Nursing Leadership in Long-Term Care: Challenges and Strategies
HealthAugust 01, 2017

Nursing leadership in long-term care: Challenges and strategies

LTC facilities can set themselves apart by fostering strong nurse leadership.

The long-term care (LTC) workforce is composed of a varied team of individuals who are charged with meeting the unique care needs of residents while providing them with a safe and positive home-like environment.

Even though RNs in LTC can have assigned formal leadership job titles, such as director of nursing, educational coordinator, charge nurse, or MDS coordinator, informal leaders can emerge and play a pivotal role in fostering quality care guidelines.

Within LTC, the need for effective leaders is especially important and further magnified by the push for quality in the face of the growing population, with the need for services expected to increase as the Baby Boomer generation ages.

Challenges in LTC leadership

Nurse leaders can also capitalize on their ability to influence and educate other disciplines in the observational skills needed in order to become another set of eyes and ears.

Transformational leaders motivate performance in others beyond customary job expectations. Extraordinary leadership is driven by a clear sense of purpose and direction that comes from a strong theoretical understanding of leadership.

In long-term care, RNs and LPNs typically have years of training and experience that enable them to make the distinctions between normal aging process manifestations and those that are caused by disease. However, certified nursing assistants (CNAs), who are often the primary frontline workers, may be less able to make this distinction, given their limited educational preparation and high turnover rates.

To bridge this educational and experience gap, it is imperative that CNAs receive additional on-the-job education tailored to meet the demands of the job. A nurse-led, team-based approach is needed in LTC that recognizes, taps into, and cultivates the expertise of all nursing levels in addition to skills offered by other multidisciplinary team members.

Supporting quality outcomes

Leaders in LTC face big challenges in creating a work environment that supports the achievement of quality care outcomes. In LTC facilities, quality of care has been a topic of national concern, resulting in complex regulatory standards and newer QAPI (Quality Assurance Performance Indicators). Quality problems are a challenge in LTC because the needs of the residents have grown more difficult with residents being frailer, having more complex health problems, and requiring more specialized care.

A significant challenge for nurse leaders in LTC is how to consistently motivate others to provide care and to do so consistently at a quality level, creating a climate within LTC in which nursing turns challenging opportunities into remarkable successes. Applying this leadership approach can foster an organizational environment that enhances the delivery of high-quality care.

Five practices

There are five strategies, called the Five Practices, for overcoming obstacles and restoring the opportunity to lead and the sense of trust in leaders. The Five Practices (Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart) create a frame of reference from which leaders can act. Use of the Five Practices sets the stage for leaders to be effective in working with as well as coaching and guiding others in the workplace. Leaders can be successful through an approach that integrates the core meaning of these practices into their leadership approach.

  1. Model the Way: Leaders establish principles concerning the way people (constituents, peers, colleagues, and customers alike) should be treated and the way goals should be pursued. They create standards of excellence and then set an example for others to follow.
  1. Inspire a Shared Vision: Leaders passionately believe that they can make a difference. They envision the future, creating an ideal and unique image of what the organization can become.
  1. Challenge the Process: Leaders search for opportunities to change the status quo. They look for innovative ways to improve the organization. In doing so, they experiment and take risks.
  1. Enable Others to Act: Leaders foster collaboration and build spirited teams. They actively involve others and understand that mutual respect is what sustains extraordinary efforts. They strengthen others, making each person feel capable and powerful.
  1. Encourage the Heart: Accomplishing extraordinary things in organizations is hard work. To keep hope and determination alive, leaders recognize contributions that individuals make. In every winning team, the members need to share in the rewards of their efforts, so leaders celebrate accomplishments.
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