When the invisible becomes the impossible: Direct care workers’ experience of organizational change

Abstract

The covid-19 pandemic transformed the experience of work for many in the healthcare sector. In the current paper, we focus on the nature of healthcare work transformation in response to a sudden and unexpected onset of organizational change for direct care workers (DCWs). DCWs provide hands-on care for older and disabled adults and children, are the largest occupational group in the US, and were in a central position of healthcare administrative and organization change during the covid-19 pandemic and recovery. Analyses are based on 26 in-depth interviews with women DCWs who were employed during the covid-19 pandemic. We find changes in staffing and procedures associated with the covid-19 pandemic increased DCWs’ formal and more visible job responsibilities while reducing the amount of time DCWs were able to spend on informal or invisible aspects of their work, primarily engaging in meaningful and non-routine interactions with patients. For many, reconciling demands to accomplish more tasks in ways that felt rewarding to themselves and to their patients were severely challenged.