Associations of Job Strain and Health: Differences Among Nurses and Personal Support Workers in Residential Care Homes During the COVID-19 Pandemic.

Publication date: May 16, 2026

The COVID-19 pandemic revealed stressful working conditions experienced by health care workers in long-term care and seniors’ (LTCS) homes worldwide. However, differences in job strain among regulated and unregulated health care workers and its relationship to their health are understudied. This study examined associations between job strain-related working conditions and health changes, exploring differences between nurses and personal support workers (PSWs). This cross-sectional study used the Survey of Health Care Workers’ Experiences During the Pandemic (2021). Job strain-related working conditions included workload increases, working overtime, and beyond-role work. Outcomes were workers’ perceived changes in general health and mental health during the pandemic. Descriptive statistics and multivariable logistic regression models were employed, stratified by occupation, and controlled for covariates. Job strain prevalence during the pandemic was high, with more nurses reporting job strain-related working conditions (increased workloads, overtime, or beyond-role work) than PSWs. Associations between job strain working conditions and worsened health varied by occupation. Beyond-role work was associated with worsened mental health for both workers, but only worsened general health for nurses, not PSWs. Differences among nurses and PSWs demonstrate the importance of understanding variations in roles, occupational experiences and policies regulating health care workers. These findings support the need for targeted monitoring of mental and general health among nurses and PSWs in LTCS settings. Occupational health practitioners can identify experiences of job strain among staff and provide counsel for solutions, collaborating with management to ensure the LTCS workforce’s health and safety.

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