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COVID-19 transmission in nursing homes may be affected by nurses with multiple jobs

Most nurses with second jobs stay within the same occupation at another location, which increases the risk of transmission.

Jeff Lagasse, Associate Editor

Nurses and other long-term care workers in nursing homes holding multiple jobs may be one of the factors contributing to the spread of COVID-19 in these facilities, according to a new study published in Medical Care Research and Review

The nature of their work in providing essential care to patients in rather close proximity and the limited access to personal protective equipment for some workers have made this profession even riskier during the pandemic. The findings examine the likelihood that nurses and direct care workers in long-term care facilities hold a second job, and how demographic differences between the two may affect this probability.


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Due to low wages and limited hours, some nurses (registered nurses and licensed practical nurses) and direct care workers (certified nursing assistants and personal and home care aides) seek secondary employment: Some 35% of personal care and nursing aides and 32% of licensed practical nurses and licensed nurses hold second jobs. This rate is higher than that of other workers.

Most nurses and direct care workers with second jobs stay within the same occupation at another location, which increases their interaction with patients and the potential for COVID-19 transmission as compared to their counterparts who have one job. 

About 34% of nurses in nursing homes take second jobs in other nursing homes, while nearly 30% of those who work in hospitals work at other hospitals. Fifty percent of direct care workers work in direct care at a second job, while others work as cashiers, in retail, or as a janitor or maid. Fifteen percent of second jobs for personal care and nursing aides are in other "essential occupations."

With higher rates of having second jobs, and many of these workers moving across health settings as they transition from one job to another, the situation creates a potential pathway for COVID-19 transmission, the findings showed. Understanding this pathway is important, especially since nursing homes have been hot spots for transmission: In New Hampshire, for example, 81% of coronavirus deaths occur in long-term care residents. 

The study was based on second-job-holding data from 2010 to 2019 from the Current Population Survey. While low wages and limited hours applied to both nurses and direct care workers, lower hours were correlated more with registered nurses and licensed practical nurses. 

The results also showed that nurses with children and African American nurses were more likely to hold second jobs than white nurses. Female and married nurses were less likely to have a second job. Nurses had higher wages than direct care workers, and they worked 30% more hours.

White direct care workers were more likely to have second jobs than Asian, American Indian and Alaskan Native workers. Similarly, African American direct care workers were also less likely to take on second jobs when work hours were excluded from the analysis, and Hispanic workers were less likely to have a second job than their non-Hispanic counterparts. Direct care workers with more education were more likely to have a second job.

The authors said federal and state initiatives aimed at raising wages through bonuses that are higher than unemployment benefits could potentially decrease the likelihood that these workers would have to take on a second job, thereby reducing exposure and chances of transmission.


Eight months ago, the nation first heard of a surge of COVID-19 deaths in a Washington State nursing home – an early warning sign of how the coronavirus could rip through such facilities. Since that time, more than 40% of Americans killed by the pandemic have lived in nursing homes.

In mid-October, a Journal of the American Geriatrics Society study detailed how three Michigan nursing homes limited the spread of the coronavirus within their walls after the first cases were diagnosed in that early peak state. 

All three nursing homes in the study went into the pandemic with a proactive, partnership-based approach to general infection prevention, with response plans already in place that paved the way for effective COVID-19 containment. This was made possible in part by their formal connections pre-COVID-19 with Michigan Medicine, the academic medical center of the University of Michigan.

This week the Department of Health and Human Services announced the second round of performance payments for nursing homes, worth $523 million, to be distributed to over 9,000 facilities.

Qualifying nursing homes will begin receiving payments December 9 for successfully reducing COVID-19 related infections and deaths between September and October.

Twitter: @JELagasse
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