April 13, 2021
In a recent study,1 Elizabeth M White, PhD and her colleagues conducted surveys of staff using opened-ended questions. The results of this study appeared in JAMDA and identified seven basic themes:
- The virus imposed constraints on PPE and COVID-19 testing.
- There were burdensome regulations and guidance.
- Many staff had concerns for themselves as well as their families.
- The staff expressed concerns for their residents.
- Burnout was experienced.
- Working in an atmosphere that fostered teamwork, communication and flexibility was valued.
- Public blame and the lack of recognition of their efforts were negative outcomes of the pandemic.
Using these experiences, long-term care administrators can implement meaningful interventions to address the modifiable aspects of these concerns, including having sufficient amounts of PPE on hand as well as dependable pipelines to access additional masks, gloves, gowns and other necessary barriers.
Although facilities themselves are governed by federal and state regulations, nursing homes can provide an interpretation and rationale for why the rules are developed as well as why they are changed. In order to have staff embrace regulations, they need to understand their purpose and why individuals should follow those guidelines.
Understanding how each staff member interprets their own risks, those who are caregivers to older people, those who have young children at home, those who have chronically ill family members in their home and staff members who live in multi-generational households is necessary in order to support their decision-making abilities. This is particularly relevant when discussing the risks and benefits of COVID-19 vaccinations with staff members.
Burnout has long been an issue for nurses in general and specifically for long-term care nurses. Symptoms of burnout may not be obvious for nursing staff and working shorthanded for protracted periods of time coupled with the impact of illness, death and concerns from family members unable to visit clearly compounded the issue. Interventions to address and manage stress, a re-evaluation of human resources policies for sick leave and vacation and employee assistance programs for mental health support should be communicated with staff.
Having a nursing department structure that promotes staff based not only on longevity but an understanding of how to motivate and lead employees should focus on teamwork and the shared responsibility for resident care. This education may not have been taught in nursing school and likely require that the facility provide the nursing staff with these skills.
Finally, COVID-19 has brought nursing homes into the public dialogue, in positive and negative ways. The scandal of reporting nursing home deaths, the fact that only 1% of Americans live in long-term care but nearly 40% of the pandemic deaths occurs in nursing homes caused many to have a negative view of the industry. However, nurses have been viewed as the heroes of the epidemic and the public may have an improved understanding about the difficulties encountered by long-term care facilities, realizing that the blame for residents’ deaths is attributed to many factors beyond the control of the nursing staff or the nursing home administrator. What we can do is to understand these issues and to move ahead with the knowledge of how to implement meaningful changes.
Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, is an assistant professor in the Department of Geriatrics and Palliative Medicine at the Philadelphia College of Osteopathic Medicine. Dr Warner-Maron is also the executive director of the Eastern Pennsylvania Geriatric Society.
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White EM, Wetle TF, Reddy A, Baier RR. Front-line Nursing Home Staff Experiences During the COVID-19 Pandemic [published correction appears in J Am Med Dir Assoc. 2021 Mar 26;:]. J Am Med Dir Assoc. 2021;22(1):199-203. doi:10.1016/j.jamda.2020.11.022