National CMS/CDC Nursing Home COVID-19 Training: Week 10 Recap

COVID-19 Knowledge for the Front Line Staff

Outside the spotlight on nursing home resident care during the COVID-19 pandemic, two speakers reminded us of the grace and strength our front line staff members have displayed. They shared their perspectives on how to acknowledge and support their dedication as the challenges continue during the July 30, 2020 National CMS/CDC Nursing Home COVID-19 Training presentation.

Alice Bonner, PhD, RN, senior advisor for aging at the Institute for Healthcare Improvement (IHI), explained the factors that impact staff health and well-being. As COVID-19 infections surge in some areas of the U.S., nursing home teams seek support to combat high rates of worry, depression, anxiety, trauma and stress.

Bonner broke down the main causes for staff trauma during COVID-19: feeling insecure and unsafe due to personal protective equipment (PPE) shortages and fear of COVID-19 transmission; feeling out-of-control with the continued spread of the virus despite safety measures; experiencing uncertainty as policies and procedures change with incomplete information or context; feeling grief for personal and resident losses; and harboring growing resentment with the challenges of quarantine, social distancing, public criticism and stigma. Adding overwork, exhaustion and lack of self-care to the mix creates a toxic stew for demoralized and disengaged staff.

Bonner outlined the steps to create dialogue between nursing home leadership and point-of-care staff in the COVID-19 era:

  • Promote a sense of safety by communicating policies and procedures, acknowledging change, sharing resources and support plans and choosing reliable sources of information. Leaders can set an example by limiting their own media and news exposure to the essentials.
  • Promote a sense of self or collective efficacy with real-time education and use of training tools, identifying points of control, defining and practicing roles and promoting problem-solving strategies.
  • Promote a sense of calm by normalizing reactions and staying present. Practice mindfulness and encourage staff to take moments to pause or meditate.
  • Promote a sense of connectedness by celebrating teams, encouraging ​"battle buddy" relationships, creating support groups and stockpiling compassion for self and others.
  • Promote a sense of hope with thank you notes, recovery stories, and importantly, by focusing on the future: ​"this too shall pass."

Other tools and resources for COVID-19 training, communication and support are available on Check out the event recording for an actionable assortment of communications best practices from assisted living staff participating in the Alzheimer's Association Project ECHO. IHI also hosts a 20-minute COVID-19 Rapid Response Network for Nursing Homes huddle every weekday for COVID-19 information and support.

Lori Porter, co-founder and CEO of the National Association of Health Care Assistants (NAHCA), shared the challenges of certified nursing assistants (CNAs) at work during the pandemic. Porter’s insights come as a 40-year veteran of long-term care. She began her career as a dietary aide and worked as a CNA, nursing home administrator and operations director before founding NAHCA in 1995.

Porter noted that CNAs comprise 37 percent of the long-term care workforce. During COVID-19, CNAs are experiencing a full spectrum of emotions: empathy, fear, exhaustion and uncertainty. CNAs report that they are working ever-longer hours to care for more than 20 residents at a time during the COVID-19 staffing crisis.

CNAs and other front line staff have fewer resources socially, financially and professionally, creating devastating effects at home and at work. CNA turnover was already high before COVID-19, Porter said, which is tied more to a lack of respect and recognition than to the demands of the position.

“It's very important to understand that they [CNAs] have the closest relationship to the resident,” Porter said. ​“Ask any family member who their expert is at the nursing home. It's almost always going to be a CNA. They're not losing a patient. CNAs are losing someone dear to them.”

Porter shared an impassioned plea for well-designed and inspiring CNA education. She noted that more than 12,000 CNAs have completed NAHCA continuing education with their own funds and no incentives other than to improve their skills in resident care. NAHCA members want an infection control certification and welcome engaging professional opportunities to expand their knowledge and their skills as CNAs, Porter said. ​“Why don’t we become a profession that goes beyond minimum compliance?” she challenged

To Learn More

Download the slides and resources from the National CMS/CDC Nursing Home COVID-19 Training Series pagevisit to connect with the QIN-QIO serving your state or territory and sign up for updates about the National CMS/CDC Nursing Home COVID-19 Training Series.