Further Resources for Managers

Encourage staff to be kind to themselves and then be kind to others.

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.

Encourage staff to sustain their social connections and maintain contact with families, friends and colleagues whom they regard as sources of social support. This is important whether they are at work, or away from work because of illness or exclusion following the self-isolation requirements. Connect often and by any means and share positive news.

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 and to sustain contacts with friends. All staff must be encouraged to take breaks,  eat and drink, exercise, and make social connections.

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 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.

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.

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.

Monitor updated guidance from the World Health Organisation (WHO), the National Institute for Heath and Care Excellence (NICE) and other authoritative sources as it emerges during COVID-19 outbreak. Be aware of the contents of the current guidance from authoritative sources including the WHO and the UK authorities.

• 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

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