groups. There were differences across wage groups for other factors and outcomes.

Implications: This study has implications for understanding how job quality factors are associated with aspects of HCWs’ well-being, as well as the process through which researchers and workers can collectively study complex interactions and report them to policymakers. As engaged social work scholars, we recognize how important this process was not only for improving measurement but also for building community power to pressure powerful employers to improve safety and well-being of those who are at once HCWs, health care consumers, and community members. In addition to building power with our partners through this process, this study generated important substantive findings, namely that workplace safety was a consistent factor associated with burnout, secondary trauma, and compassion satisfaction at all wage levels while other factors varied by wage group and outcome. The intersection of labor conditions and mental health is an important area in which more social workers should be involved, and the process of our study presents an effective example for future policy-relevant research partnerships.