Issues of concern for directors of nursing in long term care
Health care delivery has changed and the long term care facility has residents with more complex medical problems. The director of nursing (DON) faces many problems and stressors, is often dissatisfied and leaves the position within the first two years. This turnover is associated with increased cost to the facility, decrease in the quality of care provided to residents and an increase in the turnover rate of the nursing staff. While the turnover problem is significant to the agency and the industry, little has been accomplished to correct the situation.The purpose of this descriptive study was to examine the stressors and emotions that are associated with the tenure and job satisfaction of directors of nursing in long term care. The theoretical framework for this study was the revised causal model of job satisfaction developed by Agho, Mueller and Price (1993).Participants were obtained from a current list from the National Association of Director's of Nursing Administration/Long Term Care (NADONA/LTC). The population was 400 directors of nursing currently employed in long term care. The sample of 134 (34%) was obtained from the completed questionnaires. Participants completed two questionnaires about the stressors of the director's position and demographics. The procedures for the protection of human subjects were followed.Findings supported Agho, Mueller and Price's (1993) revised causal model of job satisfaction. In this study (39.6%) of the DONs reported they would not leave the position even if there were other opportunities elsewhere. This was in spite of 67 (50%) who stated the area they worked in had other nursing opportunities. DONs (77.7%) had a great deal of freedom to make decisions in the job, supporting Agho et al., (1993) findings that autonomy was important to job satisfaction as an abstract concept. Role overload was also cited by Agho et al., (1993) to effectjob satisfaction. The majority of respondents ( n = 123; 92.5%) believed the job to be stressful yet 78 (58.6%) did not leave work with feelings of failing, as well as 119 (88.8%) saw their work as having a greater purpose. This finding did not support Agho et al. (1993) model.In spite of being stressed and dealing with a high degree of repetition 83 (62.4%) of the DONs had a high degree of job satisfaction with the current position and 94 (70.2%) felt fulfilled. Believing DONs could make a positive change in the career was expressed by 115 (85.9%) which supports Agho et al. (1993) work motivation or the belief in the centrality of the work role in one's life. Findings did not support the current trend for advanced education as preparation for the position. The DONs (61.6%) in this study believed that an associate degree or diploma was adequate preparation for the position.In conclusion the DONs participating in the study were able to identify areas of stress and issues of concern which impact job satisfaction and tenure. Findings suggested that to retain a DON in long term care the administrator and staff must be supportive of decisions made while managing the department. DONs indicated jobs were stressful, required long hours, and involved dealing with staff conflict which created stressors. However, individuals loved the work, because individual believed some good was being accomplished and making a difference in people's lives which made the stress tolerable. Findings suggest the majority of the DONs remain in the position for personal satisfaction.Implications from this study suggested that the tenure and job satisfaction of the DON in long term care can be lengthened and strengthened to improve and stabilize long term care facilities and the industry as a whole. Quality of care, staffing turnover and negative/positive cost to the facility hinges on the tenure of the DON. Long term care directors may need advanced education to manage stress and handle complex daily decisions. Directors need a sense of support from the administrator and the staff to develop autonomy. Directors need to be involved in nursing organizations and hold certifications that support and provide some stature to the position. Directors may need to unite and lobby to create change in the long term care industry.