1. Berkow, Steven JD
  2. Virkstis, Katherine ND
  3. Herleth, Anne MSW, MPH
  4. Whitemarsh, Karl BA
  5. Rewers, Lauren BA


The COVID-19 pandemic has left frontline staff burned out and exhausted. Meanwhile, executives need to ask more of their staff to ensure organizational viability. In this article, the authors propose that executives commit to taking specific actions to create a more supportive work environment and form an executive-clinician compact. This article outlines the 5 actions executives should take to bolster staff engagement and resilience long-term.


Article Content

The COVID-19 pandemic has caused burnout and distress among clinicians on a scale rarely seen in modern history. An early survey of clinicians treating patients exposed to COVID-19 demonstrated high levels of depression, anxiety, insomnia, and distress among frontline staff, which were even more prevalent among nurses.1 Research on clinician well-being from the 2003 severe acute respiratory syndrome pandemic indicates that the COVID-19 pandemic may negatively impact clinician mental health in the long-term.2


As many US cities continue to see a high number of COVID-19 cases,3 health system executives face a plethora of new challenges critical to ensuring their organizations' financial sustainability, including working through a backlog of scheduled procedures, building robust telemedicine capabilities, and making substantial cost reductions to offset revenue declines. Successfully addressing these challenges means that executives must ask even more of their staff, from increasing productivity to being comfortable with ongoing uncertainty.


Creating an Executive-Clinician Compact

Nurse executives recognize that they need to develop a new strategy to support staff resilience and engagement.4,5 Efforts so far have focused on recognizing the frontline for their lifesaving work.6,7 Although recognition is important, it will not be enough to support staff through the substantial change that many health systems will continue to undergo in the coming months.


As executives ask more of their staff to ensure long-term organizational viability, we propose that leaders in turn commit to taking specific actions to create a more transparent and supportive work environment. In other words, executives should form a compact with clinicians, so each party has a mutual understanding of their commitment to each other throughout the long road to recovery.


5 Executive Actions to Engage Staff Amid COVID-19

To identify the actions that executives should take to form this compact, researchers drew on existing Advisory Board research on nurse resilience and engagement8,9 and analyzed peer-reviewed literature on clinician moral distress, strategies to support clinician well-being, and the impact of previous pandemics on clinician mental health. We propose 5 actions that healthcare executives can take to support staff in a medium- to long-term crisis. Although these actions were developed to help executives respond to the COVID-19 pandemic, we believe they are applicable to medium- to long-term crises beyond COVID-19.


* Ensure that staff are safe and feel safe when working. Healthcare organizations must maintain efforts to protect frontline staff safety, such as securing personal protective equipment and designing robust infection control protocols. As knowledge about the virus evolves, leaders must also adopt a greater level of transparency with frontline staff about who is making decisions on safety standards, what clinical evidence is guiding each decision, and when and how staff can expect updates.


* Reinvigorate your staff input channels and act on what you can. Early incident command structures prioritized rapid decision making over collecting input from a wide variety of frontline clinicians. As organizations transition out of the acute crisis, leaders should deliberately seek staff input through existing channels such as town hall forums, leader rounding, and employee councils. Leaders should be able to identify specific changes made in the last month in response to staff input.


* Do not sugarcoat the challenge ahead. In the midst of so much uncertainty, leaders understandably want to reassure their frontline. However, leaders must strive to be transparent with clinicians about the pressing economic and other challenges facing the organization. Without this context, frontline staff will struggle to understand any difficult trade-offs that executives have to make to ensure long-term viability.


* Plan for your worst-case scenarios so you do not go back on even 1 commitment. Leaders must plan for how their organization would handle a worst-case scenario to avoid making commitments to staff they cannot keep. To do so, leaders should proactively build a tiered action plan in which they assign organizational responses to likely, middle-, and worst-case economic scenarios, along with specific metrics indicating that the next tier has been reached. As the organization approaches the criteria indicating a poor scenario, leaders can prepare their staff for more substantial organizational change.


* Transition your leaders from sprint mode to marathon mode. Frontline managers are also at risk of burnout if they continue to work as they did during an acute COVID-19 surge. Executives must help managers deprioritize nonessential projects to reduce workload and encourage managers to consciously take time to invest in their own ongoing well-being.




Frontline engagement and resilience are in danger as executives have to ask more of their staff to maintain long-term organizational viability. To support staff through the COVID-19 pandemic, executives should commit to these actions to maintain a safe and supportive working environment. For more information, JONA readers can request a copy of the Advisory Board publication, Bolster Employee Engagement Amid COVID-19.10




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2. Maunder RG, Lancee WJ, Balderson KE, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis. 2006;12(12):1924-1932. [Context Link]


3. Centers for Disease Control and Prevention. United States COVID-19 cases and deaths by state. Accessed September 10, 2020. [Context Link]


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8. Herleth A. Rebuild the Foundation for a Resilient Workforce. Washington, DC: Nursing Executive Center, The Advisory Board Company; 2018. [Context Link]


9. Berkow S, Stewart J, Virkstis K, Adler K. National Prescription for Nurse Engagement. Washington, DC: Nursing Executive Center, The Advisory Board Company; 2014. [Context Link]


10. Berkow S, Vonderhaar K, Herleth A, Whitemarsh K. Bolster Employee Engagement Amid COVID-19. Washington, DC: Advisory Board; 2020. [Context Link]