10 - Exploring the Impact of the Humanitarian Migrant Crisis on an Urban Safety-Net Hospital and its Frontline Staff: A Mixed-Methods Study

Publication Number: 3009.10

Rita Wang, Lucile Packard Children's Hospital Stanford, Redwood City, CA, United States; Raquel Selcer, Boston Children's Hospital, Boston, MA, United States; Kriti Prasad, Boston University School of Medicine, Boston, MA, United States; Jeffrey Campbell, Boston University School of Medicine, Boston, MA, United States; Genevieve Preer, Boston University School of Medicine, Boston, MA, United States; Megan Sandel, Boston University School of Medicine, Boston, MA, United States

Background: Migrant families have been displaced from their home countries due to sociopolitical and economic instability, seeking refuge in the United States. In Massachusetts, they have faced challenges in navigating complex healthcare and housing systems, and often present to safety-net hospitals for support. Few studies have explored the emotional toll experienced by clinical and non-clinical healthcare frontline staff (FS) during the humanitarian migrant crisis. In navigating strained public systems, frontline staff hold unique perspectives on improving support for immigrant patients.

Objective: To examine burnout and compassion satisfaction rates of FS caring for immigrant patients during the migrant crisis, explore perspectives on the strengths and limitations of the safety-net system, and identify areas for advocacy and interventions to improve care for migrant families.

Design/Methods: In this IRB-approved mixed-methods study, we distributed the validated Professional Quality of Life survey to assess compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) of FS who cared for migrant patients from 2021-2024 at an urban safety-net hospital. We then invited FS for follow-up semi-structured interviews to explore perspectives of caring for migrant patients, factors contributing to FS stressors and resilience, and future areas for advocacy. Thirty interviews were conducted to reach thematic saturation. Through inductive thematic analysis, we noted key themes and quotes using NVivo.

Results: All 196 FS survey respondents had either moderate or high CS. More than half had moderate burnout and STS. None reported high burnout or low CS (Table 1). We interviewed 30 FS including physicians, nurses, patient navigators, social workers, chaplains, and interpreters (Table 2). Participants identified 1) strengths and challenges of the safety-net system, 2) factors contributing and protecting against FS burnout, and 3) recommendations for improved care delivery to migrant patients (Table 3).

Conclusion(s): Survey results suggest that while burnout and STS are present among FS, they also experience significant satisfaction from caring for migrant families in a safety-net system. Interview themes demonstrated that hospital mission-alignment and staff camaraderie maintained FS motivation to care for migrant families, factors that may be protective against burnout. Creating collaboration opportunities for advocacy can be protective for FS mental health. Our study also showed that FS in both clinical and non-clinical roles provide valuable reflections in improving immigrant patients' healthcare access and quality.

Table 1: Distribution of Frontline Staff Based on Measured Metrics of the Professional Quality of Life (ProQoL) Scale Survey
The total number of frontline staff who responded to the ProQoL survey was 196. Note, all percentages may not total 100 % due to rounding.

Table 2: Demographic Characteristics of Frontline Staff Participating in Qualitative Interviews
A total of 30 frontline staff members participated in an optional follow-up qualitative interview. Note, all percentages may not total 100 % due to rounding. Participants could self-identify as more than one race and/or ethnicity and multi-departmental affiliations.

Table 3: Illustrative Quotes of Frontline Staff Participants from Qualitative Interviews