Examining nursing facility staffing shortages aggravated by the COVID-19
Role
Note taker for remote user interviews and final findings deliverables creator on a team of 7
Project Duration
6 months
Tools
Qualtrics | Zoom | SPSS | Excel
Client
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South Cove Manor (SCM) is a highly-rated nursing center located in Quincy, Massachusetts. SCM aims to provide quality long-term care and short-term rehabilitation services to an Asian elderly population who might face language and cultural barriers.
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Founded in 1985, SCM moved to Quincy in 2014 to rebrand its short-term nursing services. SCM’s unique geographic location and services allow it to receive more applications from patients.
Problem
SCM is facing challenges and opportunities simultaneously. Some challenges include nursing staff shortages, low job satisfaction, and retention issues. Currently, SCM relies heavily on word of mouth to encourage nursing staff applications. The organization is seeking help to understand and address nursing shortage issues in its facility, which is increasingly important to research during the worldwide COVID-19 pandemic.
Goal
This research study is an exploratory analysis of South Cove Manor, with the objective of determining factors that can increase a person’s likelihood of applying for a nursing job. Understanding the underlying factors can help South Cove Manor improve its recruitment process and to address the staffing shortage problem.
Research Questions
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RQ1: Which employee benefits best motivate nurses to apply for nursing jobs?
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RQ2: What is the relationship between the environmental characteristics in South Cove Manor and the possibility of nurses experiencing burnout?
Research Highlights
✏️ Methods
Survey
We used a survey as our first method to look into relationships between environmental characteristics, job satisfaction, and level of burnout. Other than those questions, the survey contains seven demographic questions asking about age, gender, race, level of education, employment status, years spent in health care as well as work schedule. These help with getting the basic information of the participants and further guide for demographic data analysis.
Interviews
The interview had general demographic questions that asked about the respondents’ background, including their education level, shift schedule, and their current workplace (for working nurses) or current nursing program (for nursing students). They were also asked open-ended questions about working conditions, such as their relationship with co-workers and supervisors, along with what they considered as their favorite and most frustrating part of their job. Furthermore, the interviewer asked respondents questions like “What type of benefits, aside from pay, do you think would make a hospital or institution a great place to work” and “Does the administration/workplace meet your expectations?” to specify their job benefit preferences (childcare and transportation expenses). Finally, respondents were also asked about their experience with a burnout in the nursing industry. These questions included “Have you observed or heard about burnout in the nursing field?” and “How do you balance your work and life?”
Recruitment
This study mainly recruited nursing students in nursing schools and reached out to current working nurses by purposive sampling. For the survey, the participants were contacted through social media postings of survey links and via email to several Boston local nursing organizations and via phone (in which some of the organizations refused the request while some agreed to help us complete the survey); our team also posted our survey link on Twitter and Facebook from May 2022 to June 2022. The survey used an online questionnaire platform, Qualtrics, to collect data. For the interview, we recruited participants via email and personal contacts.
📝 Findings
SURVEY
Participants' Background
There were 69 participants finished this survey and 39 out of 69 were valid responses.
The Importance of Job Benefits
In order to figure out which job benefit is the most important one for the participants, we ran a frequency analysis for that. Using table 3 as a reference, we can tell the participants care most about having better long-term care support, robust vacation/sick leave and reduced workload. They think better childcare support and legal residency are the least important job benefits.
Sources of burnout
According to the survey, higher work demands and stressors lead to more burnout. Additionally, higher pay, good organizational policies as well as autonomy have negative correlation with (decreasing) burnout level.
Positive correlation
Negative correlation
Work demand
r = .65**
Work stressor
r = .37*
Pay
r = -.40*
Autonomy
r = .43*
Organizational policies
r = .49**
Burnout level
higher value = higher burnout level
INTERVIEWS
Participants' Background
During the interviews, each participant shared their experiences under the condition of anonymity and with the understanding that some details about their specific workplace would be withheld. While the questions posed in the interviews covered the same variables as the survey (Environmental Characteristics, Benefits, Job Satisfaction, Burnout), the open format allowed each interviewee to talk freely about their experiences and share their thoughts at length. Only six participants scheduled individual interviews (henceforth referred to as Participants A-F). They had a combined 159 years of experience in healthcare which provided invaluable qualitative insight into the data collected in the surveys. Across each interview, there were recurring responses that addressed the causes of burnout for themselves and their peers, and job benefits that they specifically sought when applying for open positions.
Burnout: Unmitigated Pressure from Patients and Their Families
Participants B, D, and E all mentioned the challenges of day-to-day work in healthcare, but powered through tough days out of a genuine desire to help others in need. However, they felt vulnerable to toxic behaviors from some patients and their families.
Participant B said: “[... T]hey just sit there and yell at you and berate you and I’m like, ‘Look, I can’t do any more than I’m already doing, and I don’t know what more to give you.’ So, by the end of those years in the nursing home, I can safely say I was completely burned out. I mean, there was no way I could continue.”
Excessive Documentation
Participants B and E both cited the patient documentation process as burdensome and inefficient. Ultimately, they felt they were spending valuable time recording symptoms and maladies rather than communicating directly with patients. As individuals who sought out careers in medicine primarily to work with patients, they felt that the documentation system reduced the time and capacity to help them. When they were seeing lots of patients in a single day, the documentation process began to consume a sizable portion of their time.
Nurse-to-Patient Ratios
According to Participants A and D, the amount of patients that nurses oversee can become so great that it increases risk of an accident or overlooked symptoms, adding to overall stress and job pressure. Participant A said that nursing homes had a bad reputation among students in nursing school as having terrible nurse-to-patient ratios. Participant D said that at times she was responsible for 27 to 30 patients at once, which significantly reduced the amount of time she could spend with each one . As Participant D worked in nursing homes, and particularly enjoyed working with elderly patient populations, she worried that such large patient loads would increase the risk of lawsuits, and that her license to practice medicine was at risk.
Exhaustion
Participants A, D, and F all cited exhaustion as endemic to the medical field and a prime source of burnout among professionals. With large patient loads and the stress to cover themselves through excessive documentation, Participant D said that, “you might find that you don’t have time to take your break,” and recalled reaching such severe levels of fatigue that she worried about her ability to drive home after her shift. Participant F added that the long hours of the job led to such exhaustion that she knew it to be a reason some of her colleagues quit the nursing field entirely.
Benefits
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Vacation Time
A benefit mentioned by Participants A, C, and D was vacation time, with the added distinction that time off should not be pooled. For example, Participant A said that she worked at an institution that “banked” time off, where vacation time and sick leave were pooled together. If a nurse took time away from work due to illness, as a result they would have less vacation time available to use. Having a structured system for time off that did not compel nurses to work while sick was essential to the participants, and they sought jobs that guaranteed vacation time and holidays if possible.
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Tuition Reimbursement
Participants A, B, and F spoke about how they admired institutions that promoted professional development among its staff. As such, they said that tuition reimbursement was a benefit that would make an institution a desirable place to work. They said this would be particularly helpful for nurses who want to further their depth of knowledge about patient care by becoming Nurse Practitioners, which requires a Master’s Degree.
💡 Recommendations for the Client
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Our research, along with feedback from survey and interview participants, identified nurse-to-patient ratios as a key contributor to burnout. We recommend discussing this topic directly with nurses during meetings—specifically, asking about their experiences with staffing ratios on each floor and whether they feel workloads are fairly distributed.
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In job postings, highlight the strong benefits South Cove Manor already offers, such as separate vacation and sick leave, to attract potential candidates.
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Respondents emphasized the importance of long-term support, including retirement and savings plans. If these benefits are available, be sure to include them in job descriptions and during interviews.
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Many respondents expressed interest in professional development opportunities, particularly tuition reimbursement programs that support career advancement toward roles like Nurse Practitioner. If feasible, consider incorporating tuition reimbursement into the benefits package.
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Invite nursing staff to participate in meetings with the board or administration when discussing facility-wide policy decisions. Providing them a platform to share their perspectives enhances their sense of autonomy and gives leadership direct insight into the patient care experience.
✨ Impact
This research provides insights into the root causes of the nursing shortage at South Cove Manor (SCM) and within the broader nursing industry. Our findings highlight the priorities and concerns of nurses, offering valuable guidance for employers. We presented our results to SCM during their weekly staff meeting and at the Screentime Conference at Boston University. Additionally, we shared our findings with local nursing centers throughout the Boston area.