Dr. El

In “Keeping workers will be biggest struggle for nursing homes as pandemic persists, national policy expert predicts,” McKnight’s Long-Term Care News Staff Writer Danielle Brown reports on the staffing problems outlined by Harvard Medical School health care policy professor David Grabowski, Ph.D. He anticipates that, because of a lack of support, direct caregivers will leave the field due to pandemic-related burnout.

The underinvestment in workers includes problems such as “PPE, testing, the failure to pay our staff a living wage, failure to offer them sick leave and other benefits.” I’d argue that in addition to these failures, there’s been inadequate emotional support of staff around pandemic-related stresses.

Pandemic effects

Along with the changes staff members are experiencing in their home lives and neighborhoods, they may have had to deal with the sudden demise of numerous beloved residents and the families that visited them, the change in job environment from an atmosphere of camaraderie and care to one of danger and fear, the strain of aiding residents who are separated from their families, and, because of visitor restrictions, seeing only the grief-stricken family members of those who are dying. 

Along with worries about having adequate PPE and the physical and financial ramifications of a positive coronavirus test, also contributing to the burnout are the need to wear extensive PPE and to function with continually shifting team members due to virus-related staff shortages.

Recognizing and managing trauma

Leaders seeking to retain their employees, attract new ones and create a positive organizational culture should acknowledge that their direct care workers have been or are currently going through a demanding and possibly traumatic experience and should help them attend to its emotional impact. Research shows that poorer wellbeing and higher burnout are associated with reduced quality and safety of patient care, greater absenteeism, and increased turnover rates.1

A 2018 review of the literature on “Traumatic stress within disaster-exposed occupations” finds that while most employees are able to restabilize emotionally within a month after a work catastrophe, there are certain factors that make this more difficult. 

The researchers find that workers who are most at risk of post-traumatic stress disorder (PTSD) are those who have had difficulties handling other life crises, lack social support, and find themselves either with intense PTSD symptoms or very detached from their emotions in the immediate aftermath of the crisis. 


The authors suggest several ways in which to address the mental wellbeing of staff members. For those workers experiencing immediate extreme distress, referral to a mental health professional is warranted. For other staff members, active monitoring is recommended.

Managers “should be educated to understand the symptoms of, and risk factors for, the more common mental health problems post-disaster (such as depression, anxiety and PTSD).” In addition to department heads, include unit nurses and others who are in the position to observe the emotional responses and interactions of their teams.

They can become more attuned to staff comments that might indicate distress, such as mentions of difficulty sleeping or of excessive drinking. They might be more mindful of arguments between workers as a possible sign of trauma-related irritability. They can increase their compassionate monitoring of coworkers who have added stressors such as a divorce or a death in the family. 

Positive coping mechanisms such as exercise and meditation can be encouraged by offering staff training, handouts on coping skills and other educational efforts. In Britain, for example, professors at the University of Nottingham created an e-toolkit called “Psychological Wellbeing for Health and Care Workers” that offers free, useful and detailed information that facilities can adapt for use to train managers and assist direct care staff.

LTC leaders themselves have their own stresses during this pandemic and may have to dig deep in order to find the emotional resources to help their subordinates. One of the consistent recommendations regarding assisting others is to “fill your own well first.” 

It’s essential for those in leadership roles to take the time for their own psychological wellbeing so that they can model appropriate emotional management for those who look to them for guidance. 

The prescription from Dr. El, first and foremost, is for radical self-care.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her at EleanorFeldmanBarbera.com.