Nursing Home Administrators' Experiences of Work Stress and Intention to Quit during the COVID-19 Pandemic

The COVID-19 pandemic negatively impacted nursing home administrators (NHAs). This study explores licensed and employed NHA's perceptions about what work stress events would drive their turnover intentions (TI) in year three of the pandemic. As part of a larger survey-based research project collecting numerical and textual data, this study conducted content analysis with qualitative data. Narrative data from 3,859 discrete responses of 1,139 NHAs, from 50 states and Washington D.C, on two open-ended electronic survey questions asking about their work stress and TI were collected February - March 2022. Categories and subcategories were counted and discussed in context as themes. We identified 4 main narrative categories with subcategories about NHA's stress about the regulatory system (e.g., excessive, conflicting, changing regulations), staffing (e.g., insufficient, agency staff), organizational pressures (e.g., work overload), and macro system stressors (e.g. media representation of nursing homes). Three main TI categories with subcategories were identified: the LTC setting and system (e.g., regulatory demands, staffing, facility surveys); personal factors (e.g. stress, career opportunities), and others (e.g., "I would never quit," or "I already decided to quit"). Whole community disaster planning, person-centered surveyor training, improved regulatory guidance, simplified reporting, adequate guidance assistance, and adequate staff could mitigate NHA stress and TI during crises. Administrator resilience should be recognized. Solutions for supporting NHAs can include long-term care industry participation in public health disaster preparedness coalitions, consistent regulatory guidelines with established communication channels, and ongoing crisis leadership training for administrators.