When the COVID-19 pandemic swept through the Netherlands in 2020, nursing homes became one of the most dangerous frontlines in the entire healthcare system. Elderly residents, many with dementia or multiple chronic conditions, were at extreme risk of severe illness and death, while the staff who cared for them worked under conditions few had ever imagined. A new study from researchers at the University of Groningen and University Medical Center Groningen, published in BMC Nursing, has now mapped the psychological toll of that period in unusual detail, tracking job demands, job resources, work functioning and mental health among thousands of Dutch nursing home employees across four separate survey waves between June 2020 and August 2021. The findings paint a picture of sustained, persistent strain rather than a crisis that rose and fell with the pandemic’s waves.
The research team, led by Ylse van Dijk, designed the investigation as a multiple cross-sectional study embedded within the broader MINUTES project, which examined COVID-19 management in Dutch nursing homes. Nine nursing home organizations took part, and staff were invited to complete questionnaires at four points in time: June through September 2020, October through December 2020, February through April 2021, and June through August 2021. These windows deliberately spanned different phases of the pandemic in the Netherlands, from the first summer lull through the devastating second wave, the vaccination rollout, and the relative calm of mid-2021. Participation was substantial, with 1,632 respondents in the first wave, 1,791 in the second, 1,479 in the third and 799 in the fourth, giving the researchers a large and repeatedly sampled workforce to analyze.
The methodological backbone of the study was a set of validated psychometric instruments. Job demands and job resources were measured with the Copenhagen Psychosocial Questionnaire, known as COPSOQ, which captures dimensions such as quantitative demands, emotional demands, and the support and meaning workers derive from their roles. Work functioning, meaning the ability to actually perform one’s job despite health complaints, was assessed with the Work Role Functioning Questionnaire. Depressive symptoms were screened using the Hospital Anxiety and Depression Scale, or HADS, while burnout was measured with the Burnout Assessment Tool, a relatively new instrument developed in the Netherlands that evaluates exhaustion, mental distance, cognitive impairment and emotional impairment as core components of the syndrome.
To analyze the data, the researchers used mixed linear regression models, a statistical approach well suited to repeated measurements collected from different individuals at each wave. The models were adjusted for age and gender, two factors known to influence both job perceptions and mental health outcomes. This allowed the team to estimate whether levels of job demands, resources, work functioning and mental health problems rose or fell in patterns that tracked the pandemic’s phases, and whether those temporal patterns differed between professional groups within the nursing homes, such as residential care staff, home care staff, practitioners and non-care personnel such as administrative and technical workers.
The headline result is sobering in its consistency. At every single wave, roughly one in five nursing home employees reported burnout or clinically relevant depressive symptoms. That prevalence did not spike during the deadliest months, nor did it ease noticeably once vaccines arrived and infection pressure subsided. Instead, the burden appears to have been remarkably flat across the entire study period, suggesting that the psychological strain on this workforce was not a transient emergency response phenomenon but a chronic condition that persisted through every phase of the pandemic.
Equally striking was what the researchers did not find. Despite the dramatic differences between the pandemic phases the study covered, no specific patterns over time emerged that could be linked to those phases for job demands, job resources, work functioning or mental health problems. The absence of a temporal signature is itself informative. It implies that whatever was driving distress among nursing home staff, it was not simply the intensity of outbreaks or the strictness of infection control measures at any given moment. The strain may instead have reflected an accumulation of pressures, including staffing shortages, grief over resident deaths, fear of infection, and the erosion of the ordinary routines and resources that normally sustain workers in long-term care.
The analysis did reveal one meaningful differentiation between professional groups. Patterns over time in quantitative demands, the sheer volume of work, and emotional demands, the psychological intensity of caring for suffering people, were similar between home care staff and practitioners on one hand, and between residential care staff and non-care staff on the other. This grouping suggests that the pandemic reshaped workloads and emotional burdens differently depending on the nature of the role. Employees providing direct care, whether inside the nursing home walls or in residents’ own homes, experienced the demands of their work in comparable ways, while those in residential settings and those in supporting non-care roles formed a second, distinct cluster of experiences.
The study was grounded in the Job Demands-Resources model, a widely used framework in occupational health psychology that posits that every job combines demands, which consume energy and can produce strain, with resources, which buffer those demands and foster engagement. Applied to the pandemic context, the model predicts that surging demands without compensating resources would push workers toward burnout and depression. The observed stability of mental health problems at around twenty percent across all waves is consistent with a situation in which both demands and resources remained elevated or disrupted throughout, rather than one in which conditions normalized over time.
The authors are careful about the limits of their design. Because each wave captured a different cross-section of staff rather than following the same individuals over time, the study cannot determine whether particular workers improved or deteriorated as the pandemic evolved. Within-person change, the phenomenon that matters most for understanding recovery and cumulative harm, is invisible to a multiple cross-sectional approach, even one repeated four times. The researchers explicitly call for additional longitudinal studies that observe individuals over time to complement their findings. Differences in wave composition, response rates and the changing composition of participating organizations may also have influenced the results in ways the adjusted models could not fully eliminate.
Even with those caveats, the study carries a clear message for health systems and policymakers. Nursing home staff, who were celebrated as heroes in the early months of the pandemic, carried a substantial and unrelenting mental health burden for well over a year, with one in five experiencing burnout or depressive symptoms at every measurement point. The lack of improvement after vaccination campaigns suggests that structural interventions, including adequate staffing, psychological support and sustainable working conditions, are needed to address what the pandemic exposed rather than assuming that time alone will heal the workforce. As long-term care systems across Europe and beyond continue to struggle with staff shortages, the Dutch data offer a quantitative reminder that the pandemic’s impact on caregiving workforces was deep, durable and, without deliberate action, likely to persist.
Subject of Research: Mental health and occupational burden among Dutch nursing home staff during the COVID-19 pandemic
Article Title: Burdens and consequences for Dutch nursing home staff during the COVID-19 pandemic: a multiple cross-sectional study
Article References: van Dijk, Y., Janus, S. I. M., de Boer, M. R., Roelen, C. A. M., & Zuidema, S. U. (2026). Burdens and consequences for Dutch nursing home staff during the COVID-19 pandemic: a multiple cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05400-6
Image Credits: AI Generated
DOI: 10.1186/s12912-026-05400-6
Keywords: COVID-19, nursing homes, mental health, burnout, depressive symptoms, nursing staff, occupational health, job demands, cross-sectional study, Netherlands, long-term care, work functioning
