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Changes in Health and Well-Being of Nursing Home Managers from a Prepandemic Baseline in February 2020 to December 2021

Published:December 27, 2022DOI:https://doi.org/10.1016/j.jamda.2022.12.004

      Abstract

      Objective

      To evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada.

      Design

      Repeated cross-sectional survey.

      Setting and Participants

      A random sample of nursing homes (n = 35) in urban areas of Alberta was selected on 3 strata (region, size, ownership). Care managers were invited to participate if they (1) managed a unit, (2) worked there for at least 3 months, and (3) worked at least 6 shifts per month.

      Methods

      We measured various mental health and well-being outcomes, including job satisfaction (Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale), burnout (Maslach Burnout Inventory—exhaustion, cynicism, efficacy), organizational citizenship behaviors (constructive efforts by individuals to implement changes to improve performance), mental and physical health (Short Form–8 Health Survey), burden of worry, and intention to leave. We use mixed effects regression to examine changes at the survey time points, controlling for staffing and resident acuity.

      Results

      The final sample included 181 care managers (87 in the pre-COVID survey; 94 in the COVID survey). Response rates were 66.9% and 82.5% for the pre-COVID and COVID surveys, respectively. In the regression analysis, we found statistically significant negative changes in job satisfaction (mean difference −0.26, 95% CI –0.47 to −0.06; P = .011), cynicism (mean difference 0.43, 95% CI 0.02-0.84; P = .041), exhaustion (mean difference 0.84, 95% CI 0.41-1.27; P < .001), and SF-8 mental health (mean difference −6.49, 95% CI –9.60 to −3.39; P < .001).

      Conclusions and Implications

      Mental health and well-being of nursing home managers worsened during the pandemic, potentially placing them at risk for leaving their jobs and in need of improved support. These findings should be a major concern for policy makers, particularly given serious prepandemic workforce shortages. Ongoing assessment and support of this understudied group are needed.

      Keywords

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      References

        • Canadian Institute for Health Information
        Long-term care homes in Canada: How many and who owns them?.
        • Statististics Canada
        Living arrangements of seniors.
        • Estabrooks C.A.
        • Straus S.E.
        • Flood C.M.
        • et al.
        Restoring trust: COVID-19 and the future of long-term care in Canada.
        FACETS. 2020; 5: 651-691
        • Grabowski D.C.
        • Mor V.
        Nursing home care in crisis in the wake of COVID-19.
        JAMA. 2020; 324: 23-24
        • National Academies of Sciences
        The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff.
        The National Academies Press, 2022: 604
        • Canadian Institute for Health Information
        COVID-19’s impact on long-term care.
        • Gray K.L.
        • Birtles H.
        • Reichelt K.
        • James I.A.
        The experiences of care home staff during the COVID-19 pandemic: A systematic review.
        Aging Ment Health. 2021; 26: 1-10
        • Takahashi T.
        • Ekoyama S.
        • Tachikawa H.
        • et al.
        Mental health of caregivers working in nursing homes during the COVID-19 pandemic.
        Dement Geriatr Cogn Disord. 2022; 51: 233-240
        • Hewitt J.
        • Carter B.
        • Vilches-Moraga A.
        • et al.
        The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study.
        Lancet Public Health. 2020; 5: e444-e451
        • Levere M.
        • Rowan P.
        • Wysocki A.
        The adverse effects of the COVID-19 pandemic on nursing home resident well-being.
        J Am Med Dir Assoc. 2021; 22 (e2): 948-954
        • Su Z.
        • McDonnell D.
        • Li Y.
        Why is COVID-19 more deadly to nursing home residents?.
        QJM. 2021; 114: 543-547
        • Zheng Q.
        • Williams C.S.
        • Shulman E.T.
        • White A.J.
        Association between staff turnover and nursing home quality - evidence from payroll-based journal data.
        J Am Geriatr Soc. 2022; 70: 2508-2516
        • Castle N.G.
        • Wagner L.M.
        • Ferguson J.C.
        • Handler S.M.
        Safety culture of nursing homes: opinions of top managers.
        Health Care Manage Rev. 2011; 36: 175-187
        • Vermeerbergen L.
        • McDermott A.M.
        • Benders J.
        Managers shaping the service triangle: navigating resident and worker interests through work design in nursing homes.
        Work Occupation. 2021; 48: 70-98
        • Carnahan J.L.
        • Unroe K.T.
        Prioritizing nursing home staff and leadership consistency to improve quality.
        J Am Geriatr Soc. 2022; 70: 2472-2473
        • Chipps E.
        • Kelley M.M.
        • Monturo C.
        • et al.
        Reflections from the middle: exploring the experience of nurse managers across the United States during the COVID-19 pandemic.
        J Nurs Adm. 2022; 52: 345-351
        • Monroe M.
        • Davies C.C.
        • Beckman D.
        • Cantrell D.
        • Brockopp D.
        Chief nursing officers: their COVID-19 experience.
        J Nurs Adm. 2022; 52: 309-313
        • Savage A.
        • Young S.
        • Titley H.K.
        • Thorne T.E.
        • Spiers J.
        • Estabrooks C.A.
        This was my Crimean War: COVID-19 experiences of nursing home leaders.
        J Am Med Dir Assoc. 2022; 23: 1827-1832
        • Aymerich C.
        • Pedruzo B.
        • Perez J.L.
        • et al.
        COVID-19 pandemic effects on health worker's mental health: Systematic review and meta-analysis.
        Eur Psychiatry. 2022; 65: e10
        • Rezaei-Hachesu V.
        • Naderyan Fe’li S.
        • Maajani K.
        • Golbabaei F.
        The Global Prevalence of Anxiety, Depression, and Insomnia among Healthcare Workers during the Covid-19 Pandemic: A Systematic Review and Meta-Analysis.
        JOHE. 2022; 11: 48-66
        • Iaconi A.
        • Duan Y.
        • Tate K.
        • et al.
        Nursing Home Managers' High Risk of Burnout.
        J Am Med Dir Assoc. 2022; 23: 173-175
        • Estabrooks C.A.
        • Squires J.E.
        • Cummings G.G.
        • Teare G.F.
        • Norton P.G.
        Study protocol for the Translating Research in Elder Care (TREC): Building context – an organizational monitoring program in long-term care project (project one).
        Implement Sci. 2009; 4: 52
        • Bowling N.A.
        • Hammond G.D.
        A meta-analytic examination of the construct validity of the Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale.
        J Vocat Behav. 2008; 73: 63-77
        • Maslach C.
        • Schaufeli W.B.
        • Leiter M.P.
        Job burnout.
        Annu Rev Psychol. 2001; 52: 397-422
        • Choi J.N.
        Change-oriented organizational citizenship behavior: effects of work environment characteristics and intervening psychological processes.
        J Organ Behav. 2007; 28: 467-484
        • Ware J.E.
        • Kosinski M.
        • Dewey J.E.
        • Gandek B.
        How to score and interpret single-item health status measures: a manual for users of the SF-8 health survey.
        Lincoln, RI: QualityMetric Incorporated. 2001; 15 (5)
        • Koepsell T.D.
        • Martin D.C.
        • Diehr P.H.
        • et al.
        Data analysis and sample size issues in evaluations of community-based health promotion and disease prevention programs: a mixed-model analysis of variance approach.
        J Clin Epidemiol. 1991; 44: 701-713
        • Hower K.I.
        • Pfaff H.
        • Pfortner T.K.
        Is time a healer? Course of demands during the COVID-19 pandemic in long-term care: a repeated cross-sectional survey in Germany.
        J Public Health. 2021; 43: e435-e437
        • Pfortner T.K.
        • Pfaff H.
        • Hower K.I.
        Will the demands by the covid-19 pandemic increase the intent to quit the profession of long-term care managers? A repeated cross-sectional study in Germany.
        J Public Health. 2021; 43: e431-e434
        • Wong C.A.
        • Spence Laschinger H.K.
        The influence of frontline manager job strain on burnout, commitment and turnover intention: a cross-sectional study.
        Int J Nurs Stud. 2015; 52: 1824-1833
        • Membrive-Jimenez M.J.
        • Pradas-Hernandez L.
        • Suleiman-Martos N.
        • et al.
        Burnout in nursing managers: A systematic review and meta-analysis of related factors, levels and prevalence.
        Int J Environ Res Public Health. 2020; 17: 3983
        • Velando-Soriano A.
        • Ortega-Campos E.
        • Gomez-Urquiza J.L.
        • Ramirez-Baena L.
        • De La Fuente E.I.
        • Canadas-De La Fuente G.A.
        Impact of social support in preventing burnout syndrome in nurses: A systematic review.
        Jpn J Nurs Sci. 2020; 17: e12269
        • Estabrooks C.A.
        • Titley H.K.
        • Thorne T.
        • et al.
        A matter for life and death: managing psychological trauma in care homes.
        J Am Med Dir Assoc. 2022; 23: 1123-1126
        • Squires J.E.
        • Hayduk L.
        • Hutchinson A.M.
        • et al.
        A protocol for advanced psychometric assessment of surveys.
        Nurs Res Pract. 2013; 2013: 156782
        • Sexton J.B.
        • Adair K.C.
        • Proulx J.
        • et al.
        Emotional exhaustion among US health care workers before and during the COVID-19 pandemic, 2019-2021.
        JAMA Netw Open. 2022; 5: e2232748