In response to Rudolph etal.’s (Reference Rudolph, Allan, Clark, Herte, Hirschi, Kunze, Schockley, Shoss, Sonnetag and Zacher2021) focal article, this commentary presents an in-depth view of the application of industrial-organizational (I-O) psychology to the health care industry in a novel coronavirus (COVID-19) pandemic context. We believe that the COVID-19 pandemic may be influencing the fit between health care workers and their job environment in a way that is more nuanced and complex than in other job sectors. Although some industries, such as restaurants and nonessential businesses, are shutting down, health care is experiencing a dramatic increase in operations and responsibility. However, the burnout rate among health care workers was increasing even prior to the pandemic (Reith, Reference Reith2018), suggesting that this increase may worsen stressors in an already strained workforce. Because health care workers represent those on whom we are relying most for their resilience within our communities worldwide, and because of the complexities of their current situation, it is vital to bring more attention to their experiences and needs at this time. Drawing from person–environment (P–E) fit theory (van Vianen, Reference van Vianen2018), we discuss ways that COVID-19 has disrupted fit for some workers while enhancing it for others and reflect upon the implications of P–E fit dynamics on the future health care workforce. The goal of this commentary is to apply a theoretical perspective to a special case of work in a COVID-19 context so that I-O research and practice can best support these essential workers during the pandemic and beyond.
Complexities of the health care worker experience
The level of exposure to COVID-19 among health care workers is significantly higher than in other industries that are still operating during the pandemic (CDC, 2020). We know that an increase in job demands is likely to affect workplace well-being and spill over into workers’ nonwork lives (Talaee, Reference Talaee, Varahram, Jamaati, Salimi and Attarchi2020). However, there is likely to be variance not only in the changes to job demands but also in the extent to which added responsibility is perceived to be a burden. Although other industries, such as transportation and lodging, are more uniformly experiencing the effects of the pandemic, what health care is facing is arguably more nuanced. Emergency departments and intensive care units bear most of the brunt of the COVID-19 caseload; to prepare for this, by either freeing up resources or hiring temporary staff for these high-volume departments, other areas such as elective surgeries or outpatient units within a health system are more likely to be furloughed. To facilitate changes to their workloads, technicians and assistants are being granted greater responsibility, which may give these workers an increased sense of value and purpose in their work. I-O psychologists must be ready to step in and support research around these efforts. Should there be evidence that this redistribution of decision-making power and medical responsibility enhances patient care and reduces the burden on providers, these responses to the current pandemic may evolve into lasting changes to a system that is mired in the issues of understaffing, work overload, and burnout. To best address these changes and support sustainable improvements, we draw from P–E fit theory to further evaluate the COVID-19 challenges that are facing the health care industry.
Changes to health care workers and environments: dynamics of fit
We believe that P–E fit theory is well suited to helping explain the complex situation within the health care industry during the COVID-19 pandemic. P–E fit refers to the compatibility of an individual with their work environment (Caplan & Van Harrison, Reference Caplan and Van Harrison1993). Individuals prefer compatibility with their environment because often they prefer consistency with their behaviors (van Vianen, Reference van Vianen2018). However, COVID-19 has significantly affected millions of workers and their work environments, demanding more of other health care workers than ever before. The changing nature of health care during the pandemic may disrupt the balance of what is expected of workers and whether they feel equipped to meet those demands. Consistent with job demands-resources theory (Bakker etal., Reference Bakker, Demerouti and Sanz-Vergel2014), this disruption of fit is likely to lead to burnout if health care workers feel as though their demands are increasing without the necessary resources available to meet those demands. Beyond job demands-resources theory, however, health care workers may also evaluate the new environment as incompatible with their career or personal goals. Regardless of the nature of the change to individual workers or their work environment, this potential disruption resulting in incompatibility is likely to have significant implications for many of the areas of I-O research and practice indicated in the focal article.
P–E fit disruption
We agree with Rudolph etal. (Reference Rudolph, Allan, Clark, Herte, Hirschi, Kunze, Schockley, Shoss, Sonnetag and Zacher2021) that the stress, demand, and uncertainty during the pandemic are harming worker well-being and mental health, broadly. However, multiple factors are creating stressors for health care workers that are not as prevalent in other job sectors. One is the massive health risk of being a frontline worker among sick patients, causing health care workers to self-isolate from their families to protect against the spread of COVID-19 (Maragakis, Reference Maragakis2020). The pandemic can result in a deterioration of family support structures and stress recovery routines outside of work, causing a disruption to the balance of work and nonwork norms on which health care workers may have relied. This pressure from both work and family safety can exacerbate existing family problems (such as marital issues, financial instability, and chore balance), lack of involvement in past hobbies, and other predictors of burnout during COVID-19. In turn, the worsening conditions that originate in a disruption of fit between the health care worker and their work environment are likely to make it harder for these employees to show up to work fully prepared to handle the demands of caring for patients.
P–E fit enhancement
There may be some positive effects of this disruption as well. In many nurse burnout cases, nurses feel that they lack meaningful work, respect from their superiors, and input in decision making (Mudallal etal., Reference Mudallal, Othman and Al Hassan2017). During the COVID-19 pandemic, nurses have been receiving more responsibility due to a lack of staffing or other changes to the work environment. Additionally, health care workers are receiving new and increased messages of respect and recognition from the community, giving nurses a greater sense of meaning. These changes may reduce burnout for some nurses who may be feeling more fulfilled during the pandemic than before it. Therefore, the work environment changes during the pandemic may cause some nurses to experience a stronger sense of fit than before the pandemic. I-O psychologists are well equipped to assist in the evaluation of these changes, so the enhanced sense of fit due to increased decision-making, responsibility, and meaningful work can be validated with data-based evidence and sustained after the pandemic. When the industry no longer needs to rely as heavily on health care workers, they may be reluctant to give up their newfound authority, which may have created a stronger sense of alignment between their own values and what the work environment requires of them.
Career implications of P–E fit dynamics in health care
Although some cases of enhanced fit are likely as described above, many health care workers may have preferred their work environment before COVID-19, where there were presumably lower levels of time pressure, stress, and fear of virus exposure. During the pandemic, the imbalance of work and family time could lead to an environment fit that is intolerable as the individual’s values are challenged. As the pandemic drags on, it may cause front line workers to consider other career paths that are less stressful, such as virtual, nonessential careers. An important consideration that is not addressed by the focal article is potential alternate career routes that health care workers may pursue should a misfit with their new work environment feel insurmountable. The health care field is highly specialized, with a narrow training pipeline in which one’s education often requires pursuing a specific position, such as an emergency department nurse or a physician’s assistant. It may prove difficult for health care workers to pursue a different career due to the specialization of their medical training. Health care workers may feel trapped within their careers, even if they feel as though COVID-19 changes are pushing them out of the health care industry as their values are challenged and stress is increased. It’s especially important to work to support these employees as they navigate the changes to their work environment so that they have the resources necessary to either meet the new and changing demands or transition into work that is a better fit with their needs and values.
The changes to health care work caused by the COVID-19 pandemic may be influencing students who are considering the health care field during this time to be less inclined to pursue a career in health care. With COVID-19 disrupting senior year preparations for graduate school such as the application process, visiting campuses, and taking the GRE, there may be an increase in applicants who feel that a crisis environment is incompatible with their goals and needs. Conversely, some may find the crisis to be a call to action. There are likely to be those who are drawn to the evolving landscape of health care, for whom the changing work environment driven by the pandemic is more aligned with their goals than it had been before.
To conclude, the pandemic will no doubt leave a lasting mark on many employees’ workplace environments in general and on that of health care workers in particular. It may be a long time before the dust settles and the consequences of changes to both health care workers and the health care industry fully manifest. As the pandemic continues, current and aspiring health care workers will likely spend time reflecting on their careers and considering what must be done to reconcile work environment changes with their own needs and their capacity to contribute to the industry as a whole. Now is the time for I-O psychologists to help health care organizations and workers navigate the evolving situation by examining the changing nature of work, identifying employee and organizational needs, and evaluating the availability of the most appropriate resources for meeting those needs. As society looks to health care to see us through this pandemic, identifying ways to support health care heroes is likely to be an area where I-O psychologists can make provide the most support.
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In response to Rudolph etal.’s (Reference Rudolph, Allan, Clark, Herte, Hirschi, Kunze, Schockley, Shoss, Sonnetag and Zacher2021) focal article, this commentary presents an in-depth view of the application of industrial-organizational (I-O) psychology to the health care industry in a novel coronavirus (COVID-19) pandemic context. We believe that the COVID-19 pandemic may be influencing the fit between health care workers and their job environment in a way that is more nuanced and complex than in other job sectors. Although some industries, such as restaurants and nonessential businesses, are shutting down, health care is experiencing a dramatic increase in operations and responsibility. However, the burnout rate among health care workers was increasing even prior to the pandemic (Reith, Reference Reith2018), suggesting that this increase may worsen stressors in an already strained workforce. Because health care workers represent those on whom we are relying most for their resilience within our communities worldwide, and because of the complexities of their current situation, it is vital to bring more attention to their experiences and needs at this time. Drawing from person–environment (P–E) fit theory (van Vianen, Reference van Vianen2018), we discuss ways that COVID-19 has disrupted fit for some workers while enhancing it for others and reflect upon the implications of P–E fit dynamics on the future health care workforce. The goal of this commentary is to apply a theoretical perspective to a special case of work in a COVID-19 context so that I-O research and practice can best support these essential workers during the pandemic and beyond.
Complexities of the health care worker experience
The level of exposure to COVID-19 among health care workers is significantly higher than in other industries that are still operating during the pandemic (CDC, 2020). We know that an increase in job demands is likely to affect workplace well-being and spill over into workers’ nonwork lives (Talaee, Reference Talaee, Varahram, Jamaati, Salimi and Attarchi2020). However, there is likely to be variance not only in the changes to job demands but also in the extent to which added responsibility is perceived to be a burden. Although other industries, such as transportation and lodging, are more uniformly experiencing the effects of the pandemic, what health care is facing is arguably more nuanced. Emergency departments and intensive care units bear most of the brunt of the COVID-19 caseload; to prepare for this, by either freeing up resources or hiring temporary staff for these high-volume departments, other areas such as elective surgeries or outpatient units within a health system are more likely to be furloughed. To facilitate changes to their workloads, technicians and assistants are being granted greater responsibility, which may give these workers an increased sense of value and purpose in their work. I-O psychologists must be ready to step in and support research around these efforts. Should there be evidence that this redistribution of decision-making power and medical responsibility enhances patient care and reduces the burden on providers, these responses to the current pandemic may evolve into lasting changes to a system that is mired in the issues of understaffing, work overload, and burnout. To best address these changes and support sustainable improvements, we draw from P–E fit theory to further evaluate the COVID-19 challenges that are facing the health care industry.
Changes to health care workers and environments: dynamics of fit
We believe that P–E fit theory is well suited to helping explain the complex situation within the health care industry during the COVID-19 pandemic. P–E fit refers to the compatibility of an individual with their work environment (Caplan & Van Harrison, Reference Caplan and Van Harrison1993). Individuals prefer compatibility with their environment because often they prefer consistency with their behaviors (van Vianen, Reference van Vianen2018). However, COVID-19 has significantly affected millions of workers and their work environments, demanding more of other health care workers than ever before. The changing nature of health care during the pandemic may disrupt the balance of what is expected of workers and whether they feel equipped to meet those demands. Consistent with job demands-resources theory (Bakker etal., Reference Bakker, Demerouti and Sanz-Vergel2014), this disruption of fit is likely to lead to burnout if health care workers feel as though their demands are increasing without the necessary resources available to meet those demands. Beyond job demands-resources theory, however, health care workers may also evaluate the new environment as incompatible with their career or personal goals. Regardless of the nature of the change to individual workers or their work environment, this potential disruption resulting in incompatibility is likely to have significant implications for many of the areas of I-O research and practice indicated in the focal article.
P–E fit disruption
We agree with Rudolph etal. (Reference Rudolph, Allan, Clark, Herte, Hirschi, Kunze, Schockley, Shoss, Sonnetag and Zacher2021) that the stress, demand, and uncertainty during the pandemic are harming worker well-being and mental health, broadly. However, multiple factors are creating stressors for health care workers that are not as prevalent in other job sectors. One is the massive health risk of being a frontline worker among sick patients, causing health care workers to self-isolate from their families to protect against the spread of COVID-19 (Maragakis, Reference Maragakis2020). The pandemic can result in a deterioration of family support structures and stress recovery routines outside of work, causing a disruption to the balance of work and nonwork norms on which health care workers may have relied. This pressure from both work and family safety can exacerbate existing family problems (such as marital issues, financial instability, and chore balance), lack of involvement in past hobbies, and other predictors of burnout during COVID-19. In turn, the worsening conditions that originate in a disruption of fit between the health care worker and their work environment are likely to make it harder for these employees to show up to work fully prepared to handle the demands of caring for patients.
P–E fit enhancement
There may be some positive effects of this disruption as well. In many nurse burnout cases, nurses feel that they lack meaningful work, respect from their superiors, and input in decision making (Mudallal etal., Reference Mudallal, Othman and Al Hassan2017). During the COVID-19 pandemic, nurses have been receiving more responsibility due to a lack of staffing or other changes to the work environment. Additionally, health care workers are receiving new and increased messages of respect and recognition from the community, giving nurses a greater sense of meaning. These changes may reduce burnout for some nurses who may be feeling more fulfilled during the pandemic than before it. Therefore, the work environment changes during the pandemic may cause some nurses to experience a stronger sense of fit than before the pandemic. I-O psychologists are well equipped to assist in the evaluation of these changes, so the enhanced sense of fit due to increased decision-making, responsibility, and meaningful work can be validated with data-based evidence and sustained after the pandemic. When the industry no longer needs to rely as heavily on health care workers, they may be reluctant to give up their newfound authority, which may have created a stronger sense of alignment between their own values and what the work environment requires of them.
Career implications of P–E fit dynamics in health care
Although some cases of enhanced fit are likely as described above, many health care workers may have preferred their work environment before COVID-19, where there were presumably lower levels of time pressure, stress, and fear of virus exposure. During the pandemic, the imbalance of work and family time could lead to an environment fit that is intolerable as the individual’s values are challenged. As the pandemic drags on, it may cause front line workers to consider other career paths that are less stressful, such as virtual, nonessential careers. An important consideration that is not addressed by the focal article is potential alternate career routes that health care workers may pursue should a misfit with their new work environment feel insurmountable. The health care field is highly specialized, with a narrow training pipeline in which one’s education often requires pursuing a specific position, such as an emergency department nurse or a physician’s assistant. It may prove difficult for health care workers to pursue a different career due to the specialization of their medical training. Health care workers may feel trapped within their careers, even if they feel as though COVID-19 changes are pushing them out of the health care industry as their values are challenged and stress is increased. It’s especially important to work to support these employees as they navigate the changes to their work environment so that they have the resources necessary to either meet the new and changing demands or transition into work that is a better fit with their needs and values.
The changes to health care work caused by the COVID-19 pandemic may be influencing students who are considering the health care field during this time to be less inclined to pursue a career in health care. With COVID-19 disrupting senior year preparations for graduate school such as the application process, visiting campuses, and taking the GRE, there may be an increase in applicants who feel that a crisis environment is incompatible with their goals and needs. Conversely, some may find the crisis to be a call to action. There are likely to be those who are drawn to the evolving landscape of health care, for whom the changing work environment driven by the pandemic is more aligned with their goals than it had been before.
To conclude, the pandemic will no doubt leave a lasting mark on many employees’ workplace environments in general and on that of health care workers in particular. It may be a long time before the dust settles and the consequences of changes to both health care workers and the health care industry fully manifest. As the pandemic continues, current and aspiring health care workers will likely spend time reflecting on their careers and considering what must be done to reconcile work environment changes with their own needs and their capacity to contribute to the industry as a whole. Now is the time for I-O psychologists to help health care organizations and workers navigate the evolving situation by examining the changing nature of work, identifying employee and organizational needs, and evaluating the availability of the most appropriate resources for meeting those needs. As society looks to health care to see us through this pandemic, identifying ways to support health care heroes is likely to be an area where I-O psychologists can make provide the most support.