Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes

Abstract

Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided.

Factors affecting job satisfaction in long‐term care unit managers, directors of care and facility administrators: A secondary analysis

“…Kanter () theorized that support is a key component of structural empowerment that promotes job satisfaction. Lack of leadership or management training experience combined with poor supervisor support may lead novice managers or administrators to experience difficulties with effectively prioritizing and delegating tasks (Hunt, Corazzini, & Anderson, ). Consistent with this, nursing managers who feel supported by their supervisors report lower intentions to leave (Hewko et al, ), suggesting that resonant leadership among supervisors and investment in nursing leadership education at all levels may improve job satisfaction, as enhanced leadership skills may promote a supportive culture that enhances employees’ job satisfaction.…”

Staff personhood in dementia care settings: “Do they care about me?”

“…While being known and valued were salient for RCAs at both sites, they were particularly pressing for Meadowview RCAs. Frequent management turnover hinders the development of positive connections with RCAs, the trust required for open dialogue and conflict resolution, and effective communication patterns (Hunt et al., ). While newly arrived managers likely face multiple pressing issues, RCAs’ experiences highlight the need to devote requisite time and effort to establishing personal relationships.…”

“…Such practices repeatedly discounted RCAs’ experiences as workers and human beings and contributed significantly to staff turnover (an ongoing issue for nursing homes; Donoghue, ). As Hunt, Corazzini, and Anderson () report, administrative turnover can further destabilise the work environment, disrupting the interpersonal connections necessary for the provision of quality care. Drawing on findings from a focused ethnography examining how the organisational care environment impedes or facilitates the provision of quality dementia care (Cooke, ), this article explores RCAs’ experiences of personhood in dementia care settings.…”

New Holistic Enrichment Program Utilizing Maslow’s Hierarchy of Needs Designed for Institutionalized Residential Care Facilities

“…Holistic quality of care suggests the integration of physical needs with mental and social needs as a caring focus [12]. Holistic care services for older adults can be established and enforced through upper management by setting the standard of expectations within IRCF employee performance reviews [13]. In some cases, it can be challenging to accomplish if clear objectives are not expressed [13].…”

“…Holistic care services for older adults can be established and enforced through upper management by setting the standard of expectations within IRCF employee performance reviews [13]. In some cases, it can be challenging to accomplish if clear objectives are not expressed [13]. Not communicating these guidelines can become confusing for the IRCF employees [13].…”