Trinity College Dublin: One in five directors of nursing plan to leave role after COVID-19, study finds

One in five (19%) directors of nursing in Irish residential care homes are actively planning to leave their posts while a further 28% have considered leaving after the stress of the COVID-19 pandemic, according to a study launched today at Trinity College Dublin.
The inter-institutional study, Experiences of Directors of Nursing in Preparing for and Managing COVID-19 in Care Homes for Older People, has called for better supports for nursing home staff and further integration of care homes into the wider healthcare system.

Directors of nursing expressed disappointment at the lack of understanding in political and media narratives on the reality and context of care home care.

Key findings, based on a survey of 122 residential care homes, included:

* Over 35% of care homes experienced significant financial challenges that may impact future viability;

* 54% of care homes experienced at least one COVID-19 outbreak;

* The elevated level of challenges that directors of nursing experienced meant many were constantly on call to respond to public health guidance revisions and outbreaks as well as staff shortages.

Lead investigator Professor Amanda Phelan, Professor of Ageing & Community Nursing, School of Nursing & Midwifery, Trinity College Dublin, said:

The pandemic highlighted a variety of pre-existing issues in the workings of private and voluntary nursing homes in Ireland. It also generated severe new challenges in the management of nursing homes as the sector was at the centre of the maelstrom. The intensity of the response to COVID-19 across the nursing home sector had a major personal and professional impact on Directors of Nursing as they provided nursing and psychological care for fearful residents, managed outbreaks, and navigated staffing challenges due to attrition or staff self-isolating.

This report asserts that a more coordinated, supportive, and integrated approach is necessary in centralising private and voluntary nursing homes within the wider Irish health systems. In crisis situations, an inclusive stakeholder approach at key decision-making forums to focus on early intervention and collaboration to safeguard citizens is fundamental.

Tadhg Daly, Chief Executive Officer, Nursing Homes Ireland, said:

Confronted directly by a pandemic, Directors of Nursing applied tremendous leadership, intensifying the application of infection, prevention and control practices that resulted in nursing homes transforming from social to more medical models. This was achieved during a period of concerted and immense pressure and strain. Gerontological nursing entails skilled knowledge of the management of diverse health conditions, encompassing a complex fusion of clinical expertise and utilisation of clinical judgment.

Against the backdrop of COVID-19, this report emphasises nursing home care is at a critical crossroads. The pandemic must represent a defining moment for gerontological care. This entails requirement for the State to recognise the expertise entailed in providing high-standard nursing home care and ensure an appropriate framework is implemented to appropriately recognise and value the specialised care provided within our nursing homes.

Dr Catherine Buckley, President of AIGNA (All-Ireland Gerontological Nurses Association), said:

The COVID-19 pandemic in all healthcare settings was challenging for both staff and people who required care. In nursing homes the burden of ensuring safety of staff and residents while adhering to regulatory standards fell mainly on the shoulders of Directors of Nursing. Directors of Nursing have to be able to balance a range of competing demands, values, strategies and regulatory frameworks in order to provide effective care services for vulnerable older people. The pandemic placed both physical and psychological demands on these nurses at this time.

As someone who was also in the trenches, managing a nursing home for a short time outside of my substantive post, I can empathise with the experiences of these Directors of Nursing. It is clear that the findings of this report must inform national policy on how private and voluntary nursing home are aligned and integrated with national supports and the voices of nurses who lived this experience should be taken account of when formulating both regulatory and national standards.

The study made the following recommendations:

* The positioning of care homes requires more status and greater connectivity within the health and social system, while public and private facilities should have more integration and governance within the health system.

* Readily accessible and individually tailored psychological supports are required to reduce workforce attrition and burnout. As post-traumatic stress has been noted for crises such as pandemics, continued support for staff is recommended.

* Investment in community or dedicated Advanced Practice Nurse posts should be considered to augment the capacity of primary care to continue and better support residents and reduce the need for acute hospital transfer. In addition, the investment in e-health in the environment of care homes can improve assessment and care planning for older people in care homes.

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