COVID-19 Transmission in Nursing Homes May Be Affected By Nurses and Direct Care Workers With Multiple Jobs


With Limited Hours and Low Wages, Workers in Long-Term Care Facilities Seek Second Jobs

HANOVER, N.H. – Dec. 7, 2020 – Nurses and other long-term care workers in nursing homes who hold 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 ReviewThe 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, has 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.

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: 6.41 percent of personal care and nursing aides and 6.23 percent of licensed practical nurses and licensed nurses hold second jobs. This rate of holding a second job is 35 percent and 32 percent, respectively, 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. Approximately 34 percent of nurses in nursing homes take second jobs in other nursing homes while nearly 30 percent of those who work in hospitals work at other hospitals. Fifty percent of direct care workers work in direct care as 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 second job holding among direct care workers and nurses in long-term care than other workers, and many of these workers moving across health settings from their first to second jobs, this creates a potential pathway for COVID-19 transmission,” explains co-author Kristin E. Smith, a visiting associate professor of sociology at Dartmouth. “In New Hampshire, 81 percent of COVID-19 deaths are to long-term care residents, representing the highest percentage of deaths to long-term care residents in the country, so understanding employment dynamics and disparities in this sector could never be more timely than now.”

The study was based on second job holding data from 2010 to 2019 from the Current Population Survey. While low wages and limited hours were associated with holding a second job for direct care workers, lower hours were more strongly correlated with second job holding among 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 worked 30 percent more hours.

White direct care workers were more likely to have second jobs than Asian, American Indian, 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 COVID-19 pandemic is shining the spotlight on inequalities throughout our society, particularly in healthcare systems, where we are now seeing real-life implications for loved ones in nursing homes, who are such a vulnerable population,” added Smith. “Federal and state-level initiatives aimed at raising wages through bonuses that are higher than unemployment benefits could potentially help decrease the likelihood that these essential care workers must take on a second job and help reduce exposure for COVID-19 transmission.”

Smith’s research focuses on gender inequality, labor markets and employment, and work and family policy, including a recent study on the pay of essential care workers.

Smith is available for comment at: The study was led by co-authors Reagan A. Baughman and Bryce Stanley at the University of New Hampshire.