As members of the Human Factors and Resources Working Group at HTW Dresden, we have contributed to recent research of the Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, BAuA) within the project “Interventions focusing on work organisation as a part of pandemic management in inpatient care services” by conducting guide-based interviews with managers in inpatient care facilities - together with our colleague at Maria Zink (BAuA). Among the questions we wanted to answer with this interview study were the following:

Which challenges associated with the COVID-19 pandemic were professional nurses and their managers confronted with? Which consequences did this have on the managers´ health?

Which work organisation strategies and interventions were carried out by the facilities in order to deal with the challenges? How effective did these strategies and interventions prove to be?

The project aims at generating knowledge about organisational interventions which support human-centred work in times of a pandemic (or similar crisis-like situation) in inpatient care facilities (hospitals and nursing homes) Thus, we are looking for interventions which were initiated and implemented to reduce the probability of negative consequences the range of loads associated with the pandemic might have for nurses and managers.

We were able to recruit thirty-one managers from (hospitals) and twenty-two managers from long-term residential care facilities (nursing homes) for participation in the interviews. Of the seventeen participating care facilities, sixteen are located in Saxony and one is located in. The facilities selected are of various sizes and ownership.

Impressions from our site visits

We received a friendly welcome when we visited the hospitals and nursing homes. During the interviews it was noticeable that the interviewees were strongly motivated to talk about their work during the COVID-19 pandemic in depth. Here we present first impressions from these interviews.

Challenges during the pandemic period

From the very beginning of the pandemic work in hospitals and nursing homes was dominated by uncertainty and fear.. The professional nurses told us that they had been afraid of catching COVID-19 themselves or infecting patients, residents and their own families. There was huge concern about how things would develop in the future. On the one hand, there was a lack of knowledge about how to treat the new disease and a lack of experience with appropriate therapies. On the other hand, the exceptionally high mortality rates among patients and residents were extremely challenging.

"Dealing with death and dying came to have a completely different meaning, we had an extra refrigerated container for the deceased in our hospital; I often transported them myself since my staff often couldn’t do it."
– Nursing manager

Apart from this, the very dynamic situation during the pandemic exacerbated the situation in the care facilities. For instance, due to staffing shortages and large numbers of absences managers had to reorganise duty rosters daily.

“So every day was a puzzle, you’d hardly put the rosters together than the whole thing collapsed like a house of cards because staff had called in sick again.”
– Team leader

Negative impact of multiple load

The interaction of multiple loads such as higher work intensity, different facets of physical and mental strain (e. g. dying, death, fear), the load associated with wearing personal protective equipment (PPE), the necessity of reorganizing duty rosters daily and other issues led to adverse work situations for nurses and managers throughout the different waves of the pandemic. This became apparent to us in many of the interviews. With regard to health the interviewees not only reported complaints that were already known - such as disturbed sleep, or mental as well as psychosomatic complaints - . They also talked about how nurses and managers themselves were affected by an infection with the SARS-CoV-2 virus or COVID-19.

Teamwork during the pandemic period

According to the managers’ statements, it was teamwork, one of the most powerful resources in nursing and care, that made it possible to get through the pandemic period. Many interviewees emphasised noticable improvements in teamwork, communication, and inter-professional collaboration. Other supportive resources were greater flexibility of the organisations as well as the employees and advances with regard to digitalisation.

Several interventions

The managers described various interventions they had implemented to counteract the pandemic. One of the most important intervention was the consistent implementation of a hygiene strategy, in particular the various forms of a testing strategy.

“Employees were involved in the selection of protective equipment, which materials were to prefer – since theyhave to wear it!”
– Home manager

Furthermore, changes in work processes and structures were reported. For instance, backup duty rosters for the case of staff absences were compiled. Wards were combined or even had to be closed. Service staff, volunteers, Bundeswehr soldiers, or temporary personnel sometimes performed simple nursing or care duties to support the professional nurses.

Research cooperation

The cooperation between the project team around Dr Marlen Melzer at the Federal Institute for Occupational Safety and Health (BAuA) and the interdisciplinary team of the Human Factors and Resources (HFR) Working Group at HTW Dresden was instigated for the BAuA project “Interventions focusing on work organisation as part of pandemic management in inpatient care facilities”. The HFR Working Group is led by Professor von der Weth and conducts applied research on the design of decent, health-promotingwork and individuals’ changing roles in working life. Its project team consists of the care manager Karin Fuchs and the ergonomist Rinat Saifoulline.

We would like to express our deep gratitude to all the people who agreed with being interviewed for the trust in us and the large amount of valuable information they provided - which we will evaluate systematically as the project continues.

Suggested citation

Fuchs, Karin; Saifoulline, Rinat: “Interventions focusing on work organisation as a part of pandemic management in inpatient care facilities”, (online), 2023. Dortmund: Federal Institute for Occupational Safety and Health. Available at: https://www.baua.de/EN/Topics/Work-design/Working-organisation/Care/Interview-pandemic-management.html