Since 2020, many nursing home workers have seriously weighed the prospect of quitting their jobs, with thousands abandoning the sector altogether.
But a new McKnight’s Long-Term Care News survey finds far fewer administrators and nurse leaders are considering leaving their current positions — dropping to a level not seen since pre-pandemic days.
The 2024 McKnight’s Mood of the Market Survey found 36.7% of administrators, directors of nursing and other leadership staff who responded to a summer survey had “seriously considered” quitting in the last three months. That’s a significant improvement from the 2023 survey, when nearly half (49.6%) said they were seriously considering a move.
It’s also the lowest number reported since McKnight’s launched the survey in 2019, when 37% of respondents said they’d seriously considered quitting. That percentage topped out at nearly 56% in 2021, when the survey was conducted just after a major peak in nursing home deaths from COVID-19.
With major illness seemingly under control amid this summer’s nationwide spike in cases, nursing home workers returned their focus to typical, everyday challenges, including workforce shortages and regulatory burdens.
Amid the 2024 survey findings there was more good news: Nearly 76% of respondents said they were either “very satisfied or somewhat satisfied” with their current jobs. That’s less than a 1 percentage point increase over 2023, but the share saying “very satisfied” rose by 4.5 percentage points. Among administrators, the share of very satisfied workers jumped nearly 10% in a single year, up from 35.6%.
Matt Leach, a compensation specialist who helps skilled nursing providers create pay scales designed to recruit and retain, told McKnight’s this week he was surprised the combined numbers weren’t even higher, given what he’s hearing from providers and their employees.
“What we’re seeing, and what your data confirms, is that it’s just a return to normality. I think a lot of people threw that around two years ago, but it seems like we’re finally there, in terms of the stability of pay raises, the stability of staffing,” said Leach, principal and senior compensation consultant with Total Compensation Solutions. “I think that that’s why these folks are, for the most part, so satisfied.”
This year’s Mood of the Market survey drew 723 responses from directors of nursing, assistant directors of nursing, administrators and their assistants. It was distributed by email from late July to mid-August.
The survey found a growing sense of workplace optimism among nursing home managers across several categories, particularly when it came to managing workload and being paid well for the work they’re doing. But survey results also indicate operators still have work to do to ensure they keep workers for the short-term, as well as the long-term, especially as full implementation of a federal staffing mandate approaches.
Nurses remain stressed
As for quitting, the “easing up a bit of the staffing and the workforce piece,” has probably helped improve the situation for some, as has getting used to some of the nursing home regulations and reporting requirements added during the pandemic, said Denise Boudreau, president of Drive, which helps senior living and healthcare companies address workplace culture.
But with more than a third of surveyed building leaders still considering quitting, owners and operators shouldn’t be willing to settle for the status quo, she added.
“It’s awesome that it’s better, but still how sad is that?” she said. “I just think our field in general needs to do better for people. There’s a lot of people that could use support in all sorts of different ways, whether it’s leadership development that would make them stronger leaders and make their job a little easier for themselves — and then also that people that work around them, make their jobs better as well — or stress management.
“When people are stressed, they’re not making the best decisions,” added Boudreau, a licensed nursing home administrator. “They’re not treating the people that work there the best and so forth. It’s just natural.”
Nursing home workers may in fact be slightly happier with their jobs than their peers in other US industries. A survey published in May found that 62.7% of American employees were “content” at work, even satisfaction in subcategories such as workplace culture, work-life balance, benefits and time-off policies declined.
Who’s feeling the squeeze the most in long-term care? Nurse leaders remain more likely to say they have considered quitting (39.5%) versus administrators (34.3%). Still, the nurse leader number was down more than 14 percentage points from 2023.
Nurse leaders responding to the Mood of the Market survey also were less likely to say they were “very satisfied” with their jobs (31.8%) than the overall respondents (38.8%) and came in more than 13 percentage points lower than administrators (45.1%).
Ongoing frontline staffing shortages — or lack of competencies among new hires — may be partly to blame, said Amy Stewart, chief nursing officer at the American Association of Post-Acute Care Nurses.
“One of the challenges that we hear about at AAPACN is directors of nursing specifically not being as involved in the admission process,” she said. “We do see that corporate staff are making a decision to admit and maybe the facility itself feels like they can’t handle the patient’s acuity or they don’t have the staff. We’re still hearing that some facilities are admitting despite not having the staff or the competence to care for the residents that are being admitted.”
But, Stewart said, that’s not an across-the-board issue, and she believes other 2024 survey findings reveal a shinier side of the same coin.
Owners and operators that have closed their doors to new admissions due to a lack of staff aren’t just doing so to meet regulatory requirements; the move can be seen as listening to the concerns of the nurse leaders who are on site and coordinating patient care. And with more providers attempting to address workplace culture, more nurse leaders have been able to take advantage of the shift and find places where they can derive better job satisfaction.
“It’s really a testament to culture, that it really matters today more than anything [else] will to the frontline nurses,” Stewart said. “If they don’t like how they’re treated at their current facility, they can go somewhere else.”
Still doing too much work
To address workload concerns, McKnight’s asked respondents whether they’re “asked to do too much at work.” This year’s results offered a mixed bag.
The share who said “very much so, yes” dropped from 19.2% in 2023 to 17% in 2024. But the share saying they are “generally yes” asked to do too much rose from 36.5% to 39.8% and the number saying “generally no” fell from 37.3% to 34.9%.
Again, nurse leaders were more likely to feel the burden of being overworked, with 59.5% saying they were very much or generally asked to do too much. By comparison, 54.3% of administrators chose one of those two options.
Leach said it makes sense that nurse leaders, especially directors of nursing, would continue to absorb the brunt of shortages, even if they’re no longer filling in on the floor for CNAs like they were forced to do in 2020 and 2021. A national RN shortage, though, is increasing the potential for DONs to be forced into extra shifts.
“We’re not even talking about the elephant in the room with the staffing requirements that are coming,” Leach said. “But with the shortage of healthcare workers and RNs, they’re just asked to do more. [With] fewer people, they’re being asked to do more because of that shortage and just because of budget constraints.”
Add on increased time spent on mandatory regulatory reporting — or MDS nurses learning new manuals and state payment systems — and it’s easy to see how nurse leaders can feel overwhelmed.
“The regulatory aspect of their jobs, especially the DON, it’s very negative,” Leach added. “It’s one of the worst things that they have to deal with.”
Next up: The 2024 McKnight’s Mood of the Market examines pay satisfaction and the changes nursing home building leaders want to make their jobs better.
