TABLE 3.

Certified nursing assistants' perceptions of challenges and strategies to support frontline workers

Challenges

Examples from CNAs

Experience of staffing gaps Note: both “more‐supported” and “less‐supported” groups reported staffing as their primary challenge

If we have enough staff, we could give the level of care [dying residents] really need… maybe some extra time to hold their hands to go through the traveling process or just give them the comfort that is needed, that we would want in their position. If you work Friday short, Saturday short, Sunday short, Monday on or short, you expect for us to come for the next day because we are overwhelmed, right. Then we better stay home instead of coming in and drop somebody or injure ourselves. One of our co‐workers, she [fell] sick and when she called me and I said, “oh, we are only two on the floor”, she [canceled] the sick call. I see all the sacrifice I gave [the facility] during the COVID. And leave my kid to come just work here. Now I'm being laid off because they said they are struggling with income.

Strategies	Groups reporting more supportive work environments	Groups reporting less supportive work environments
Teamwork across staff and management	[My unit] is rehab, so we have different people coming in and the therapists and the doctors all the time. They also chip in to help.	[Management should] stop separating yourself from us and come down and help us…especially if you are not gonna give us the staff. It was like a nightmare because some security did not want to help, and we had so many bodies to take [to the morgue] and they refused to help…we called the supervisors and see if they could help. And they said they was gonna speak to the director or somebody and see, you know, why they are not helping the CNAs or the nursing staff…nobody really wanted to cooperate. [The nurses] do not really ask us anything, they only do what they want to do.
Accessible and responsive leadership	You could [request training] through your nurse educator, you can bring it up with your floor manager… our nursing office is an open door. You can even go into the nursing office and speak to the nurse… and they'll take it from there and they'll run with it. I was at the [front entrance] taking temperatures and [the administrator] was out there at times with us…I said, “we need help. We need counseling. We need somebody to talk to.' And he said, “I thank you so much for letting me know this. We're going to put in place people that you guys can talk to.”	I probably just need [leadership] to listen to all [staff] in the building. From nursing, to housekeeping, to maintenance, dietary. They need to really have ‐ I mean, we have the town meetings, but most of the time the town meetings are based on what they have to tell us…They should have a town meeting where we can let them know what's going on. The protocol to follow is the supervisor or your floor nurse, I do not think we go beyond that. Sometimes we are not heard.
Transparent communication	There were very transparent with everything that every day you have different updates… making sure we get those updates in real time and that we could prepare for the day to come or just change whatever changes we need to make. They just give it to us as they get it. The most important thing [is] the information that the managers give us here on a daily basis about the pandemic. They were really open and honest about everything as they get it, about every change as they get it. I think knowledge is power. [Daily in‐service updates] just give you a sense of security and a sense of comfort.	When they start to tell you what you need to do, that one basic person is the one that should really be telling you, not 20 people 'cause then you get lost. And this is what can damage a lot of us along with the residents because you get lost in the shuffle. [If we know] we have active [COVID] cases in this floor or this room we [know we] have to take extra precaution…so that communication is very important.
Recognition of mental health and work–life balance	We basically know [who has children] so we really work around this, “okay, she's coming in [late] at eight”, as long as we know we have someone coming. [Administrators] were calling you finding out if you need somebody to come take care of your kids so you can work, or if you want to drop them somewhere. I think it is helpful to have someone to stop by, get talked to when they get burned out.	Instead of say[ing], “This person was here. They did not get sick. They did not take vacations. They did not take nothing. Let us give this person a break.” They do not mind here. All they want here is that their job is being done. Just come to work and when you drop dead, fine. I'm feeling a little overwhelmed, I just need a day for me ….but then you are not going to want to take care of you because you need the income.