Healthcare Personnel's Perspectives on the Impacts of Multiple Disasters on the Workforce in Puerto Rico.

Objective: To examine how healthcare personnel in Puerto Rico perceive the impact of successive disasters on the healthcare workforce.

Study setting and design: Qualitative in-depth semi-structured interviews were conducted with key informants from hospitals and Federally Qualified Health Centers (FQHCs) across Puerto Rico. Interviews were conducted via Zoom or in-person between 2023 and 2025.

Data sources and analytic sample: Thirty-one (31) key informants were interviewed. Deductive and inductive thematic content analyses were conducted using both a priori codes informed by the interview questions and emergent codes following data collection. Each transcript was coded by 2-3 coders using NVivo 14 software. Coding discrepancies were discussed until a consensus was reached. This study focuses on findings from two deductive codes that align with the study's research questions.

Principal findings: Repeated exposure to successive disasters in Puerto Rico contributed to a prolonged state of emotional distress among healthcare workers and staff, including feelings of stress, sadness, fear, and anxiety. These emotions contributed to burnout, staff attrition, and staff turnover. Recent healthcare graduates often lacked relevant clinical experience due to COVID-19 pandemic-related shifts to online education, which placed additional pressure on facilities to provide this essential training.

Conclusions: Successive disasters led to prolonged emotional distress among the healthcare workforce, contributing to burnout, attrition, turnover, and reduced capacity to deliver high-quality care. The findings underscore the need for workforce policies that reduce disaster-related stressors and increase mental health support and clinical training opportunities for healthcare workers in Puerto Rico amid future disasters.