Who will care for the caregivers?

Research shows that stable leadership provided by a nursing home's director of nursing (DON) is the foundation of good quality. Conversely, a high DON turnover often results in a quality meltdown at all levels. A recent study, seeking to uncover the root causes of DON turnover, looked at 103 DONs working in Virginia nursing homes. Although DONs overwhelming affirmed their role and agreed that they were overall satisfied, a majority said they would not choose to be a DON again or recommend the role to others. Not surprisingly, low staff retention rates, mounting administrative responsibilities, growing regulatory and legal constraints, and unrealistic time commitments were the leading causes of frustration. Given less time to spend on the responsibilities that lie at the very heart of their mission-direct-care and clinical issues, quality improvement, family relations, staff mentoring and professional development-DONS are likely to experience burnout unless long-term care owners and managers reconfigure their role.