Why It Matters
Across the country, approximately 40 percent of all deaths from COVID-19 have been in long-term care facilities. Grief, trauma, long-term stress, and exhaustion are compounding existing challenges. Nursing home staff burnout is reaching a critical point.
IHI is a participant in the AHRQ/Project ECHO National Nursing Home COVID-19 Action Network, a partnership between the Agency for Healthcare Research and Quality (AHRQ), the University of New Mexico’s ECHO Institute, and IHI. The Network has been convened to train and support US nursing homes in evidence-based practices to support residents and staff in COVID-19 infection prevention and control. The IHI Training Center is delivering the standardized curriculum to five cohorts of nursing homes based in Delaware, Florida, Georgia, Louisiana, and North Carolina.
During the pandemic, staff care for residents while managing concerns about their own health and the safety of their family members. Their goals are to provide safe, high-quality care for residents, support staff, and create a just culture. The following ideas for enhancing staff joy in work come from IHI Training Center participants.
- Ensure staff safety.
- Provide adequate PPE, including face shields for added protection; make the testing algorithm public; and offer staff rapid COVID-19 tests on request.
- Establish back-up processes for critical or emotionally challenging situations.
- Answer questions and address concerns about the safety of the COVID-19 vaccines.
- Keep staff continually informed about changes using newsletters, bulletin boards, huddles, stand-up and stand-down meetings, and information while rounding.
- Help staff members to take precautions at home and to teach their household members about safety. Offer masks or hand sanitizer.
- Provide Employee Assistance Programs and other support.
- Offer the services of a mental health professional virtually or in person.
- Make debriefing discussions available before staff members head home from their shifts.
- Connect with a local hospice care provider to offer grief and bereavement counseling.
- Designate a quiet room that staff can visit for privacy and stress relief during a shift.
- Offer appreciation and enjoyable diversions.
- Use “positive gossip” to spread good news by word of mouth so leaders can celebrate staff members who perform beyond expectations.
- Recognize staff for a job well done verbally, through events (e.g., luncheons, cookouts), or in writing (e.g., thank-you cards).
- Provide staff a basket of ingredients for a nice meal at home as thanks for working on a holiday.
- Provide healthy, energy-boosting treats.
- On special occasions (e.g., Thanksgiving, Christmas, and New Year’s Eve), hold regular prize drawings throughout the day.
- Celebrate successes by handing out tokens that can be redeemed at an on-site store.
- Encourage and make it easy for nursing home residents and families to identify staff who have earned special recognition.
Activities Directors and staff work to lift the spirits of staff and residents at a time when extra creativity is required to come up with things to do while physical distancing. For example, we have heard about activities taking place in hallways while residents stay in their doorways. These include staff singing and dancing; bingo; batting balloons or a beach ball with pool noodles; “parades” with decorated carts; or an ice cream “truck” or snack cart playing music for staff and residents.
As facilitators and staff members supporting this “all teach, all learn” program, we are seeing firsthand the dedication, compassion, and creativity of nursing home staff members. We look forward to sharing more of what they’re teaching us about how to promote safety and support staff and residents during the pandemic.
Gail A. Nielsen, BSHCA, FAHRA, RTR, is faculty for the IHI Training Center of the National Nursing Home COVID-19 Action Network. Marina Renton, MPhil, is an IHI Project Manager. Becka DeSmidt, MPH, is Senior Manager of IHI Open School & Virtual Programs.
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