Perspectives of certified nursing assistants and administrators on staffing the nursing home frontline during the COVID‐19 pandemic

Abstract

Objective To identify best practices to support and grow the frontline nursing home workforce based on the lived experience of certified nursing assistants (CNAs) and administrators during COVID‐19. Study setting Primary data collection with CNAs and administrators in six New York metro area nursing homes during fall 2020. Study design Semi‐structured interviews and focus groups exploring staffing challenges during COVID‐19, strategies used to address them, and recommendations moving forward. Data collection We conducted interviews with 6 administrators and held 10 focus groups with day and evening shift CNAs ( n = 56) at 6 nursing homes. Data were recorded and transcribed verbatim and analyzed through directed content analysis using a combined inductive and deductive approach to compare perceptions across sites and roles. Principal findings CNAs and administrators identified chronic staffing shortages that affected resident care and staff burnout as a primary concern moving forward. CNAs who felt most supported and confident in their continued ability to manage their work and the pandemic described leadership efforts to support workers' emotional health and work–life balance, teamwork across staff and management, and accessible and responsive leadership. However, not all CNAs felt these strategies were in place. Conclusions Based on priorities identified by CNAs and administrators, we recommend several organizational/industry and policy‐level practices to support retention for this workforce. Practices to stabilize the workforce should include 1) teamwork and person‐centered operational practices including transparent communication; 2) increasing permanent staff to avoid shortages; and 3) evaluating and building on successful COVID‐related innovations (self‐managed teams and flexible benefits). Policy and regulatory changes to promote these efforts are necessary to developing industry‐wide structural practices that target CNA recruitment and retention.

In Their Own Words: The Challenges Experienced by Certified Nursing Assistants and Administrators During the COVID-19 Pandemic

“…This analysis focused specifically on the challenges identified by CNAs and administrators posed by this novel, stressful experience to inform future supports for the workforce. Findings on adaptations and needed resources were reported separately ( Franzosa et al, in press).…”

Advancing use of virtual visits and virtual education in Oklahoma nursing homes in response to COVID‐19

“…Staff reported a positive impact on job satisfaction and resident quality of life. These findings are particularly relevant given challenges with staff retention in NHs exacerbated by the COVID‐10 pandemic 7 . Increasing the use of smart tablets in NHs may be one approach to improving staff satisfaction as well as increasing real‐time access to online clinical support tools.…”

“…These findings are particularly relevant given challenges with staff retention in NHs exacerbated by the COVID-10 pandemic. 7 Increasing the use of smart tablets in NHs may be one approach to improving staff satisfaction as well as increasing realtime access to online clinical support tools. Also, more than half of staff indicated that NH residents were proficient in using a tablet, though many residents did require training from staff to use tablets.…”

Perspectives of nursing home administrators across the United States during the COVID‐19 pandemic

“…19,20 Research documenting the impact of the pandemic to date is largely quantitative, relies on one-time surveys with nursing home administrators or staff, or is limited to one location. [21][22][23] Beyond what we know from existing quantitative research, this knowledge does not capture the actual and potential depth of experiences and perspectives of the COVID-19 crisis in nursing homes. Our qualitative research helps to fill this gap, through repeated, semi-structured, indepth interviews with nursing home administrators across the country, conducted over the course of the pandemic.…”

“…Research documenting the impact of the pandemic to date is largely quantitative, relies on one‐time surveys with nursing home administrators or staff, or is limited to one location 21–23 . Beyond what we know from existing quantitative research, this knowledge does not capture the actual and potential depth of experiences and perspectives of the COVID‐19 crisis in nursing homes.…”