We wanted to understand sources of stress, including betrayal, on health workers during the pandemic. People talk a lot about the frontline healthcare workers and immediately equate them with people wearing scrubs. We included them but we also wanted to study nonclinical workers, whose roles were kind of unrecognized.

Both clinical and nonclinical workers reported that the institution was not doing what it was supposed to do (for example, not providing enough personal protective equipment) or doing what it wasn’t supposed to (for example, ignoring workers’ request for compensation). That was a salient source of stress. We didn’t really expect that.

We also found that failing to keep a trusted relationship between the health institution and employees resulted in higher levels of burnout and career choice regret, which would potentially affect workers’ mental health.

Of course, what the leadership of the institution does is important. But we found that the mid-level management role is really essential. Good management at that level really does have a buffering effect. Fair compensation is also really important. And emotional compensation—just a thank you from leadership, continually saying, “We notice you and your work,” that’s really important.