‘My Crimean War’ – Long-term care managers on working during the early waves of the pandemic

“Despair.” “Guilt.” “Hell.” “Traumatizing.” “This was my Crimean War.”

These are the words of nursing home managers talking about their work experiences during the early part of the COVID-19 pandemic.

Like Florence Nightingale and her nurses who coped with poor sanitation, supply shortages and overwhelming numbers of wounded soldiers during the 1850s Crimean War, nursing home leaders and their frontline staff worked tirelessly under gruelling conditions in the early months of COVID-19 to care for residents and keep them safe.

Despite their best efforts, the virus swept through many nursing homes, sickening and killing thousands of residents and staff. The deaths, lockdowns, severe staffing shortages and overwhelming workloads COVID-19 brought have taken a toll on everyone associated with long-term care, including the managers and directors of care responsible for frontline staff and ensuring good quality of care for residents.

Two studies that my colleagues and I recently published reveal that these leaders are exhausted, at risk of burnout and considering leaving their job or the nursing profession altogether. We cannot afford to lose them.

Workforce shortages are already a long-standing problem in nursing homes and leaders have a direct effect on staff turnover and the quality of care the homes provide. Governments and other decision makers need to understand the profoundly negative effect that the pandemic has had on nursing home leaders and develop and adopt policies and strategies to better support them.

One of our studies involved interviews with 21 nursing home leaders from eight nursing homes in Alberta and British Columbia between January and April 2021. The managers we interviewed felt a tremendous sense of responsibility for protecting residents, staff, and their own families from COVID-19 and were devastated when the virus made it into their nursing homes. One manager called it a “kick in the stomach,” as she described the despair she felt seeing staff and residents sick and dying from COVID-19.

Managers also reported experiencing grief and guilt for residents isolated from their families and for sick and dying residents and staff who contracted COVID-19 at their nursing homes.

Nursing home leaders had to deal with overwhelming workloads resulting from frequent changes in public health orders, often with short notice, that left them scrambling to put new measures in place. Staff shortages sometimes required them to do frontline care as well as their administrative duties. Many worked weeks without any time off.

One nursing leader described the period as “probably the worst experience of my 40 years in nursing,” saying, “There were a few mornings I’d come in when I should have six health care aides and two LPNs [licensed practical nurses] and there was myself and two health care aides to run this floor of 34 patients sick with COVID. It was traumatizing!”
The second study shows how managers’ scores on important quality of work life and health measures deteriorated over time. For this study, we surveyed 181 care managers at 27 nursing homes in Alberta in February 2020, before the pandemic, and in December 2021, 21 months into it.

Comparing the results from both sets of surveys, we found that as time went on, nursing home leaders experienced significant decreases in job satisfaction, mental health and confidence in being able to do their work. Their levels of exhaustion and cynicism rose, putting them at risk of burnout.

Prior to the pandemic, these measures had been stable for more than a decade.

Nursing home leaders also reported carrying a tremendous “burden of worry” about the mental health and well-being of their staff, which added to their own stress and exhaustion.

Some leaders said they were contemplating resigning or retiring from nursing, citing the overwhelming workload and stress, lack of support and recognition, feeling ineffective and personal/family issues as the reasons.

The studies’ findings paint an alarming picture of leaders stretched to the limit emotionally, mentally and physically as they strived to meet the needs and expectations of residents, families, senior management, staff, regulators and the public during a very chaotic period.

And it is not over. They continue to face residents and staff who are sick, and staff shortages that leave them unable to provide the care that residents’ need. COVID and its ongoing aftermath haven’t gone away.

Given the serious workforce shortages and other issues already facing nursing homes, we cannot afford to ignore these findings. Governments and policy makers need to act now to address the concerns raised and find ways to support these leaders.

Dr. Carole A. Estabrooks is Scientific Director of the pan-Canadian Translating Research in Elder Care (TREC) and Professor & Canada Research Chair, Faculty of Nursing at the University of Alberta.