From applause back into the abyss: A longitudinal qualitative study of the lived experiences of low-status healthcare workers during the COVID-19 crisis

Certified nurse assistants constitute a relatively low-status but essential occupational group in the Dutch long-term care sector. This study examines how their lived experiences over the course of the COVID-19 pandemic. The longitudinal qualitative study draws on two complementary data sources. First, a total of 32 in-depth interviews with certified nurse assistants, which took place in two rounds: between September and October 2020, and between March and April 2021. Second, real-time WhatsApp group conversations between certified nurse assistants from March 2020 to March 2021. In the early stages of the pandemic, certified nurse assistants expressed fear and worry alongside pride. Over time, these experiences evolved into frustration and bitterness. Changes in lived experiences closely mirrored certified nurse assistants’ perceived levels of societal solidarity and attention from policymakers. Initial public recognition and support proved fleeting, and waning compliance with social distancing measures, combined with policy prioritization of higher-status HCWs, amplified pre-pandemic feelings of frustration, invisibility and neglect. The study contributes by foregrounding how and why the unique lived experiences over a lower-status occupational groups evolved over the course of the pandemic. In so doing, it develops an understanding of how entrenched institutionalized occupational hierarchies in healthcare, reflected in government and organizational policies, shaped these lived experiences, highlighting the structural conditions that sustain their invisibility and undervaluation. The study foregrounds that the negligence, ignorance and devaluation that CNAs experienced were not just symptoms of crisis conditions, but long-standing structural states that require sustained attention from care organizations and national policymakers. • Longitudinal qualitative study of lived experiences of a low-status healthcare workers during the COVID-19 pandemic. • Lived experiences of certified nurse assistants changed over the course of the pandemic. • Attentiveness to the changing lived experiences of low-status healthcare workers during a pandemic is needed to organize support resources that are tailored to their needs. • Lived experiences were shaped by perceived neglect and ignorance of policymakers and society, informed by institutionalized occupational hierarchies and inequalities. • Made publicly visible by the pandemic, these inequalities must be addressed or risk worsening and threatening lower-status HCWs’ retention.