Psychological and Structural Burdens and Nursing Home Administrator Turnover Intentions During the COVID-19 Pandemic.

The COVID-19 pandemic created challenges for U. S. nursing home administrators (NHA) and staff. This study explored organizational and psychological factors associated with NHA stress, dissatisfaction, and turnover intent (TI) during the third year of the pandemic. Results from a nationwide, cross-sectional survey of 1139 NHAs were merged with Centers for Medicare and Medicaid Services nursing home survey deficiency, staffing, complaint, and other operations data. A hierarchical, generalized estimating equations model with ordered logit link found that NHAs with higher COVID stress (AOR = 1.65, 95% CI = 1.22, 2.23), higher use of agency/contract staff (AOR = 1.50, 95% CI = 1.08.2.09) and higher role conflict were more likely to indicate TI. NHAs with higher job satisfaction in workload, work content, and rewards were less likely to hold TI. Industry leaders should create strategies to reduce NHA's job stress and role conflicts and provide opportunities for improving staff recruitment and retention, reducing reliance on agency staffing.

Nurse Practitioner Employment in Relation to Nursing Staff Turnover and Resident Care Outcomes in US Nursing Homes.

OBJECTIVES: A growing number of nurse practitioners (NPs) are employed in nursing homes (NHs) through various NP staffing mechanisms. The purpose of this study was to examine if having NH-employed NPs was associated with nursing staff turnover and resident care outcomes measured as hospital utilization, infection control citations, and substantiated complaints in NHs in 2021-2022. DESIGN: A cross-sectional, retrospective study. SETTING AND PARTICIPANTS: A total of 13,966 NHs from payroll-based journal (PBJ) and claim-based quality measures published by the Centers for Medicare and Medicaid Services in 2021-2022. METHODS: Facilities were identified as having NH-employed NPs if at least 1 employed NP with paid working hours ≥10 per week was reported through the PBJ. We examined if having NH-employed NPs was associated with nursing staff turnover rates, unplanned hospital utilization, infection control citations, and substantiated complaints using doubly robust estimation that combined inverse probability weight representing the NH's likelihood of employing NPs and outcome regression. RESULTS: Approximately, 2.8% of NHs had employed NPs. Facilities with NH-employed NPs tended to be larger, hospital affiliated, and not for profit with greater medical and nursing staff availability. In addition, a significantly higher proportion of facilities with NH-employed NPs were in metropolitan areas or states with full NP practice independence. We found that facilities with NH-employed NPs had significantly lower registered nurse (adjusted ß, -5.40; 95% CI, -9.50 to -1.30) and certified nursing assistant turnover rates (adjusted ß, -3.35; 95% CI, -6.29 to -0.40). Facilities with NH-employed NPs also had significantly fewer long-stay resident hospitalizations, infection control citations, and substantial complaints compared with those with no NH-employed NPs. CONCLUSIONS AND IMPLICATIONS: This study highlights the value of NH-employed NPs to improve registered nurse and certified nursing assistant staff retention and NH resident outcomes. NH stakeholders and policymakers may consider various strategies to incentivize NP employment in NHs such as removing regulatory barriers to NP practice.

Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status.

The purpose of the study was to examine trends in COVID-19 cases, related deaths, and staffing shortages in nursing homes (NH) by rural and urban status from May 2020 to Feb 2021. Generalized linear mixed models with state-fixed effects were used to estimate the interaction effect of study period and rural/urban status on having at least: one COVID-19 case, one related death, and/or at least one week of staffing shortage using the NH COVID-19 data spanning the 40-week period. The findings revealed shortages in staff, particularly direct care providers, were greatly accelerated in rural NHs as the pandemic wore on over time. Conversely, staffing shortages in urban NHs were relatively stable despite the fluctuating COVID-19 cases over the same time period. The findings highlight the need of identifying effective strategies that prevent rural NHs from encountering staffing deficits in response to long-lasting natural disasters such as the COVID-19 pandemic.

Nursing Home Administrator's Job Satisfaction, Work Stressors, and Intent to Leave.

This study examines how job satisfaction in six subscales and select stressors and demographic covariates influence nursing home administrator's (NHA) intentions to quit. Quantitative and qualitative data were collected from 311 NHAs in five states. Adjusted odds ratios and 95% confidence intervals for the ordered logistic regression models indicated that NHAs with satisfying work demands, rewards, and coworkers, and who experienced less role conflict and had fewer prior nursing home jobs had lower turnover intentions. Although generally satisfied, roughly 24% reported intending to quit. Surprisingly, NHAs reporting higher job skills were more likely to consider leaving, suggesting that talented NHAs may choose career advancement eased by stigma-free job-hopping in an industry with high mobility norms. Qualitative data suggested that job satisfaction/dissatisfaction was influenced by a more nuanced interpretation of satisfying and more taxing job facets and quitting triggers, including themes such as helping residents and struggling with regulations.

Pediatric disaster simulation in graduate and undergraduate nursing education.

A university partnered with community agencies to include children and parents in a mass casualty full scale exercise on an academic campus. Nursing undergraduate students provided care to students in a multidisciplinary environment that involved hundreds of victims and health care personnel. One graduate nursing student worked with a youth theater group to provide disaster preparedness education to the children, culminating in their participation in the disaster exercise. Parents reported that the exercise was positive, that they would participate again, and that their children enjoyed the experience.

State long-term care ombudsmen's perceptions of their program's disaster preparedness roles and readiness.

A telephone survey of 43 state long-term care ombudsmen (LTCO) assessed their familiarity with relevant long-term care disaster resources, their provision of disaster aids and training to staff, and their perceived preparedness to lead their programs during public crises. Thirty-four directors (78%) reported being fairly well to fully prepared to support their local programs during public emergencies. However, ANOVAs showed that the 27 disaster experienced ombudsmen felt no better prepared to help their local paid and volunteer staff deal with public emergencies than disaster inexperienced ombudsmen. Those directly involved with emergency planners felt better prepared to help their substate staff to know where to start helping residents during a public crisis than ombudsmen who had no involvement with disaster planners. Familiarity with the Centers for Medicare and Medicaid Services Emergency Planning Checklist for LTC Ombudsmen (2007) was strongly associated with the ombudsmen's familiarity with emergency resources and regulations.

Dysfunctional health service conflict: causes and accelerants.

This article examines the causes and accelerants of dysfunctional health service conflict and how it emerges from the health system's core hierarchical structures, specialized roles, participant psychodynamics, culture, and values. This article sets out to answer whether health care conflict is more widespread and intense than in other settings and if it is, why? To this end, health care power, gender, and educational status gaps are examined with an eye to how they undermine open communication, teamwork, and collaborative forms of conflict and spark a range of dysfunctions, including a pervasive culture of fear; the deny-and-defend lawsuit response; widespread patterns of hierarchical, generational, and lateral bullying; overly avoidant conflict styles among non-elite groups; and a range of other behaviors that lead to numerous human resource problems, including burnout, higher staff turnover, increased errors, poor employee citizenship behavior, patient dissatisfaction, increased patient complaints, and lawsuits. Bad patient outcomes include decreased compliance and increased morbidity and mortality. Health care managers must understand the root causes of these problems to treat them at the source and implement solutions that avoid negative conflict spirals that undermine organizational morale and efficiency.

Current practice and policy realities revisited: undertrained nursing home social workers in the U.S.

Despite a nearly 20-year-old legislation to strengthen social work (SW) coverage within nursing homes and decades of literature exploring the need for SW training, untrained and undertrained social workers dominate American nursing homes. Many persons who call themselves social workers are not educated as such, but nevertheless, must work in complex, conflict-ridden nursing homes without assessment and advocacy skills essential to address the symptoms and to fully respond to subjugated residents' needs. The call for more qualified social workers to be employed in nursing homes is a recognition that the residents' psychosocial needs are not being met. We examine how inconsistent national requirements, inadequate professional educational preparation, and work overload are all symptoms of a general societal unwillingness to recognize residents' needs. The authors utilize a morphogenic systems perspective to describe the open interaction between all disciplines, which can be unduly strained without properly trained workers. The social work literature is reviewed with a renewed interest in addressing the problem profession-wide.

Nursing home complaints: who's complaining and what's gender got to do with it?

Long Term Care Ombudsman Complaint data from one state's 261 nursing homes are examined in the study. We assessed differences between male and female groups, including chiefly residents, but also ombudsmen, the residents' relatives or friends, administrators, legal representatives, and others regarding types and rates of complaints as reported in the Administration on Aging (AoA) major categories of: Resident Care, Resident Rights, Administration, Quality of Life, and Complaints Not Against Facility. Proportionately, male residents lodged more complaints than females. Further, males complained more than females about Resident Rights violations and filed more Complaints Not Against Facility. Females lodged significantly more complaints about Care, Quality of Life and Administration.Thus, males were more likely to report technical, impersonal, and legalistic issues, than females, who were more likely to express concerns about personal care and socioemotional-environmental issues. Results yielded further evidence of gender differences in the patterns of resident complaints. Nursing home social workers are highlighted as agents in changing embedded stereotypes about residents and complaints.

The causes and consequences of conflict and violence in nursing homes: working toward a collaborative work culture.

Interpersonal conflict, often spiraling to violence and abuse, is one of the most daunting challenges facing nursing home administrators and their departmental heads. Mounting evidence documents how they spend an inordinate amount of time dealing with angry families, adversarial ombudsmen, regulators, and other hostile parties as well as handling the aftermath of the ubiquitous conflict between the residents and their direct caregivers. All this is in addition to coping with the normal interdepartmental and line staff forms of conflict that typify any organization. This paper details the special dynamics that accelerate dysfunctional conflict in nursing homes and presents strategies, tactics, and style recommendations that will help nursing home leaders build more collaborative work cultures to minimize the effects of dysfunctional conflict.

Factors important to success in the volunteer long-term care ombudsman role.

This study found that the satisfaction of one state's largely older volunteers' altruistic, affiliation, and self-improvement motives corresponded to increased organizational loyalty and better performance across several dimensions. Younger volunteers served for shorter periods and were more highly motivated by the "self-improvement" need. Altruism and organizational loyalty emerged as particularly important motivations.

The causes and consequences of conflict and violence in nursing homes: working toward a collaborative work culture.

Interpersonal conflict, often spiraling to violence and abuse, is one of the most daunting challenges facing nursing home administrators and their departmental heads. Mounting evidence documents how they spend an inordinate amount of time dealing with angry families, adversarial ombudsmen, regulators, and other hostile parties as well as handling the aftermath of the ubiquitous conflict between the residents and their direct caregivers. All this is in addition to coping with the normal interdepartmental and line staff forms of conflict that typify any organization. This paper details the special dynamics that accelerate dysfunctional conflict in nursing homes and presents strategies, tactics, and style recommendations that will help nursing home leaders build more collaborative work cultures to minimize the effects of dysfunctional conflict.