Research isolates nursing residence managers’ distinctive stressors from the COVID-era

Excessive guilt, extra infection control precautions, unprecedented long hours and personal sacrifices for healthcare were rife among nursing home managers during the height of the pandemic, a unique new study shows.

Most COVID-era studies of the stress, burnout, and career impact of nursing home workers lacked a focus on how the pandemic has impacted construction managers. It is now becoming apparent how great the additional burden of personnel responsibility was.

An analysis of 21 managers and care leaders in the first four months of 2021, before Canada had widespread vaccine distribution, identified four key themes that illustrate the impact of the pandemic on leaders: 1) responsibility to protect, 2) overwhelming workload, 3) mental health and emotional toll and 4) moving forward.

“Nursing home managers felt an overwhelming responsibility to protect residents, staff and their own families,” the University of Alberta researchers wrote in the November issue of JAMDA. “This prompted many to push infection control well beyond public health precautions, both for themselves and for staff. Executives described how they suspended social interactions in their own homes and asked employees to do the same. Managers were acutely aware that their actions, and those of their staff and families, could be fatal to residents in their care.”

Despite the best efforts of those responsible, COVID-19 spread to most nursing homes. A third of the study participants experienced one or more severe outbreaks prior to their interview with the researchers.

“When the first outbreaks occurred, managers reported feeling devastated at their inability to protect staff and residents,” the study’s findings read. “Leaders feared infecting others and took even more

strict measures to protect their families and communities. A leader described forgoing medical treatment to avoid infecting other healthcare facilities. Another spoke of isolating in her basement, while upstairs her father told her young son she wasn’t


Bad political leadership

Overwork caused chaos, accelerated by last-minute public health policy updates, constant understaffing, and scheduling and rescheduling. Weeks often went by without a day off.

“Executives described learning about new nursing home mandates at the same time as the public through media announcements, often late on Friday,” the study reads. “They made efforts to implement new measures, often the very next day. They described wasting time, money and resources revising internal processes to comply, only to hear about the changes a day later.”

The study contained observations made by participants. On the subject of the mental and emotional toll, one said: “There are still a few of our employees with post-COVID related symptoms, very serious ones. Those are them [colleague] and myself, we carry a lot of guilt and we can’t help it, but I mean they were employees that we reinstated.”

The toll prompted respondents to reconsider their careers.

“I believe the things that I witnessed and was a part of will affect me for the rest of my life,” one noted. “I think that’s what made me want to bring my retirement date forward, to tell you the truth.” Another: “I’m outta here. I do not 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 my years of nursing I’ve never worked so hard.”

There was light during and after the darkness, the researchers reported. Participants noted positive changes from the depths of the emergency. These included better team cohesion, staff personal and professional growth, and their own personal relationships with staff improved through taking on front-line responsibilities. They also identified long-needed changes to care processes, funding, full-time staffing, and technology that enable family contact with residents.

The research was funded by the Alberta Department of Health and the Canadian Institutes of Health Research.

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