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Nursing recruitment

Change is essential to retain long-term care nurses

BY: Heather Cygan on November 1, 2017

The shortage of RNs working in long-term care is real and negatively impacts patients and their families.

Many employers find that recruiting and retaining RNs is an ongoing and difficult problem. With a U.S. population of those 65 and older expected to double by the year 2050, “resolving the nursing shortage in long-term care presents a big challenge,” said Urvi Patel, director of quality improvement with the American Health Care Association in Washington, D.C.

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“Rural areas and smaller facilities generally have a more difficult time recruiting and retaining nursing staff as compared to urban areas, like other types of businesses,” Patel continued. “Fewer available workers due to a smaller population can contribute to staffing challenges.”

Factors that contribute to the long-term care nursing shortage

Robert E. Burke, PhD, director of the Wertlieb Educational Institute for Long Term Care at George Washington University in Washington, D.C., said working in long-term care is not considered a prestigious career by society, the media, and many times by others in healthcare.

“Some see nurses working in long-term care as diaper changers and not doing real nursing,” he said.

In fact, caring for the geriatric population requires RNs to work at the top of their game and have a heart for the elderly population, he said.

Adding to the RN shortage in long-term care are pay rates that are typically lower compared with hospital pay. Contributing to the lower pay rates are the low reimbursement rates from both Medicare and state Medicaid programs, Burke said.

“At some point, for many nurses working in long-term care, they’ll move on to their local hospital where they can earn more money and feel they’re in a more prestigious position,” he said.

Limited advancement opportunities stall career growth

Pamela Lauer, program director at the state of Texas Center for Nursing Workforce Studies, Center for Health Statistics, said the vacancy rates for most patient care positions in long-term care is high, with the highest rate at 15.7% for RN positions in long-term care facilities in Texas, according to a report by the Texas Department of of State Health Services called the 2016 Long Term Care Nurse Staffing Study: Vacancy and Turnover.

The Texas Center for Nursing Workforce Studies conducts several types of nurse staffing studies, one of which focuses on long-term care. Its most recent study, conducted in 2016, uncovered high turnover rates for directors of nursing at long-term care facilities.

“Fifty percent of the respondents said they’ve been in their position as a director of nursing for less than one year,” said Lauer, referencing the study.

The lack of a career ladder, and limited professional opportunities, also contributes to high vacancy and turnover rates for RNs, Burke said.

“Even for directors of nursing there are limited opportunities for growth,” he said. “Unless an organization has several facilities and can promote a director of nursing to a vice president of quality assurance, or other high-level position that oversees several locations, there is no place for a motivated nurse to go within the organization.”

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Strategies to recruit and retain long-term care nurses

Paul Osterman, PhD, professor at the Massachusetts Institute of Technology Sloan School of Management said, “We need to attract more people to work in long-term care, and the way to do that is by making these better jobs.”

He said there are several ways in which this could be accomplished:

  • Increasing compensation and pay rates.
  • Improving job satisfaction levels by creating an environment where RNs and all workers feel they’re part of a team, are heard by their leaders and feel their work matters and is taken seriously.
  • Expanding the education, training and scope of practice for CNAs, home-health aides and personal care assistants to free up RNs to work at their full capacity as their license and education provides them.

Tasks such as dressing dry wounds, administering packaged medications and changing catheters are some of the procedures Osterman said could be relegated to CNAs if training, education and scope of practice was expanded to include these types of tasks.

“This would free up time for the RNs working in long-term care to do more to manage the chronic and acute conditions they’ve been educated and trained in – all leading to improved patient outcomes,” Osterman said.

Mindsets also need to shift about long-term care

Burke said there are several strategies to change the trajectory of chronic staffing shortages in long-term care.

“Our society needs to do a better job at respecting the elderly and recognizing their value,” he said.

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This includes a commitment from federal and state lawmakers to address the laws and policies that contribute to the shortage such as, but not limited to, the low reimbursement rates from Medicare and state Medicaid programs, Burke said.

“Schools of nursing and nursing professionals have a responsibility to acknowledge that caring for the elderly is hard work, requires excellent nursing skills and is a valued specialty to work in,” Burke said.

Cultural influences such as the media, a more mobile society and a lack of exposure to the elderly and grandparents for some young people, also play a role in making long-term care a less desirable career path, Burke said.

The media could do a better job in their portrayal of older people, Burke added. “Many times, the older folks in TV shows are portrayed as buffoons,” he said, which plays into the stereotype of mumbling, bumbling elders.

Exposing youth to older people and what they contribute to society with their knowledge and life experiences is important “as some kids have never experienced spending time with a grandparent,” Burke said. “Why would anyone want to work with the elderly if they know nothing about them?”

The average age of a person admitted to a nursing home is 80 years old, the oldest baby boomers are 71 right now, Burke said.

“We have nine years to put our best strategies together in making long-term care nursing a more desirable career,” Burke said. “This is not a second-class occupation, it’s a noble profession.”


Freelance writer Carole Jakucs, BSN, RN, PHN, contributed to the writing and research of this article.

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Heather Cygan

Heather Cygan is senior director of content and creative strategy for the advertising solutions division of Nurse.com. She has been developing healthcare content for more than 10 years and has a bachelors of arts degree in journalism from Eastern Illinois University. Connect with and follow her on LinkedIn.