Tips for Managers and Team Leaders

• Staff may feel particularly vulnerable at being asked to undertake things that they do not feel trained to do, or that they no longer feel skilled to undertake
• It is important to provide training, support, ongoing supervision and feedback on practical skills
• Students and other learners who have been redeployed or had their training interrupted may experience additional stress or anxiety about this move. They may worry about the tasks they are facing
• Enable these people particularly to ‘buddy up' with an experienced team member and try to offer them familiar supervision and support
• Help them to map their new experiences on to their original programmes of study, so that all learning makes more sense
• Encourage them to use reflective journals or other methods of documenting their time; not only can it help process the experience but it gives evidence towards progression when studies formally recommence
• ‘Fresh eyes’ can sometimes be most useful in seeing what was missed by others; encourage them to openly question for everyone’s benefit

• High quality leadership is hugely important: be a good role model and follow the principles you are suggesting to your staff
• This means honesty, fairness and transparency about the challenges and ambiguities staff are facing, along with:
  • Good supervision
  • Access to proper equipment, time for rest breaks, quiet rooms
  • Peer support within teams, allowing time for questions from your colleagues
  • Be aware of staff who are vulnerable (e.g. with pre-existing medical or mental disorders) and find appropriate solutions for them

• Decompression and structured operational debriefs: These are made routine ways to relieve the build-up of stress during a shift by sharing at its end and learning from each other. This sharing has to be blame-free, iterative, reflective, kind and supportive. It cascades and influences compassion and attitudes to each other and our ill patients. It is sometimes called operational team debriefing.
• NB. Ensure staff do not feel compelled to talk about personal experiences they do not feel ready to talk about
• There are different styles used to help decompress including ‘buddy systems’ and modified Schwartz rounds with a facilitator
• However, psychological debriefing session/s, which were in vogue some years ago, after a traumatic misadventure have been found to be harmful and worsen the psychological outcomes for staff
• As a manager or team leader it may be helpful to seek advice from your colleagues in psychiatry or clinical psychology on how to set up an appropriate support system for your staff. You are advised to refer to the national pathway
• It is necessary to have other mechanisms to reach out to those who do not immediately participate (or even more worryingly, refuse to participate) in offers of support or processes intended to support mental wellbeing
• We are not superheroes. We need to be looked after too. That is a top priority so that we can carry on effectively in our role or service

• Moral injury occurs when there is conflict between your moral code and the decisions that you and others have had to take. This is a well-recognised risk when difficult decisions have to be made under pressure
• Moral injury can result in persistent guilt, shame, self-disgust or disillusion with the team and the task
• Though not a formal mental condition in itself, it can make a person much more vulnerable to mental health problems
• Team leaders need to help their staff with these dilemmas. Decompression/operational team debriefing may help
• Remember simple things like support from each other buddies, team members and line manager makes a huge difference. Some staff may have additional needs. Support should be considered along the usual pathways for the organisation, locally and using national support services
• Learning from experiences means that at times decisions or policies may need to be reviewed

• Encourage staff not to hesitate to ask you or your institution for help
• Encourage them to call friends or family – it helps to avoid them feeling isolated inside a closed environment
• Ensure you and your staff have breaks during the day: you will be more useful if you’re well rested than if you are too tired
• Think about putting into place rotations between high stress duties and lower stress duties 
• Think about working in pairs, between junior and senior professionals. This facilitates support and management of stress
• Make use of existing support mechanisms in your organisation and the NHS Staff Support helpline

• The correct PPE in plentiful supply
• Adequate rest breaks
• Good quality food available
• Assisting with maintaining contact virtually with loved ones
• Psychological safety within teams has been shown to reduce errors
• Emotional support does not stand in place of physical needs and resources

• Stay hydrated, eat and have toilet breaks
• If it gets too hot – tell others and take a short break
• Beware exhaustion –
  • Constant awareness and vigilance regarding infection control is a pressure – and it’s important to recognise it
  • Be aware that masks etc can rub the skin and distract; use a barrier cream on cleansed skin
• Counter the physical isolation of PPE – staff need to be able to communicate with others when possible, including of course their patients – remember patients may well also feel overwhelmed

• Healthcare workers can be affected by both self-critical and external stigma related to the COVID-19 virus and its impact, such as:
  • Healthcare workers’ self-stigma about voicing their needs and fears
  • Managers can help by empathising, pointing out that stigma is unsurprising, if distressing within the COVID-19 situation, and highlighting camaraderie at work
  • Others’ fear of contact with those treating patients with COVID-19

• Potential trauma plays out across more than one aspect of staff members’ lives. Work, home and friendships may be affected over time
• Set up a system for staff to feedback on management initiatives so that concerns can be raised and responded to rapidly in a visible way
• If staff are being moved away from their home area, or cannot go home because of a fear for their loved ones, this can exacerbate guilt at not being at home to support their families

• They may show you this through what they say or how they behave
• Be supportive and compassionate. It is not their fault but rather the situation
• People may display longer term stress and even burnout in an apparently disproportionate response to a single incident. Be aware of this
• People who are new to an environment or situation often need longer to process what’s happening. Allow for this

Support the Workers 
Rapid evidence-based training and support curriculum for staff providing psychosocial support to frontline workers.

The Lancet 
Mental Health Care for Medical Staff in China during Covid-19 outbreak

Intensive Care Society 
Poster series aimed at improving our understanding of psychological wellbeing at work

US department for Veterans Affairs 

US department for Veterans Affairs - National Center for PTSD 
Helping people manage stress associated with the Covid-19 Virus outbreak

Center for the Study of Traumatic Stress (US) 
Leadership Communication: Anticipating and Responding to Stressful Events

Center for the Study of Traumatic Stress (US) - Leaders Guide 
Leaders Guide to Risk Communication in the Face of Coronavirus and Other Emerging Public Health Threats

NHS Employers
Protecting the Mental Wellbeing of Staff

Centre for Mental Health
Keeping yourself and others safe: Leadership in the age of COVID-19

Dr Alys Cole-King 
Optimising staff preparedness, wellbeing, and functioning during the COVID-19 pandemic response