Frontline, Essential, and Invisible: The Needs of Low Wage Workers in Hospital Settings during COVID-19

Investigators: Lisa de Saxe Zerden PhD, MSW; Erica Richman PhD MSW; Brianna Lombardi PhD, MSW

Objective: Reports of burnout among the health workforce, particularly in relation to COVID-19, have expanded exponentially. However, burnout research often focuses on clinical providers such as nurses and doctors. Lower-paid, essential workers within health systems provide equally important, but often less lauded, services. This study aimed to understand the unique experiences of low-wage, essential, frontline hospital workers during COVID-19 to better identify strategies to support them during and beyond the pandemic.

Methods: To understand the unique experiences of environmental services workers at hospitals, including food service and house-keeping staff, during the COVID-19 pandemic this study conducted in-depth qualitative interviews with twenty workers from three states.

Results: Seven themes emerged from the interviews. Four themes focused on reported sources of burnout: 1) Changes in duties and being understaffed; 2) Fear of potentially contracting COVID-19 and risk in endangering others; 3) Desire for recognition about risks and importance of their jobs; 4) Lack of clarity around COVID-19 benefits and perceived unequal distribution of these resources.

Respondents also described protective factors that buffered their experiences: 1) Employer provision of paid time off specifically designated for COVID-19; 2) Organizational efforts to provide mental health support; 3) Self-coping strategies and a sense of pride in their jobs.

Policy Implications: Clear communication on resources, sick leave, mental health supports, and self-coping strategies were beneficial for participants. Hospital systems need to deploy concrete interventions to support workers’ tangible needs, while simultaneously also creating a culture shift in how this type of work is valued across health systems.

Project Products: 

Manuscript
Research brief
  • Zerden, LD, Richman, E, Forte, A, Lombardi, B. Frontline, Essential, and Invisible: The Needs of Low Wage Workers in Hospital Settings during COVID-19. Carolina Health Workforce Research Center, Cecil G. Sheps Center for Health Services Research, UNC-CH. January 2022.

View the brief

Presentations, webinars, and refereed conference papers and posters
  • Zerden, L.D., Wagner, L., Richman, E. L., Lombardi, B.M., Forte, A., Toivanen-Atilla, K. Chapman, S. 2022. Essential and Invisible: Addressing Burnout for Low-Wage Frontline Workers during COVID-19. Poster Presentation, Academy Health, Washington D.C.
  • Lombardi, B. COVID-19’s Impact on Safety Net Providers and Frontline Health Workforce in the US. International Health Workforce Collaborative Annual Meeting. May 4, 2022.