National Nursing Home Training Series: Week 7 Recap

Managing Staffing Challenges

Nursing home staffing is a challenge even in the best of times. Shannon Cupka, EdM; Martha Jaworski, RN, BSN, CIC and Adrienne Butterwick, MPH, CHES, improvement advisors with Comagine Health, shared nursing home staffing approaches for the COVID-19 era in their July 9, 2020 presentation for the National CMS/CDC Nursing Home COVID-19 Training. Comagine Health is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Idaho, New Mexico, Nevada, Oregon, Utah and Washington.

Stay Present

Something as simple as daily rounds and huddles, supplemented by one-on-one discussions, allow facility leaders to check in with their teams. Anxiety may be contagious, but so, too, is calm.

Daily rounds and huddles are ideal venues to reinforce evidence-based information about COVID-19 transmission. You can describe how facility practices are in place for staff health and protection and help them connect their choices and behavior to the health and safety of colleagues, loved ones and residents. Consider cultivating champions within your teams – dietary, nursing aides, maintenance and others – to spread these messages. Peer supports like well-being checks may also start within these teams. Comagine Health has created a variety of resources on mental health and resiliency to support your staff members during these challenging times.

Create Contingencies

At the same time, you will want to stay in contact with your state and local health authorities and industry associations to learn what resources are available to address staffing shortages. The CMS Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes is updated twice a month with links and information on state programs, such as:

  • Practitioner and professional license extensions
  • Exemptions for out-of-state workers and temporary nurse aide positions
  • Partnerships to locate volunteer health care professionals
  • Expedited certified nurse assistant (CNA) training processes
  • Job placement programs for furloughed or retired health care workers
  • Temporary rate increases
  • Short-term staffing assistance for those who cannot maintain staffing
  • Enhanced telehealth policies
  • Waivers to reduce staffing burdens

Adapt CDC Guidance

Your leadership team should be refining plans to fill in for staff with positive COVID-19 tests and protocols to return to work following unprotected exposures. The Centers for Disease Control and Prevention (CDC) has drafted return-to-work guidance for COVID-19-positive nursing home employees. While these guidelines should not replace state and local mandates, some highlights:

The CDC recommends that staff with symptoms or a positive COVID-19 test do not return to work until:

  • At least 10 days have passed since symptoms first appeared
  • The staff member has not had a fever or respiratory symptoms for at least three days
  • The staff member has had two negative test results administered at least 24 hours apart

For staff who are asymptomatic with a positive COVID-19 test, CDC recommends that staff members do not resume work until:

  • Ten days have passed and no symptoms have developed
  • The staff member has had two negative test results administered at least 24 hours apart

Check out the presentation slides for more information about return-to-work practices and work restrictions.

When You Have a Staffing Crisis

You may consider allowing staff members to continue to work if they have had unprotected exposures, but are not known to be infected. These workers should receive daily symptom screenings and wear facemasks at work for at least two weeks after the unprotected exposure.

Critical staff shortages may require transfers of COVID-19-positive residents to designated facilities in the region.

From Adversity Comes Opportunity

QIN-QIOs offer nursing homes quality assurance performance improvement (QAPI) tools that are designed to help gather data and test and refine processes to improve seemingly intractable health care problems. The QIN-QIO in your state or territory is ready to show you how to apply QAPI tools to today’s staffing challenges. You’ll document your efforts and learn what works, including practices you may want to continue once the crisis abates. 

To Learn More

Download the Comagine Health QIN-QIO slides and resources from the National CMS/CDC Nursing Home COVID-19 Training Series page, visit 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.