Further Resources for Managers
Here we offer further support for leaders and managers to help you respond to the needs of your staff.
Use these key messages to help formulate an agenda for team discussion or Schwartz rounds.
Be kind to yourself and one another
Encourage staff to be kind to themselves and then be kind to others.
Assist staff to manage their concerns
Enable staff to acknowledge and discuss their real concerns so that they can be supported in addressing them. Concerns might include anxiety about contamination and the greater levels of risk some staff might face, and about what access there will be to psychosocial support from within their teams.
Moral distress and ethical considerations
Effective leaders should recognise the potential impacts of the pandemic on the standards of care, and that staff face moral strain and distress as they are unable, or feel unable, to do everything possible for all patients. Managers should agree a local process for developing an ethical framework for staff to work within.
Remember to eat, drink, rest, and sustain contacts with friends
Remember to eat, drink and to sustain contacts with friends. All staff must be encouraged to take breaks, eat and drink, exercise, and make social connections.
Continue supervision and relevant training
At least maintain existing levels of clinical supervision and relevant training. Ensure that opportunities for informal peer support are valued and continue during a pandemic. More formal peer-based support should be available that enables reflection on practice e.g. through virtual Schwartz Rounds.
Challenge incipient loneliness
Challenge incipient loneliness that comes from being very busy on the frontline and remind staff that they need to keep in contact with families and friends, using whatever means are available and appropriate. Encourage staff to keep up-to date with academic and research developments relating to the pandemic.
Support for frontline staff should be visible
Plan and enact a good public risk communication and advisory strategy involving staff, the public and the media, to provide timely and credible information and advice. Senior general and clinical managers should be visible to staff on the frontline and seen to share the risks, as is appropriate.
Follow assessment and treatment protocols
Encourage staff to adhere to assessment and treatment protocols and ensure staff are aware of any necessary changes from protocols that were used pre-COVID-19. Staff need to be well-informed, consulted and involved in the plans. Employers should be aware of, and endeavour to prevent staff from, developing distress. Plan to assist staff to mitigate the stress that they are likely to experience, and have protocols in place for fast-track referrals for staff who might be developing more serious psychosocial problems and mental disorders.
Be aware of the document from the World Health Organisation on Mental Health and Psychosocial Considerations
Key messages from Greenberg et al. (2020)
- Healthcare staff are at increased risk of moral injury and mental health problems when dealing with challenges of the Covid-19 pandemic
- Healthcare managers need to proactively take steps to protect the mental wellbeing of staff
- Managers should be frank about the situations staff are likely to face
- Staff can be supported by reinforcing teams, and providing regular contact, to discuss decisions and check on wellbeing
- Once the crisis begins to recede, staff must be actively monitored, supported, and, where necessary, provided with evidence based treatments
Resources and References
Ethical Guidance on COVID-19 and Primary Care
Guidance on making challenging decisions in primary care
Podcast – Human Factors and Working under pressure
Tips from staff working with Covid-19 patients, very relevant and poignant
COVID Trauma Response Working Group
Offers trauma-informed responses to stress of COVID
King's College Health Partners
Offers a range of reminders and resources/links
NHS Employers: Staff wellbeing and support (March 2020)
Staff support including employer duty of care
Intensive Care Society
Several links to useful posters including 'Advice for sustaining staff wellbeing…'
Moral Injury - Neil Greenberg et al.
Sets out issues and key messages around difficult decisions
Advice for Dept of Veterans affairs USA
Managing healthcare workers' stress
 Professor Richard Williams, University of S. Wales; Dr Esther Murray, St Bartholomew and Royal London Hospitals; Dr Adrian Neal, Aneurin Bevan University Health Board; Ms Verity Kemp, Independent Health Emergency Planning Consultant, Sheffield.
 Neil Greenberg, Professor of defence mental health; Mary Docherty, Consultant liaison psychiatrist; Sam Gnanapragasam, NIHR academic clinical fellow in psychiatry; Sir Simon Wessely, Regius professor of psychiatry
Further support is available from NHS England.
This document provides general information and discussions about health and related subjects. The information and other content provided in this document, or in any linked materials, are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment.
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