Excessive feelings of guilt, extra infection control precautions, unprecedented long work hours and personal healthcare sacrifices were common among nursing home leaders during the height of the pandemic, a unique new study reveals.
Missing in most COVID-era studies on nursing home staff stress, burnout and career implications has been a focus on how the pandemic has affected building leaders. Now, there’s a picture of just how heavy the additional burden of staff responsibility was.
An analysis of 21 managers and directors of care during the first four months of 2021, before Canada had wide vaccine distribution, identified four major themes illustrating the pandemic’s impact on the leaders: 1) responsibility to protect, 2) overwhelming workloads, 3) mental and emotional toll and 4) moving forward.
“Nursing home leaders felt overwhelmingly responsible for protecting residents, staff, and their own families,” the University of Alberta researchers wrote in the November issue of JAMDA. “This led many to promote infection control, for both themselves and staff, well beyond public health precautions. Leaders described suspending social interactions within their own households and asking staff to do the same. Leaders were acutely aware that their actions, and those of their staff and families, could be fatal for residents in their care.”
Despite the leaders’ best efforts, COVID-19 spread into most nursing homes. One-third of the study participants experienced one or more severe outbreaks before their interview with researchers.
“When first outbreaks hit, leaders reported feeling devastated by their inability to protect staff and residents,” study findings noted. “Leaders feared infecting others and took even more stringent measures to protect their families and communities. One leader described foregoing medical treatment to avoid infecting other health settings. Another spoke about isolating in her basement while, upstairs, her father told her young son that she was not home.”
Poor policy guidance
Work overload caused chaos, hastened by short-notice updates of public health policy, constant understaffing, and planning and replanning of schedules. Weeks often went by without a day off.
“Leaders described learning of new nursing home mandates simultaneously with the public through media announcements, frequently late on Friday,” the study noted. “They scrambled to implement new measures, often by the next day. They described wasting time, money and resources reworking internal processes to comply, only to learn of changes a day later.”
The study featured observations from participants. On the theme of mental and emotional toll, one said, “There are still a couple of our staff members out with post-COVID related symptoms, very serious ones. Those are the ones that [colleague] and myself, we carry lots of guilt over and we can’t change it, but I mean, they were staff that we redeployed.”
The toll resulted in those interviewed rethinking their career.
“I believe the things that I’ve witnessed, and been part of, will impact me for the rest of my life,” one noted. “I think it’s made me move up my retirement date, to tell you the truth.” Another: “I’m out of here. I don’t care. I don’t care if I can’t afford it. I just don’t care. Not that I don’t care about the people here, but in all of my years of nursing, I have never worked this hard.”
There was light during and after the darkness, the researchers reported. Participants noted positive changes from the depths of the emergency. They included better team cohesion, staff’s personal and professional growth, and their own personal relations with staff improved from assuming frontline duties. They also noted long-needed changes around care processes, funding, full-time staffing, and technology enabling family contact with residents.
The investigation was funded by the Alberta Ministry of Health and the Canadian Institutes of Health Research.
