‘We’re Putting Out So Many Fires’: Skilled Nursing Workers Forced to Wear Multiple Hats, Increasing Burnout Risks

The labor shortage has meant that workers in nursing homes have had to juggle various roles and chip in on a range of tasks, so much so that some providers have begun hiring people for this ability to cross over.

“I think everybody in the community has to wear several hats and help out where needed … they’ve been doing that for the last three years, so they’re used to [it] at this point,” Amber Iskander, Executive Director of Human Resources at CarDon & Associates, told SNN.

Indiana-based CarDon owns and operates 19 senior housing and rehabilitation communities in Indiana and provides skilled nursing, assisted living, memory care, independent living and long-term care. 

Adapting to this juggling hasn’t always been easy, and carries risks such as burnout. It can also be less cost effective for organizations when trained employees in higher salaried roles have to do work in housekeeping and dining. But it has become a norm that many operators are finding difficult to change.

“During the day, you’re putting out so many fires … you’re trying to catch up on your own work every night. That’s tiring,” said Laurel Lingle, vice president at Majestic Care. The Indiana-based operator manages 27 skilled nursing facilities and seven assisted living centers across three states.

In her corporate role at the head office, Lingle’s job is to hire, develop and retain candidates, but she finds herself getting pulled into facilities and juggling all kinds of jobs, from passing trays to emptying trash to scrambling to find nurses to filling shifts to helping the clinical staff and director of nursing services.

“It’s all hands on deck when you’re in a building … We don’t walk in as ‘home office.’ We walk in as an extension of that building and whatever’s needed,” Lingle said.

And it’s not just her department, but all departments, including the nurses, for whom this juggling act goes on and sometimes prolongs the working hours, Lingle said.

“I feel terrible for the care team member who’s got perfect attendance,” she said. “They are there day in, day out, every single night, and not getting to spend time with their family, either, because we had another call in. So it’s all the way around. I think it’s hard. It’s hard on everyone these days and people are tired.”

For Lingle herself, what’s lost with this juggling is applying her expertise in human resources and fully committing to the task of finding workers.

“It’s so hard to put my resources in those strategic type operational items when you’re just putting out fires,” Lingle said.

That said, Lingle said that Majestic Care is always looking for ways to improve the pipeline of nurses with the hopes of ending the chaos of crossover work – something that the pandemic brought on as the new norm.

One step that Majestic Care and others have implemented to that end is to allow their licensed practical nurses (LPNs) and registered nurses (RNs) to become educators – juggling, yes, but in a closely related role. The organization allows its facilities to provide the training for CNAs who are receiving their academic training at the local Hondros College of Nursing.

“Outside my door right now, I have advertisements for faculty to teach at different colleges,” Lingle said. “I mean, a lot of the folks from college will send me a poster, and say, ‘Hey, would you put this up? Do you have anybody that would be interested on weekends to help out?’”

She indulges these requests despite Majestic Care’s busy nursing staff having little time to devote to these efforts, Lingle said, with one hope: “I think if we have somebody that will teach, then they can push [CNAs] to us … We have to keep thinking of where that next person’s got to come from.”

Avoiding burnout

All this juggling can be a source of burnout. And, one way that providers say that they are able to prevent burnout stemming from adopting multiple roles is by hiring natural multitaskers and developing workforce programs that allow workers to be leaders.

“It’s a tricky balance, but things people have gotten used to,” said Amy Haug, chief human resources officer at CarDon. “Employees, even in corporate offices, will often say, ‘I’ll go to this community to help or I’ll be here on this day.’ So having a corporate team that is able to help in that way is probably a bonus for us.”

Not only is juggling multiple responsibilities a necessary trait, but a pandemic era practice that won’t be gone, at least anytime soon, Haug said, and so providers might as well embrace it.

With this recognition, some nursing homes are hiring people for the ability to juggle successfully, with CarDon placing such capabilities “at the top of the list” during the interview stage, Haug said.

“We set the expectations in the interview process and say, ‘Listen, our world is where you’re multitasking, you’re switching functional areas occasionally to work in different areas. If you’re not somebody that enjoys that variety of tasks, then you might want to think about this job because it’s more likely than not that you’re going to be on the go. You’re going to experience different things,’” she said.

If supervisors are having to wear multiple hats, that also means younger employees have to be able to work with limited supervision and work independently, especially these days, Haug said.

“I would hope from a staffing standpoint, we do get back to where we are targeted to be. But it’s interesting because I think some people actually get energized by being able to [juggle tasks] … If you’re hiring the right person to the right profile, then I think we have people that don’t necessarily mind and they kind of enjoy helping out the team.”

In addition to hiring for juggling multiple tasks, Haug said she seeks to develop leadership skills to prevent burnout.

“We’ve really noticed, too, the value of developing our frontline leaders and giving them more tools to work as managers and leaders and empowering them,” said Haug regarding her company’s LEAP program. 

The LEAP program at CarDon teaches employees to be upbeat, including teaching managers how to use “appreciative language” and how to have difficult conversations. 

So far, all this management of multiple tasks isn’t necessarily leading to burnout, as conventional wisdom would have it.

“[Employees] start feeling the burnout and the fatigue when they can’t take their time away,” said Haug.

Separation of roles can be done

Some nursing homes are eager to return to the old norm, and are working hard to maintain a separation of roles. They believe this pandemic-era vestige is counterproductive and are striving to enable employees to work according to specialization.

Marc Halpert, CEO of Monarch Healthcare Management, feels that each employee should focus on their specialty. The Minnesota-based nursing home operator provides skilled nursing and rehabilitation services as well as memory care, assisted living, and independent living across 49 communities.

“You don’t want a nurse going to work in the kitchen, and then not taking care of her people. They’re trained in certain areas, and so to go ahead and start training someone else just is not a good use of time, but in emergencies, you do what you need to do,” said Halpert, adding that the pandemic really tested that principle. Halpert said that since every department was short staffed, pulling people out of their designated roles was necessary but not helpful.

And now that the pandemic has entered a new phase, the company has made a great effort to keep roles separated.

“Since COVID is really winding down, we’ve actually been fairly good in that area, where culinary deals with culinary, housekeeping deals with housekeeping, and nurses are able to be nurses … it’s worked out and we’re standing up straight,” Halpert said.