The practices of managers and registered nurses (RNs) in long-term care facilities are frequently ineffective in assisting the licensed practical nurses (LPNs) and healthcare aides (HCAs) whom they supervise. Little research exists that examines the area of supportive relationships between nursing staff and supervisors in these settings. The purpose of this study was to gather data that could improve management practices in long-term care residential facilities and enhance the quality of the supervisory relationships between supervisors (nurse managers and RNs) and care providers (HCAs and LPNs) in these settings. The study also identified factors that influence the supervisors' ability to establish supportive relationships with care providers. The challenges and barriers to nurse managers and leaders related to enacting supportive behaviors are discussed as well as their implications for long-term care settings.

This study supports the idea that the fundamental tenets of good leadership--communication, involvement, and empowerment--are foundational for real change in dementia care to be attained and sustained.

To improve patient safety culture, nurse managers should focus on the identified factors and adopt multiple strategies. Specifically, nurse mangers should try to build trust with nurses, demonstrate sincere safety commitments, and set patient safety as a true priority.