Table 3.

Representative Quotes From Interview Participants

Quote no.	Quote From Nursing Home Leader	Participant no.
Theme 1: Responsibility to protect
1	I'm being so cautious, I don't want to be the one to bring Covid into this building, and I really think that you need to act with integrity and practice what you preach. We're saying to our staff, you know, “send your husband to the grocery store if you can” and “don't be hanging out at the arena with your kids” and “just keep to your bubble. Don't carpool. Don't do this. Don't do that. And stay home for Christmas.” And so, you try to practice that yourself.	P06
2	It's a lot of responsibility, that if you go somewhere and unknowingly get yourself exposed, you have no symptoms, and you come to work, that you really can conceivably kill a lot of people.	P04
3	It's been a challenge with working in long-term care. Particularly for my family. Because as soon as Covid started, I was like, “You guys are—you're locked down. You're not going anywhere.” Not only because of the provincial guidelines but because if they get something, I bring it here [facility], it just really kind of weighs on you.	P10
4	It just went through here, like it blew through. We do a hand washing program. . . we had the hand sanitizer. . . we always follow PPE. . . . Nothing seemed to matter because within 48 hours it was completely through my unit.	P22
5	The actual day we got the first positive results. That was disheartening. You literally felt like there was, I describe as a kick in the stomach. We had worked so hard keeping COVID out. It was a moment in time, and the first time in my career, that I literally broke down. I broke down, literally. I cried and I cried, and I cried. Because you started seeing your staff, you started seeing your residents dying, and that feeling of being overwhelmed. I can describe it as a feeling of despair.	P18
6	When our unit was on full outbreak, I mean I couldn't see my daughter, my son, my grandkids. I didn't want them to come anywhere near me. I didn't want to go into a grocery store. I was supposed to go for X-rays, I wouldn't go for them because – and for physio, because I just didn't, I never knew if I was a carrier. You know?	P22
7	When we had an outbreak, my mom moved out because of her health condition. So, it was only me, and my dad, and my boy. But it was so hard. . . . Being on isolation I didn't tell my son that I'm still home. I was in the basement. So, I told him that I'm at the hospital; otherwise he won't stay away. And it's so hard for me to hear him but I can't go to him, can't see him. And then when you walk in the house, he asks, “Is COVID still there?” Like every single day.	P17
8	They have no right to put me at risk when I've already battled it. . . . I've already been to hell. You're not going to put me there again!	P22
Theme 2: Overwhelming Workloads
9	One of the things I found most challenging about this is that the rules change [so fast] your head just spins.	P04
10	I spent probably most of late Thursday and Friday booking our staff into their second dose of their vaccine. And that was, it took a long time. We've organized them all. We've got lists and checklists and we've done the whole thing. And yesterday I got an email saying that all the vaccine second doses are cancelled.	P04
11	Quit doing that on Friday afternoons, because the public expects, if you say there is going to be outdoor visits, they expect them the next morning!	P06
12	There were a few mornings I'd come in when I should have six health care aides and two LPNs [licensed practical nurses] and there was myself and two health care aides to run this floor of 34 patients sick with COVID. It was traumatizing! It was probably the worst experience of my 40 years in nursing.	P22
13	We have no casual pool. It's gone. If people want to go on vacation, they can't, there's nobody to replace them. And when you're trying to hire in a market where you have this restriction of “well, you can only work in one place.” And everybody's trying to hire whoever is graduating. It's been very difficult, and I do recognize, I do see the burnout.	P01
14	We were burning them out by working them hours and hours every day, well beyond what they were scheduled, they were burnt out. Like they didn't see it in themselves, you know? Like some of that was a challenge too.	P11
Theme 3: Mental and Emotional Toll
15	You don't understand. We're here, we're coming into this place every day. Scared spitless. . . I've never felt that level of anxiety.	P07
16	I just feel tired all the time but don't sleep well. Like you're tired but you go lay in bed and then you don't sleep, and things run through your mind. It's been hard.	P10
17	It just feels like it's 24/7/365 and I feel tired. It just never stops or goes away.	P12
18	I just don't know if I have it in me to do this again. The adrenaline gets going and the amount of work we accomplished in hours a lot of days. . . or on a Saturday night, we're still here! I don't know if I can mentally handle that again.	P11
19	That's my ethical dilemma. . . as a manager I follow the rules and make sure they are all followed, infection control, social distancing, but when I actually look at my residents as people, I am asking myself, did we do the right thing for them?	P21
20	Not being able to give [family members] a hug and console them, and we're looking at each other through the masks and everything, seeing the tears coming down their eyes and I'm trying to stay strong for my staff. You're crying inside, you're crying for their loved one.	P22
21	There are still a couple of our staff members out with post-COVID related symptoms, very serious ones. Those. . . are the ones that [colleague] and myself, we carry lots of guilt over and we can't change it, but I mean, they were staff that we redeployed.	P11
Theme 4: Moving Forward
22	We've got to be mindful of how we really want to treat our elderly. What type of level of care do we want to provide for our elderly moving forward? I think the government has to stop and have a clear look at that.	P18
23	Adequate funding so that we can actually provide the care that these poor people need, not just during COVID.	P05
24	If we don't learn, if we don't change things from this, then it's just going to be a repeat. There's no reason we won't repeat it again.	P04
25	I believe the things that I've witnessed, and been part of, will impact me for the rest of my life. I think it's made me move up my retirement date to tell you the truth.	P11
26	I'm out of here. I don't care. I don't care if I can't afford it. . . . I just don't care. Not that I don't care about the people here, but in all of my years of nursing, I have never worked this hard.	P07