The COVID-19 pandemic has received worldwide attention. The increased workload has resulted in greater pressure and emotional issues for healthcare workers [1, 2]. However, little theoretical or empirical work has been devoted to understanding the associations between this pressure and the emotional experiences of healthcare workers during the COVID-19 period.
Healthcare workers are vulnerable to emotional exhaustion. In Britain, between 31% and 54.3% of doctors reported experiencing high emotional exhaustion before the COVID-19 pandemic [3], and as such, exhaustion is likely to be even higher at the current time. Research has demonstrated that front-line medical staff fighting against COVID-19 experience high levels of anxiety and depression [4, 5]. Thus, emotional exhaustion among healthcare workers is associated with a variety of occupational stresses that are likely to increase during the COVID-19 pandemic [6, 7].
In China, more than 40,000 medical staff went to Hubei province to assist with COVID-19, which was regarded as one of the fastest spreading, most extensive, and most challenging public health emergencies China has ever encountered. During the fight against COVID-19, front-line healthcare workers are not only confronting increasing workload and infection risk but also struggling with the exhaustion of their emotional resources. Recently, researchers have called for more attention to be paid to the mental health of first-line medical staff [8, 9, 10]. Therefore, the current state of healthcare workers’ emotional exhaustion, and the key influencing factors and mechanisms of this pressure-emotion mechanism, need to be urgently investigated.
Having a social support network can lead to more effective coping strategies to deal with stress. People under stress can gain a feeling of attachment, care, or help received from interpersonal relationships through social support. One way to gain social support is through social sharing, which occurs when people share their experiences and feelings with others after experiencing emotional events [11], and in particular, negative events [12].
It is unclear how social sharing affects the emotional exhaustion of front-line healthcare workers specifically in the COVID-19 context. Previous studies have regarded social sharing as a positive behavior. For example, a survey of call center employees found that social sharing helped to deplete employee emotional burnout after experiencing work stressors [13]. However, social sharing was recently associated with further deterioration to employee emotional exhaustion when confronting customer mistreatment [12]. According to the conservation of resources theory [14], healthcare workers are more likely to regard time pressure as a threat associated with losing or depleting their resources, which would bring a significant psychological burden. To confront that threat, they would take action such as engaging in social sharing to defend, conserve, and acquire their valued resources. However, social sharing may have the undesired effect of prolonging the negative experience. Therefore, in consideration of front-line healthcare workers during the COVID-19 pandemic, the effect of social sharing on emotional exhaustion remains unknown.
According to emotion regulation theory [15], certain measures can be taken to alleviate the impact of negative events on emotion. Front-line healthcare workers are under heavy rescue burden as they not only put themselves at risk for COVID-19 but also have to rescue increasing patients during a very tense time. As one of the main methods of emotional regulation, cognitive reappraisal enables individuals to appraise stress from a positive perspective. Under the influence of cognitive reappraisal, front-line healthcare workers may reinterpret both their rescue burden and stress as the noble mission of saving lives, thus giving a sense of higher value to their work. As such, people would decrease in their complaining about and sharing of negative events with others as a result of engaging in cognitive reappraisal.
Medical staff, as the main force in facing the potential long-term prevalence of COVID-19 and other unknown infectious diseases [16], require greater attention to be paid to their own health. Our study aimed to explore the relationships among time pressure, emotional exhaustion, social sharing, and cognitive reappraisal, as a means to deepen our understanding of the characteristics and related mechanisms of healthcare workers' emotional exhaustion during the COVID-19 pandemic. This work also aimed to provide a theoretical foundation for the management of healthcare workers' emotional experience as well as the development of psychological interventions, which would be beneficial in improving the emergency response capacity of the public health system.
A theoretical model (see Figure 1a) was established to examine three research questions. First, we aimed to identify the influence of time pressure on emotional exhaustion and explore the potential mediating mechanisms between them. Front-line healthcare workers fighting against COVID-19 are under high pressure due to both heavy workload and urgent time requirements. Research has shown that time pressure has a negative impact, and that individual depression is heavily influenced by the time urgency perceived [17]. In the stressor–outcome literature, scholars have suggested that anxiety, restlessness, and other stressors trigger an individual’s stress response, such as negative emotions and job burnout [18]. Scholars have noted the importance of time pressure and its relation to time constraints and individual perception of stress [19]. Healthcare workers who take responsibility for assisting or treating patients with COVID-19 are likely to experience heavy stress. Under the demands of time pressure, anxiety or restlessness may be aggravated, resulting in emotional exhaustion. Given the importance of understanding the impact of time pressure on the emotional exhaustion of front-line healthcare workers during the COVID-19 pandemic, our study fills a critical gap in the literature by explaining how time pressure influences emotional exhaustion in this context.
Second, we sought to uncover whether social sharing has a positive or negative impact on emotional exhaustion. The conservation of resources theory suggests that individuals experiencing a high level of pressure tend to use coping strategies to deal with negative emotions for the sake of conserving their psychological resources [14]. One of the most common ways that individuals engage in coping is by seeking social support, which is the assistance received from and/or concern perceived by others. When facing time pressures, healthcare workers may wish to relieve their stress and gain social support through sharing negative experiences with others, but the extended review and rumination of negative events may prolong their negative emotions, and thus consume their emotional resources. Hence, we predicted that social sharing would worsen emotional exhaustion rather than relieve it.
Third, we aimed to identify the moderating role of cognitive reappraisal in the relationship between time pressure and emotional exhaustion through social sharing. Healthcare workers undertake heavy burdens resulting from constrained time combined with arduous tasks and may vent their negative emotions through social sharing, such as complaining to others. However, if engaging in cognitive reappraisal, front-line healthcare workers may appraise their pressure in a positive way. They may regard their rescue burden as a glory mission due to their responsibility for saving lives. Thus, we predicted that people would decrease their social sharing (e.g., through complaining or sharing the negative event with others) when their cognitive reappraisal is high. Furthermore, increasing cognitive reappraisal is beneficial to reduce negative emotions and emotional exhaustion [20]. In contrast, we predicted that if individuals are low in cognitive reappraisal, they will have a greater emotional response to stressors and engage in more social sharing behaviors. In this way, time pressure may indirectly lead to increases in emotional exhaustion through social sharing.