Table 3.

Key Topics and Themes from Qualitative Interviews with Frontline Staff

Topic/Theme	Definition	Example Quote
Toll of the virus	Descriptions of trauma, stress, or other mental health impacts of working during the pandemic, including fears related to contracting and spreading the virus and witnessing the toll of COVID-19 on residents in nursing homes.	Traumatizing. That's the only word I can think of…I slept in my car a few times. I slept in a hotel that I had to pay for out of my own pocket. I didn't wanna bring it home to anybody…Everyone was really scared. (CNA) I think the way it affected staff morale, like, I remember one housekeeping guy, he was very upset. He was like, “I don't want to jeopardize my children's health”…I was anxious. (CNA) But definitely that added pressure [from caring for vulnerable patients] is something, and you can feel it…One false step or one missed move, and things can go really bad. So, I can see people around me, coworkers and the management, they're really stressed. (CNA)
Home & work-life balance stressors	Stressors associated with pandemic-related changes at home or that affect work-life balance.	Travel time was impacted. Sometimes your travel time, because of lack of workers with public transportation, it was doubled. So, you know, it took a toll sleep-wise and body-wise on you. (CNA) It took more time for us to get to work because of transportation, and when we got there we had to wear – change our clothes and put on a special uniform, sterilize our stuff, and put them in a locker, and when we leave we have to take it off and sterilize our lockers…it took about an extra 20 – 30 minutes to come in and leave. (CNA) A lot of people – I wanna say at least 90% of the CNAs and nurses have children which means none of these kids are in school. So, they all have to pay for childcare. Nobody really thinks about that…because of no childcare, being short on rent. (CNA)
Workplace stressors
Perceived administrative support	Staff perceptions of administrative support (or lack thereof) during the pandemic, including the impact of these experiences on staff morale and wellbeing.	Whenever we feel like I have a stuffy nose or runny nose, usually before [the pandemic], like you need to find somebody to cover your shift. But now it's been more lenient. [Administrators] listen to us, more understanding that we are taking care of the patients and you don't want your staff to be sick. (CNA) Understaffed, underpaid, overworked, underappreciated, anything that starts with a U-N, we are…The Director of Nursing pretended to have COVID and didn't even have COVID because she was too scared to come to work. The administrator left for weeks at a time. They literally abandoned their staff. (CNA) I mean, I think [administration] is doing a pretty good job. Like we had…a Halloween party for the patients. They gave out little gift cards to all the staff, so no, I think they're doing the best they can, you know what I mean? (CNA) Let us know that you care about us and about what we're going through…Let us know that we're all in this together. If you're pretty much secluded in your office, and we have to work on the floor short-staffed, what is that really saying to us? We're all nervous, and we're all scared. (Nurse) We didn't get the COVID pay, which I was mad about, because most facilities did. And I felt that, it's not right… If you're going to jeopardize your life and you're standing at the front line, you're entitled to receive it. And I felt very bad that I did not receive that. (Nurse)
Workload	Descriptions of pandemic-related changes to workloads and impact on staff morale and wellbeing.	Some people were more stressed because there was more work we had to do because of the virus. We had to make sure things were sterilized and disinfected more times during the day. (CNA) The acuity and the need of the patient was increased…It was just the demand of the job increased because the patient's needs increase. (Nurse) Out of five of the nurses, two of them quit…They never rehired any other nurses. The morale of the staff went down because…the administration never cared about how their workload has increased…so that reduced our morale here…The pay still remains the same. The workload has gone up. (Nurse) I would say the only time we really feel unsafe is when we're extremely understaffed which happens every other day, so. And they cut staff on top of it. (CNA)
Safety Conditions	Perceptions of safety at work and stressors related to it, including access to and utilization of personal protective equipment (PPE), perceptions of safety protocols in place, and perceived risk from colleagues or patients, and thoughts on infection control policies.	I don't feel very safe because I usually interact with very many patients…Even though I use the PPE, I don't feel that safe…I don't know when I'll meet an individual who's sick. So, that really scares me. (Nurse) It was just a little scary. I just felt like we didn't have enough access to hand sanitizer, little things like that, even though it was a – even though it's a nursing home, I would think they would have all of that stuff readily available, but it had to take some time to actually get the dispensers up and things like that. (CNA) I know certain supervisors and certain managers – if they see you without a mask, you're gonna get a write-up, whereas certain managers will let you pass. It's just not 100% everyone is on the same page, so it's a little frustrating because sometimes I have to be the tattletale, and I don't like being that person at the job. (CNA) Honestly, I've questioned my safety at work…I feel like when I go to work, I have to take that chance because I don't know who my coworker has been in contact with, or I don't know if the person I'm caring for has a family member that possibly could have come in contact and didn't know, so I just always think about my safety, and it's really on my mind a lot. (CNA)
Recommendations for Administrators	Staff recommendations for facility administrators for improving staff wellbeing and staff morale or for increasing preparedness for future pandemics or similar crises.	If we're forced to work, I think there should be an incentive, or there should be a bonus, or there should be extra protection against if we do have to call a sick day or things like that, or if you're forcing us to come to work, then are you gonna supply us with a babysitter if we have children?…I think if they understood more – the higher power – I think it would make a lot of people a little bit less stressed, a little bit more comfortable with what's going on, not so fearful. (CNA) I think about how they should support the employees is by increasing the number of staff. This will increase the morale of the employees. (CNA) I would hope that they would give us more sick time off…Maybe an extra day or two for mental health, you know? You know, that might help because our job is not only mentally demanding, it's also physically demanding at times, too. (CNA) I think there should be a person that…talks to employees about their worries or how they're feeling because of the pandemic because me personally, I'm a little jealous of the people that can stay home. (CNA)