Impact of the single site order in LTC: exacerbation of an overburdened system

Farinaz Havaei; Joanie Sims-Gould; Sabina Staempfli; Thea Franke; Minjeong Park; Andy Ma; Megan Kaulius

doi:10.1186/s12913-023-09670-7

Impact of the single site order in LTC: exacerbation of an overburdened system

BMC Health Serv Res. 2023 Jun 20;23(1):666. doi: 10.1186/s12913-023-09670-7.

Authors

Farinaz Havaei¹, Joanie Sims-Gould², Sabina Staempfli³, Thea Franke², Minjeong Park⁴, Andy Ma³, Megan Kaulius³

Affiliations

¹ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada. farinaz.havaei@ubc.ca.
² Center for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
³ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada.
⁴ Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada.

Abstract

Background: The long-term care (LTC) sector has been at the epicentre of COVID-19 in Canada. This study aimed to understand the impact that the Single Site Order (SSO) had on staff and leadership in four LTC homes in the Lower Mainland of British Columbia, Canada.

Methods: A mixed method study was conducted by analyzing administrative staffing data. Overtime, turnover, and job vacancy data were extracted and analyzed from four quarters before (April 2019 - March 2020) and four quarters during the pandemic (April 2020 - March 2021) using scatterplots and two-part linear trendlines across total direct care nursing staff and by designation (i.e., registered nurses (RNs), licenced practical nurses (LPNs) and care aids (CAs)). Virtual interviews were conducted with a purposive sample of leadership (10) and staff (18) from each of the four partner care homes (n = 28). Transcripts were analyzed in NVivo 12 using thematic analysis.

Results: Quantitative data indicated that the total overtime rate increased from before to during the pandemic, with RNs demonstrating the steepest rate increase. Additionally, while rates of voluntary turnover showed an upward trend before the pandemic for all direct care nursing staff, the rate for LPNs and, most drastically, for RNs was higher during the pandemic, while this rate decreased for CAs. Qualitative analysis identified two main themes and sub-themes: (1) overtime (loss of staff, mental health, and sick leave) and (2) staff turnover (the need to train new staff, and gender/race) as the most notable impacts associated with the SSO.

Conclusions: The results of this study indicate that the outcomes due to COVID-19 and the SSO are not equal across nursing designations, with the RN shortage in the LTC sector highly evident. Quantitative and qualitative data underscore the substantial impact the pandemic and associated policies have on the LTC sector, namely, that staff are over-worked and care homes are understaffed.

Keywords: COVID-19; Impact; Mixed-methods; Nursing human resources; Single site policy.

MeSH terms

British Columbia / epidemiology
COVID-19* / epidemiology
Employment
Humans
Long-Term Care*
Nursing Homes

Abstract

MeSH terms

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