Table 2

The nurture framework: an approach for supporting health professionals during the COVID-19 pandemic and beyond

ValueSupporting examples from respondent dataRecommendations for practice
Trust‘Transparency builds trust. The smoke and mirror tactic of large organisations builds fear and rebellion. It is also highly patronising. If you tell clinicians, you are in trouble and need help… we will use innovative and out of the box thinking to help… if you treat us like mushrooms… you will instantly lose our goodwill (clearly essential in this case), our trust… And our respect’ – #114 (Consultant doctor, gender not stated, NZ European).
‘We have been continually be told not to use PPE unless absolutely necessary, each time the PPE has started to run low our practice/recommendations/criteria have changed to fit the availability of PPE. This had led to an absolute distrust that we are following the best clinical recommendations, instead prioritising reducing the hospitals costs’ – #922 (Anaesthetic technician, male, Māori).
‘Sharing that information makes me feel trust toward the organisation. Transparency and disclosure can create respect, and these form a team mentality’ – #534 (Healthcare assistant, female, NZ European).
  • Healthcare workers are included in decision-making processes.

  • Clinical representation at an organisation’s governance level.

  • Close engagement with healthcare workers in times of PPE supply shortages.

  • Working environment is collaborative rather than managerialist.

Transparency‘Transparency of information during stressful times provides great insight along with understanding. Withholding information provides insecurity/uncertainty and loss of confidence in leadership’ – #1264 (Dental hygienist, female, Māori).
‘Many of the communication issues were due to evolving understanding of proper use of PPE but there was a level of secretiveness and defensiveness when questions were asked that contributed to fear and rumour’ – #1632 (Early career doctor, female, NZ European).
‘Staff were advised about supply chain problems, but without the details, no one knew what to expect next. From an infection control perspective, this is a potential risk, because staff start to make decisions about what is best, and masks are seen worn inappropriately or put in pockets for re-use, as people become nervous that supplies will run out’ – #1179 (Nurse, female, NZ European).
  • Open communication with clear rationale for decision-making provided.

  • Stock level information is accessible to healthcare workers.

  • Honest communication about uncertainty.

  • System failures are appropriately acknowledged rather than blaming individuals.

Safety‘100% adequate and appropriate provision of PPE gear [sic] needs to be provided otherwise I believe we should have the same rights as the general populace and be able to make decisions on our personal well-being not being compromised by a workplace environment’ – #669 (Social worker, female, NZ European).
‘Why were we so unprepared for a pandemic? Are we prepared for the next pandemic? The feeling amongst the nursing staff is that we were like cannon fodder. Pushed out into the front line without protection.(…) This placed staff in an unacceptable place and may have left our vulnerable patients without enough nurses to care for them. Terrified to be working if the next virus is stronger than COVID 19. Will resign in the short term before I put my health at risk’ – #1181 (Nurse, female, NZ European).
‘Feel that some professions did not have equal access to PPE and were told not to wear certain aspects of PPE despite have the clinical reasoning to be able to assess risk and what was required’ – #349 (Physiotherapist, female, NZ European).
  • Commitment towards appropriate occupational health and safety standards for all healthcare workers.

  • Fit testing and checking of FFRs and appropriate PPE donning/doffing training regularly available as per approved safety standards.

  • Welfare/well-being services readily available for healthcare workers requiring them.

  • Safety is acknowledged as a minimum requirement for nurtured healthcare workers.

Respect‘They were inconsistent about the need for PPE and cagey about their policy and uncaring regarding whether I got the plague or not’ #375 (Consultant doctor, male, Māori).
‘The organisation developed an Incident Management Team (IMT) which did a very poor job of communicating who the members were and their roles. The lead clinician sent condescending emails to staff concerns and there was poor communication to frontline staff. The members of the IMT lacked an understanding of the issues faced and we were left to develop our own protocols which the IMT subsequently challenged until they were shown our rationale. This was despite many repeated attempts in engaging them while developing our protocols’ – #1328 (Consultant doctor, male, Asian).
‘Why is it that supermarket workers had access to PPE, and were allowed to wear PPE during the first wave, and we (frontline health workers) weren't? Why did hairdressers get access to PPE when ours was kept under lock and key? Sure, the(organisation*) was going by MoH (Ministry of Health) / WHO (World Health Organization) “guidelines”, but why do other professions care more about their staff than(organisation*)? And why is it okay?’ – #86 (Nurse, female, Asian).
  • Equity between healthcare professions in terms of access to PPE is ensured.

  • Healthcare workers’ concerns are listened to and responded to meaningfully.

  • Care and compassion are demonstrated rather than defensiveness.

  • Healthcare workers are treated as equals within organisations.

  • *The organisation’s name was omitted to ensure anonymity.

  • FFRs, filtering facepiece respirators; NZ, New Zealand.