In today’s climate and environment, the conventional relationship between caring, economic, and leadership practices may no longer meet the needs of patients, clinicians, providers, or systems. It is asserted that in the current complicated and complex healthcare environment challenged by a multitude of issues, a shift toward human caring values and an ethic of authentic healing relationships is required, especially in light of the current COVID-19 pandemic. The costs of unethical behaviour can be even greater for followers. When we assume the benefits of leadership, we also assume ethical burdens. It is the assertion and experience of the authors that the triangle of ethics and ethical behaviour, followers, and patient’s outcomes is closely interrelated and affects each other in a very intimate and direct way. Unethical leadership may lead to follower disappointment and distrust, leading to lack of interest and commitment, consequently negatively impacting patient outcomes and organizational effectiveness.

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In today's climate and environment, the conventional relationship between caring, economic, and administrative practices no longer serves the interest of patients, clinicians, or systems. A shift toward human caring values and an ethic of authentic healing relationships is required as systems now have to value human resources and life purposes, inner meaning, and processes for providers and patients alike. The costs of unethical behavior can be even greater for followers. When we assume the benefits of leadership, we also assume ethical burdens. It is the assertion and experience of the author that the triangle of ethics and ethical behavior, followers, and patient's outcomes are closely interrelated and affect each other in a very intimate and direct way. Unethical leadership may lead to follower disappointment and distrust, leading to lack of interest and commitment, consequently negatively impacting patient outcomes and organizational effectiveness.

To slow the spread of COVID-19 within the Canadian long-term residential care (LTRC) sector, a series of pandemic management strategies were introduced, including restricted visitation and single site employment. These strategies were enacted to prevent and control infection, resulting in unknown impact on direct care staff and staff capacity to deliver quality care or service.Objective: To explore staff reports of outcomes associated with LTRC pandemic management strategies, particularly their impact on LTRC staff mental health, work behaviours and quality of care or service provision. Method:This was a case study using mixed methods including a longitudinal survey and interviews with staff from one LTRC site in British Columbia. Survey data from 68 staff who participated in both survey times were analyzed using regressions with relative weight analysis. Semi-structured interviews were conducted with 26 LTRC staff and analyzed using content analysis.Findings: Survey data demonstrated that staff perceived the sick time policy and staffing levels as the most inadequate pandemic management strategies. Survey data also showed the visitation policy, the sick time policy and the single site employment policy were most significantly associated with negative outcomes to staff mental health, work behaviours and quality of care or service delivery. Qualitative data suggested connections between these policies and inadequate staffing levels and heavy workloads. Limitations:The study design along with the low response rate and the small sample size limits the generalizability of the findings to other settings. Implications:The development and implementation of pandemic management strategies must be informed by and give consideration to working conditions of LTRC staff including long standing systemic issues such as staffing shortages and heavy workloads.