Clinical Editor's Corner: Kern

Impact of COVID-19 on Morale in the Cath Lab (Includes Video Discussion)

Morton J. Kern, MD, MSCAI, FACC, FAHA

Clinical Editor; Chief of Cardiology, Long Beach VA Medical Center, Long Beach, California; Professor of Medicine, University of California, Irvine Medical Center, Orange, California

Morton J. Kern, MD, MSCAI, FACC, FAHA

Clinical Editor; Chief of Cardiology, Long Beach VA Medical Center, Long Beach, California; Professor of Medicine, University of California, Irvine Medical Center, Orange, California

Editor's Note: VIDEO BELOW

Watch CLD's Clinical Editor Morton Kern, MD, as he is joined by guest panelists Srihari Naidu, MD, and Bailey Ann Estes, BSN, RN-BC, RNFA, CNOR, RCIS, in a 30-minute discussion of their research.

When the story of this century is written, researchers and historians will say that 2020 was a terrible, horrible, no good, very bad year (if I can borrow from the famous children’s book by Judith Viorst). The COVID-19 pandemic continues to wreak havoc across the world and our workplace. No one has been spared. COVID-19 has changed the way we work, play, and relate to one another. It is adversely affecting our family’s health, fortunes, and future. Not everyone has been of the same mind as how to prevent the collapse of the healthcare system in order to preserve hospital ICU beds, but the reality of COVID’s impact is undeniable.

To quantitate the impact of COVID-19 on the cath lab, Estes and colleagues1 surveyed cath lab nurses and technologists across the country. Their findings provide important and novel insights into our workplace functions, psychologic state of mind, and future concerns. The study began with an online questionnaire sent back by 450 respondents, of which 283 were nurses and 167 were technologists. The 45-question survey asked about work life, biggest concerns, depression, personal protective equipment (PPE), and administrative support. Most (349 [78%]) respondents were female. The mean age range was 41-50 years. COVID increased stress or anxiety in most, since 68% of respondents were their family’s primary financial provider.

Notable, and perhaps not unexpected, was the fact that 95% of respondents reported a decrease in morale due to the pandemic, which was due mostly to change in work hours, workplace relocation, and layoffs. A majority (74%) of nurses and technologists noted a decrease of 75% or more in patient volume and a decrease in work hours was reported for 65% of nurses and technologists. To meet the hospital’s staffing needs, cath lab workers reported a dramatic change in the care delivery experience. There were high rates of direct care for COVID-19 patients (47%), relocation (45%), layoffs/furloughs of part-time or per diem staff (42%), layoffs of full-time staff (12%), and decreased work hours (65%).

There was a large self-reported increase in mental distress and/or depression (36%). Depression was strongly associated with workplace relocation, staff preparedness, and fewer work hours. The predictors of depression are listed in Table 1. Estes and colleagues1 concluded that changes to cardiac cath lab staffing with relocation, layoffs, furloughs, and diminished work hours which produced financial and emotional calamity all contributed to reduced morale.

Recommendations to Mitigate the Problems

According to Estes and colleagues, leaders should prioritize communication and effective action plans to put systems in place to uncover and reduce mental distress, both inside and outside the workplace. This includes ensuring adequate PPE and training, without which, the staff will not feel comfortable or be prepared to manage COVID-19 patients. Make extra efforts with the goal of retaining nurses/technologists. Without enough trained nurses and techs, the system will collapse to the detriment of all. Particular attention should be paid to those in large urban hospitals, those at most risk for relocation, layoffs, and furloughs, and continually improving perceptions and actual preparedness through better administrative communication and actions. Estes and colleagues said, “A majority of attention and resources has been placed on the patient and physician experience, both in the media and within professional societal consensus documents. Our study suggests that special attention and resources should also be paid to nurses and technologists for their wellbeing to address potential for increased mental and financial distress. Administrative communication on these issues is perceived as poor.”



Speaking With Bailey Ann Estes, RN

I had the pleasure of speaking with Bailey Ann Estes, RN, about how she and her team reached out to nurses and techs across the country to gauge the impact of COVID-19 on their lives. Bailey is from Hendrick Medical Center in Abilene, Texas, and has worked in the lab for about 6 years. She has been interested in writing about the cath lab experience. She and her team are supported by her physician lead, Dr. Joji Varghese, and his colleagues. Experiencing the impact of COVID-19 patients in the rural Texas community, she used social media and the platform Survey Monkey to send an anonymous questionnaire, asking about the logistical, financial, and psychological impact of COVID-19 on cath lab work. Cath Lab Digest and others also helped to share this opportunity to answer the questionnaire via Facebook and Twitter. The answers were then collected, collated, and analyzed for the paper. As noted below, the key finding was that morale is low in 95% of respondents and that with low morale comes some degree of depression. The main contributing factors to depression were then identified as relocation of workplace, concern about adequate preparedness, and loss of work hours. Bailey’s main message is that we should be aware that indeed we are all in this together (“you are not alone”). She also emphasized the following points: We all have the same concerns and fears (work hours, work location, getting sick, and taking time for mental and personal health). Know that your voices as cath lab staff need to be and will be heard, despite the fact that you are perceived to be working just behind the front lines. Lastly, members of administration should provide key support and work to reduce any disconnection in communication between administration and staff. Administrators should emphasize transparency, teamwork, and mutual care among team members. The approach recommended by Estes and colleagues is not only helpful now, during the pandemic, but will also be transformative for the future of working life in the cath lab.

My Thoughts for Building Morale and Strength

All of us recall stories from our friends, parents, and grandparents about the calamities in their lives.  They often say, “Oh, this is not so bad. Look what happened in [name the disaster: the pandemic of 1918, WWI, WWII, the Holocaust, Korean War, Vietnam War, World Trade Center bombing, etc.].” But we know that their attempt to compare the present disaster to the past does not change the impact that this here-and-now pandemic of 2020 has on our lives.

What can we do to build inner strength? We can put our energy into helping each person we work with and each family member. Support them with a kind word, an act of kindness, and make time for them. A lofty goal, I know, but it is true. A sincere smile is but a small gift. Give a gift of knowledge: teach someone a new thing or idea. An elbow bump is a means of telling someone you are with them (we all know hugs are out). Communicate clearly and constructively. Drop the complaints as much as possible. Lead by example. While we are all in this together, not everyone feels this is true. Pop psychology is not my strong suit, but I think that the words of Ben E. King’s timeless classic, “Stand by Me”,2 are a useful morale builder now. 

Disclosures: Dr. Morton Kern reports he is a consultant for Abiomed, Abbott Vascular, Philips Volcano, ACIST Medical, and Opsens Inc.

Dr. Kern can be contacted at

On Twitter @drmortkern

  1. Estes BA, Varghese JJ, Jacques J, Naidu SS. Logistical, financial, and psychological impact of the COVID-19 pandemic on cardiac catheterization lab nurses and technologists: A U.S. national survey. J Invasive Cardiol. 2021 Jan;33(1):E9-E15. Epub 2020 Dec 6. PMID: 33279880.
  2. King BE. Stand by me lyrics. Available online at Accessed January 25, 2021.

Additional Suggested Reading

Szerlip M, Anwaruddin S, Aronow HD, et al. Considerations for cardiac catheterization laboratory procedures during the COVID-19 pandemic: perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) members and graduates. Catheter Cardiovasc Interv. 2020 Sep 1; 96(3): 586-597. doi: 10.1002/ccd.28887. Epub 2020 Apr 21.

Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Cardiol. 2020 May 12; 75(18): 2352-2371. doi: 10.1016/j.jacc.2020.03.031. Epub 2020 Mar 19.

Garcia S, Albaghdadi MS, Meraj PM, et al. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. 2020 Jun 9; 75(22): 2871-2872. doi: 10.1016/j.jacc.2020.04.011. Epub 2020 Apr 10.