Hearing the voices of Australian healthcare workers during the COVID-19 pandemic

Background: The statistics of healthcare worker (HCW) COVID-19 infections do not convey the lived experience of HCWs during the pandemic. This study explores the working conditions and issues faced by Australian HCWs. Methods: Qualitative analysis of free-text responses from Australian HCWs from 3 August to 5 August 2020 from an open letter calling for better respiratory protection for HCWs, transparent reporting of HCW COVID-19 infections and diversity in national infection control policy development. The open letter was sent to an email list of 23,000 HCWs from a previous campaign and promoted on social media. Results: Among 2,733 HCWs who signed the open letter during the study period, 407 free-text responses were analysed. Doctors and nurses accounted for 58% and 35% of respondents, respectively. Most respondents came from Victoria (48%); New South Wales (18%); Queensland (12%) or Western Australia (12%). Dominant themes included concerns about: work health and safety standards; guidelines on respiratory protection including the omission of fit-testing of P2/N95 respirators; deficiencies in the availability, quality, appropriateness and training of personal protective equipment; a top-down workplace culture that enabled bullying in response to concerns about safety that culminated a loss of trust in leadership, self-reported COVID-19 infections in some respondents and moral injury. Conclusion: Occupational moral injury in HCWs is the consequence of lapses in leadership at policy-making and organisational levels that have violated the normative expectations of HCWs. The challenge for healthcare leaders is to address workplace culture, consultation and engagement with HCWs in order to prevent this hidden pandemic from spreading throughout the health system.