Abuse and Wellbeing of Long-Term Care Workers in the COVID-19 Era: Evidence from the UK

Workplace Violence and Worker Well-Being: A Preliminary Cross-Sectional Study

PURPOSE

To investigate the prevalence of workplace violence (WPV) in home health care and long-term care facilities (LTCFs) and explore the relationship between WPV and worker well-being.

METHOD

A cross-sectional survey was conducted with health care workers in an agency that provided care in homes or LTCFs. Six measures of worker well-being were collected: satisfaction with work and life, work-related rumination, work/family conflict, burnout, and turnover intention. Surveys also assessed type and frequency of WPV.

RESULTS

Seventeen participants completed surveys. Verbal abuse by patients was the most often experienced type of WPV. Employees who reported experiencing WPV had higher burnout and lower satisfaction with work and life.

CONCLUSION

WPV routinely occurs in home health care and LTCFs and appears to be related to worker well-being. Facility managers who can control WPV will likely impact the well-being of employees. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Workplace violence and intention to quit in the English NHS

NHS job vacancies remain at record levels and an increasing number of staff are leaving the NHS. Work-related violence is an aspect that has received little attention as a possible driving force in dropout rates among NHS workforce. Recent figures indicate that approximately 15% of NHS staff had experienced physical violence while at work (NHS Staff Survey, 2022). Given the prevalence of abuse and the consequences it may have on staff wellbeing, we examine the impact of workplace violence on intention to quit the organisation. We employ data from the NHS Staff Survey, a rich dataset that records the experience and views of staff working in the NHS. We use data from 2018 to 2022 of NHS employees surveyed in all NHS acute hospitals, with a sample size of 1,814,120 observations. We study the impact of experiencing physical or verbal violence in the workplace on the intention to quit the organization, examining differences according to perpetrator type. Our analysis also sheds light on any aggravated effect the pandemic had on intention to leave for those exposed to violence. The results suggest that experiencing physical violence increases the intention to leave by 10 percentage points. The effect of verbal violence is quantitatively greater in magnitude, increasing intention to leave by 21 percentage points. Violence from managers has the largest detrimental effect, followed by exposure to violence from multiple perpetrators and violence from colleagues. Heterogeneous effects exist according to occupational group, gender, age and ethnicity. The pandemic only had a marginal contribution to these effects. Staff health, trust in management and quality of patient care are some of the possible mechanisms through which violence influences the intention to quit. Overall, the results suggest that targeted interventions are needed to improve retention after exposure to violence.

'You're out on a limb, on your own': Social care personal assistants' (PAs') reflections on working in the Covid-19 pandemic - implications for wider health and care services

CONTEXT

In England, Personal Assistants (PAs) are part of an international trend towards state funded but client-hired or directly employed care workers. The Covid-19 pandemic highlighted and exacerbated pre-existing risks and advantages of this arrangement for both PAs and people with care and support needs.

OBJECTIVES

We aim to report PAs' reflections on their experiences of working since the pandemic started in 2020 and highlight the longer-term implications for health and care services.

METHODS

We undertook a large-scale, qualitative study in 2016-17 involving interviews with 104 PAs about their working lives. We re-interviewed PAs from this group twice to ask how the pandemic had affected them, once at the start of the pandemic in Spring 2020 and again in December 2021 -April 2022. This article reports findings from the last set of interviews undertaken with 38 PAs. Thematic analysis was conducted of interviews in which PAs discussed changes in tasks and responsibilities, pay and conditions, training, relationships and plans.

FINDINGS

This article focuses on the following themes: PAs' perceptions of their outsider status; support and training needs; job security; and whether PAs have an appetite for regulation to provide greater professional standing and connections.

LIMITATIONS

Interviews in this study were carried out during the Covid-19 pandemic over the telephone or virtually rather than in person so may have missed certain body language or informal relationship building. The sample may be under-representative of non-British PAs. We were unable to triangulate participants' accounts with others'.

IMPLICATIONS

This study highlights the importance of national and local government including the PA workforce in planning for national emergencies. Consideration should be given by policy makers and local health and care systems to how PAs can be better supported than currently.

Relationship between Experience of Client Violence and Turnover Intention among Workers in Long-Term Care Facilities for Older Adults: Focusing on Nurses, Social Workers, and Care Workers

To prevent discontinuity of long-term care service and guarantee the quality of care, it is important to clarify the determinants of turnover intentions of long-term care workers. They are at a higher risk of experiencing violence—including physical, emotional, and sexual—from patients or their families, possibly leading to high turnover intention. This study aims to verify how having experienced client violence affect turnover intention of long-term care workers and to suggest implications to prevent frequent turnover in long-term care field. Logistic regression analysis was conducted between groups who have experienced client violence and who have not, using 2019 Korean LTC Survey data. Results revealed that, first, there were differences in determinants of turnover intention depending on groups. Second, having experienced client violence had a different effect on turnover intention based on personal characteristics. Third, gender and occupational differences were found. Based on our results, we highlighted the need for discussions on interventions to address client violence exposure among long-term care workers.

English care home staff morale and preparedness during the Covid pandemic: A longitudinal analysis

BACKGROUND

: Staff actions to prevent infection introduction and transmission in long-term care facilities (LTCFs) were key to reducing morbidity and mortality from COVID-19. Implementing infection control measures (ICMs) requires training, adherence and complex decision making while trying to deliver high quality care. We surveyed LTCF staff in England about their preparedness and morale at three timepoints during the COVID-19 epidemic.

METHODS

: Online structured survey targeted at LTCF workers (any role) administered at three timepoints (November 2020-January 2021; August-November 2021; March-May 2022). Narrative summary of answers, narrative and statistical summary (proportionality with Pearson's chi-square or Fisher's Exact Test) of possible differences in answers between waves.

RESULTS

: Across all three survey waves, 387 responses were received. Morale, attitudes towards working environment and perception about colleague collaboration were mostly positive at all survey points. Infection control training was perceived as adequate. Staff felt mostly positive emotions at work. The working environment remained challenging. Masks were the single form of PPE most consistently used; eye protection the least used. Mask-wearing was linked to poorer communication and resident discomfort as well as mild negative health impacts on many staff, such as dehydration and adverse skin reactions. Hand sanitiser caused skin irritation.

CONCUSIONS

: Staff morale and working practices were generally good even though the working environment provided many new challenges that did not exist pre-pandemic.