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Managing a Long-Term Care Home, is not for Sissies...Why Nurse Managers are hightailing it, out of Dodge

Posted Jun 29th, 2016

Working as a Registered Staff member in the role of Administrator, or Director/Assistant Director of Care in a LTC home carries a huge level of responsibility that impacts not only the pocket book, but also tests the educational prowess, power of negotiation, peacemaking skills, budget stretching, and resourcefulness of the employee.  Long hours, non-unionized wages (where caps have lasted years) combined with an enormous level of responsibility and liability, leave one wondering how to get the heck out of Dodge.

What a shame, we are losing so many amazing people to other positions when the need for strong leaders is great.

 Hello Politicians...

Are we prepared to enhance the quality of work life to attract the top guns in this profession? 


Are we content to hope the few remaining Florence Nightingale types find their way to our elders, because they are simply searching for a meaningful career?

Somehow, with a growing youthful workforce who is more adept in work -life balance, I think we are in big trouble unless there are significant changes in the long-term care industry.


So what are the deterrents to being a Senior Manager in LTC? 

1.     Twenty- four seven on call responsibilities:   With many jobs, once the door closes behind you for the day, that is the end of your accountability.  In LTC (long-term care), there is an ongoing "on call" component that contributes to many sleepless nights.  There may be a rotating managerial on call roster in some homes but ultimately the buck for care concerns, stops here.

2.     Stripping Job Qualifications by way of new legislation:   New Legislation in the past few years has had an impact on Administrators working in the industry. (Not all Admins are RNs) In my case, after working as an Administrator for several years, new MOHLTC legislation disqualified my ability to assume the same position in another company, unless a specially designated, course was completed.  Hence after more than a decade of successfully completing a job there was a requirement to attend sessions with new managers to meet the same job criteria.  

3.     Lack of kudos for a job well done:   Type A personalities will find it difficult to face the ongoing conquest to find perfection.  MOHLTC regulations create extensive criteria for "compliance" adherence, and in spite of best efforts, as long as humans work in homes there will be citations.  (No, there are no 'shout outs' in reports for exemplary performance!) 

4.     In spite of Whistle Blowing protection there is a punitive component to reporting concerns to the MOHLTC:   When a Home reports a case of suspected abuse, the outcome if  validated, is punitive for the site.

Even if a home has completed education, supervision, and investigates any reported complaints with absolute thoroughness, there will be a citation because the abuse happened.  This is a pretty stressful situation, as even the best manager cannot control the actions of everyone.  Kudos to the home for exercising due diligence and reporting, investigating and following up, but your record will remain mired in the eyes of the public.

5.     Firing inadequate employees, once part of the union is extremely difficult:   I understand the union has a role in the workplace, to support an equitable and cooperative, management-employee relationships.  Dismissals are often negotiated to get the job done, and because there is no PSW registry with mandatory dismissal reporting, the employee sashays to another home.  (Believe me, I have worked with terrific stewards who were forced to defend folks they had little faith in.) 
6.     Burial by a myriad of paperwork:   My days consisted of no less than 9.5 hours in office, and consistently a mass of catch up on my personal time.  This was the only way I could conduct regular rounds and visit staff and residents.  Meeting with residents and families was also an absolute, so time needed to be skimmed from my personal life to be effective.

7.     Lack of pensions in private companies:   Depending on the company, "retirement gratuities" do little to create a comfortable retirement nest egg.  Working in a hospital provides an amazing pension, and probably less stress. ( Because you really do have days off.)

8.     Accountability for unregulated care providers:   Although there are many terrific caregivers, the onus of responsibility in overseeing numerous staff is exhausting and stressful.  Not to mention managing absenteeism, and stretching thin budgets to care for a more frail populace.

9.     High level of burn out as job demands:   Both physical and mental can lead to exhaustion and undue stress.


10.    Negative press:   With all of the negative publicity, one had better "whisper" they work in, or manage a LTC home, because the immediate public response is reflective on negative news articles.  Not a great incentive for new nurses.


So why do/did Registered Staff stay in Long-Term care?

There are a band of nurses who truly love working with seniors and want to see care delivered with quality and dignity.  There is job satisfaction in holding a hand, seeing a smile and insuring those who contributed so greatly to our heritage are given care and compassion.  Many of us stay because we are led by our hearts to give service in an area, where need is high, and financial rewards lower than many jobs.  

So if we want to keep these angels of care, there better be more emphasis on quality of work life and positive reinforcement for a job well done. Consult nurses when changing long-term care legislation.

Because....Constantly being at the end of a critical yardstick makes for Registered staff shortages in an area that is desperate for leadership!

The information enclosed, is not directed towards, or reflective of any specific Long-Term Care home, company or corporation.  Opinions expressed are those of the author, and are done so without malice towards any individual, group, or organization.  Should you wish to send a comment, please use the web site email as a point of access.


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