The burdens of caregiving: how the second wave of the COVID-19 pandemic impacted nursing staff and management

08/03/2021 | by University of Cologne | Cologne Health Corona

A scientific study by the University of Cologne identifies challenges and stresses faced by nursing staff during the Corona pandemic from the point of view of care managers. It also illustrates why there are nevertheless some reasons for optimism.

The photo shows a woman with brown hair wearing a light blue nurse's uniform over a long-sleeved red top. She has her hands on her hips. Only the lower half of her face is visible, which is covered by a medical mask.
During the COVID-19 pandemic, nursing staff are experiencing new challenges and stresses. Image source: Unsplash

In their recently publicised study, researchers from the Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) interviewed managers from outpatient and inpatient care facilities in Germany about the current situation in care. The study was conducted with the participation of experts from the Working Group on Nursing, Health and Ageing of the Competence Network Public Health COVID-19. The Competence Network Public Health COVID-19 is an ad hoc consortium of more than 25 scientific societies from the field of public health, pooling their expertise. 299 managers from the nursing sector took part in the survey. The survey was conducted both at the beginning of the first pandemic wave in April 2020 and during the course of the second pandemic wave between December 2020 and January 2021. The results have now been published as a study under the title “Care in Times of Corona - Impending System Collapse or Everyday Madness? 2nd scientific study on challenges and stresses from the perspective of care managers” (Versorgung in Zeiten von Corona - Drohender Systemkollaps oder normaler Wahnsinn? 2. wissenschaftliche Studie zu Herausforderungen und Belastungen aus der Sichtweise von Leitungskräften).

The study results show that the nursing care system in Germany was still at breaking point at the time of the second wave survey. In the course of the Corona pandemic, some of the challenges and burdens have shifted and intensified. “Since its outbreak, the COVID-19 pandemic can be understood as a kind of burning glass revealing a multitude of existing structural deficits that have been overlaid by new challenges and burdens in long-term care,” says private lecturer Dr Timo-Kolja Pförtner from the IMVR.

Coping with the first wave of the pandemic was accompanied by a considerable number of people in care who died from and with COVID-19. With the emergence of the second pandemic wave at the end of 2020, economic aspects in particular moved into the public and political consciousness. Although care continued to receive attention in Germany at this time, it no longer reached the level it had at the beginning of the pandemic. “With our study, we would like to show which challenges and burdens nursing facilities had to deal with in the context of the second wave as well,” explains Dr. Pförtner.

The main results of the study can be highlighted as:

  1. Testing of patients and staff as a new task: While the procurement and consumption of protective equipment was a central challenge and burden at the beginning of the pandemic, this shifted to the testing of patients and staff in the course of the second wave survey. The additional workload associated with testing was largely borne by the nursing staff, who additionally had to deal with staff shortages and absences in the course of the second survey.
  2. Concern for the well-being of patients and staff: The effects of the pandemic on the psychological well-being of those in need of long-term care - and especially those suffering from dementia - continued to be a great stressor for the nursing staff in the course of the second survey. The concern for the well-being of those in need of care and staff members therefore represents a central challenge for care institutions in the course of the pandemic.
  3. The launch of the vaccination campaign brings relief and uncertainty at the same time: The study results make clear that the vaccination campaign of care recipients and care staff, which was already underway in the course of the second survey, provided initial relief, but was also accompanied by many uncertainties among the staff. It is clear that, at the time of the survey, some of the nursing staff were critical of vaccination due to a lack of and conflicting information. 
  4. Poorer health of management staff and lower presenteeism: According to the assessments, the well-being of the management staff surveyed continued to deteriorate in the course of the pandemic. On the other hand, the number of managers who appeared at work despite being ill or feeling ill (presenteeism) decreased in the course of the pandemic: while in the first wave 18 per cent of respondents stated that they never went to work sick, in the second wave this figure was 45 per cent.
  5. The shortage of skilled workers further increased in the course of the pandemic: The results make it clear that the shortage of skilled workers, which was already prevalent in Germany before and at the beginning of the pandemic, has become more relevant in the course of the pandemic. As is clear from the information provided by the interviewees, the German labour market has been “depleted” for some time, which has led to a further intensification of work and an increased workload for nursing staff and managers.
  6. The Robert Koch Institute as a central source of information: In addition to the health authorities and professional associations, the Robert Koch Institute is the central source of information for dealing with the pandemic, according to the managers interviewed. A positive picture emerges with regard to the degree of information and the handling of information on the pandemic.
  7. Organisational coping capacity is rated highly (coping optimism): Despite the multi-layered effects of the pandemic, a large proportion of respondents still believe that they can cope with the associated challenges and burdens. This indicates that care institutions are experienced in emergencies and thus resilient.
  8. Social cohesion and empowerment as key factors for crisis management: The survey results highlight that social cohesion and collective agency are among the strongest resources for coping with the pandemic situation. In view of generally scarce financial, material and human resources, social togetherness, emotional support and mutual trust seem to gain in importance.


For further information, please contact Priv.-Doz. Dr. Timo-Kolja Pförtner, IMVR - Institute for Medical Sociology, Health Services Research, and Rehabilitation Science, timo-kolja.pfoertner[@]

Press contact: Mathias Martin, m.martin[@]

Translation: Eva Laurie, elaurie[@]

Find the study on ResearchGate:

"Versorgung in Zeiten von Corona - Drohender Systemkollaps oder normaler Wahnsinn? 2. wissenschaftliche Studie zu Herausforderungen und Belastungen aus der Sichtweise von Leitungskräften"


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