Background The Covid-19 pandemic led to increased work-related strain and psychosocial burden in nurses worldwide, resulting in high prevalences of mental health problems. Nurses in long-term care facilities seem to be especially affected by the pandemic. Nevertheless, there are few findings indicating possible positive changes for health care workers. Therefore, we investigated which psychosocial burdens and potential positive aspects nurses working in long-term care facilities experience during the Covid-19 pandemic. Methods We conducted a mixed-methods study among nurses and nursing assistants working in nursing homes in Germany. The survey contained the third German version of the Copenhagen Psychosocial Questionnaire (COPSOQ III). Using Welch’s t-tests, we compared the COPSOQ results of our sample against a pre-pandemic reference group of geriatric nurses from Germany. Additionally, we conducted semi-structured interviews with geriatric nurses with a special focus on psychosocial stress, to reach a deeper understanding of their experiences on work-related changes and burdens during the pandemic. Data were analysed using thematic coding (Braun and Clarke). Results Our survey sample (n = 177) differed significantly from the pre-pandemic reference group in 14 out of 31 COPSOQ scales. Almost all of these differences indicated negative changes. Our sample scored significantly worse regarding the scales ‘quantitative demands’, ‘hiding emotions’, ‘work-privacy conflicts’, ‘role conflicts’, ‘quality of leadership’, ‘support at work’, ‘recognition’, ‘physical demands’, ‘intention to leave profession’, ‘burnout’, ‘presenteeism’ and ‘inability to relax’. The interviews (n = 15) revealed six main themes related to nurses’ psychosocial stress: ‘overall working conditions’, ‘concern for residents’, ‘management of relatives’, ‘inability to provide terminal care‘, ‘tensions between being infected and infecting others’ and ‘technicisation of care’. ‘Enhanced community cohesion’ (interviews), ‘meaning of work’ and ‘quantity of social relations’ (COPSOQ III) were identified as positive effects of the pandemic. Conclusions Results clearly illustrate an aggravation of geriatric nurses’ situation and psychosocial burden and only few positive changes due to the Covid-19 pandemic. Pre-existing hardships seem to have further deteriorated and new stressors added to nurses’ strain. The perceived erosion of care, due to an overemphasis of the technical in relation to the social and emotional dimensions of care, seems to be especially burdensome to geriatric nurses.

Zusammenfassung Pflegekräften kommt eine zentrale Rolle bei der Bekämpfung der Corona-Pandemie zu, auch da der Erfolg der Eindämmung des Virus maßgeblich davon abhängt, wie gut seine Ausbreitung in diversen Pflegesettings verhindert werden kann. Die Kenntnis über den Belastungszustand und zentrale Belastungsfaktoren von Pflegekräften während der ersten Welle der Corona-Krise kann daher wichtige Erkenntnisse liefern, die die Entlastung dieser systemrelevanten Berufsgruppe ermöglichen.

From 2004, German social health insurers are bound by law to offer their insured a gatekeeping option. In return for renouncing direct access to specialist care, the insured can be granted bonus payments by their social health insurer. So far, experience with gatekeeping is very limited in Germany. In social health insurance, sickness funds are very reluctant to offer gatekeeping, although this was already legally possible before 2004. In the private health insurance sector, cost savings in gatekeeping tariffs are probably the result of self-selection of the insured rather than more cost-efficient provision of health care services. International experience does not prove that gatekeeping results in cost savings or a better patient-physician relationship. Although in countries with a strong primary care system there is a higher life expectancy, gatekeeping is not the only factor to bring about this effect. It is not to be expected that the new legislation will result in a major proliferation of gatekeeping options in German social health insurance. Either the gatekeeping options will not be attractive for the insured or sickness funds will use gatekeeping options as an instrument for risk selection.

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