Building Resilient Nurse Leaders in Long Term Care

Nurses have a pivotal role in the nursing home setting as they are responsible for oversight of nursing assistants, clinical problem solving, and regulatory compliance.

The role of the long term care nurse has dramatically changed over the last ten years from traditional nursing home care to providing intense clinical care to adults of all ages, including post-acute rehabilitation and end of life.

Short term rehabilitation patients have complex needs requiring intense skilled care. Long term residents are frail, over half have dementia, and more than 50% require extensive support with activities of daily living. These changes place an inordinate amount of stress on nurses resulting in a tumultuous workplace for both experienced and less experienced nurses. The challenging environment can have a negative impact on both nurse and patient satisfaction, and result in poor quality outcomes.

Nurses in long term care lack the skills that promote personal resilience and the ability to thrive in the new paradigm of long term care. The concept of resilience refers to a person’s ability to manage stress and respond effectively to an adverse work environment. The increasing expectations of nursing home care demand skills and expertise beyond that of nurses employed in long term care. Over 2/3 of registered nurses (RNs) employed in long term care hold associate degrees and the majority of licensed nurses employed in nursing homes are licensed practical nurses. Their academic preparation is not adequate for thriving in an unpredictable care environment. Many nurses employed in long term care are new graduate nurses that are unable to find employment within the acute care system and accept positions in long term care to gain clinical experience and wait for an acute care opportunity. This “waiting time” often results in nurses with low motivation and high turnover. High turnover contributes to poor quality of care and low staff morale .

Long term care providers do not have the financial or human resources to provide adequate training and support for nurses in long term care. General orientation for newly employed RNs and LPNs consists of an average of 5-8 days in most facilities and is focused on mandatory requirements and regulatory compliance. Training does not include curriculum focused on leadership competencies such as resilience that prepare the nurse for navigating the challenges of the work environment. As most long term care nurse managers and directors of nursing have limited leadership and management skills, and primarily learned “on the job”, the pool of expert role models and mentors for new nurses is limited. To thrive, rather than just survive in the long term care environment, nurses need training in resilient behavior that teaches them how to manage their emotions, build relationships, take care of their personal health and adapt to change.