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In 2019, American seniors—defined as those aged 65 years or older—made up roughly 16.5 percent of the world’s senior population. This figure is expected to increase to 22 percent by 2050. And with an increase in the aging population, there will be an even greater rise in seniors needing more long term care assistance, whether at home or in a nursing home facility, in the distant future. 

This trend of insufficient supply for increasing demand will undoubtedly continue. Yet, despite the rapidly aging population, a survey reveals that two-thirds of Americans aged 40 or older have done little to no future planning for long term care assistance. Currently, there are approximately 15,500 skilled nursing facilities (SNFs) across the United States, which provide care to 1.35 million people. Worryingly, roughly seventy-five percent of these nursing homes are understaffed and running below the CMS expected Registered Nurse (RN) staffing levels. 

So why is it so challenging to recruit and retain registered nurses and have them embrace the long term care nursing life? In addition to insufficient pay and demanding days, the heightened problems caused by the pandemic have made it harder to find nurses willing to work. 

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Leadership challenges in nursing have only become greater during the pandemic.

When the staff at a facility tests positive for COVID-19 or is quarantined, the remaining staff are required to work additional overtime and longer shifts, leading to burnout. Further, in August 2021, the federal vaccine mandate was introduced, requiring that all long term care facilities that receive Medicare and Medicaid funding must vaccinate their staff, further exacerbating the staffing shortage by moving staff members who refuse the enforced vaccine to resign. 

The silver lining is that some facilities are coping with the aftermath of the pandemic, and eighteen months later, they are bouncing back as a result of  implementing new and improved policies that strengthen the facility. One such facility is Ridge Care, North Carolina, where Olivia Jenkins serves as the director of resident care services. 

Jenkins recently shared her unique approach to educating the next generation of nurses by coaching them to find solutions, see the bigger picture, and understand their residents’ obligation during her appearance on the LTC Heroes podcast. Her leadership style is to nurture her team by “creating other leaders, rather than followers,” allowing for more autonomous decisions. You can listen to the entire interview below: 

Professional Issues in Nursing That Impact Recruitment and Retention

While the long term care industry provides a rich and valuable learning environ­ment for qualified nurses, it is often overlooked because of specific professional issues in nursing that steer registered nurses away from the sector. There is also a distinct lack of understanding in the sector, which further perpetuates the stigma associated with long term care.

Here are four common misconceptions about long term care and nursing issues that make such work seem less attractive, thus impacting the recruitment of new staff and retaining the old: 

  1. Long term care offers fewer opportunities for career progression.

There has long been a misconception that the long term care industry offers fewer opportunities for career progression compared with other nursing fields. Yet, “With the population going up over the age 65, [the industry] is only going to create more positions and more growth,” said Jenkins. 

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The nursing life requires a great deal of critical thinking.

It is hoped that, as the population ages and the industry expands, there will be an increase in demand for long term care services and long term care software, driving more qualified nurses to continue their professional development in the industry. There are various areas of expertise that registered nurses can continue and specialize in, such as:

  • Dementia care
  • IV therapy
  • Wound care
  • Diabetes manage­ment
  • Infec­tion control
  • Chronic pain management
  • Leader­ship
  • Compliance policy 
  • Case manage­ment
  • Educa­tion

A nurse can also specialize in one area, like dementia care, while studying other areas of interest, like infection control or wound care. This results in having multi-trained nurses with a broader range of clinical and critical thinking. As Jenkins commented, “It is definitely a job that you can grow into where you want to be.”

  1.  There is less critical thinking in long term care.

Another misconception is that nursing life in long term care requires less critical thinking than other nursing fields. However, this couldn’t be further from the truth, as the reality is that long term care nurses often face various clinical situations where they need to be highly analytical and critical.

Long term care residents tend to have multiple ailments. Therefore, nurses need to assess clinical situations while providing a critical perspec­tive when treating residents. Furthermore, nurses in long term care must also have profi­cient knowledge in medicine and pharmaceuticals, including in drug dose calcu­la­tions and drug manage­ment. Therefore, they need to undergo more profes­sional training and education to support this ongoing competency.

  1. Long term care nurses tend to work alone rather than as a team.

Contrary to popular belief, long term care nurses need to collaborate with a wide variety of clinical and non-clinical personnel. On the non-clinical side, they need to update and convey the residents’ condition to their families while collaborating with healthcare agencies to arrange for medical equipment and follow-up recommendations. Nurses also need to communicate with the broader team within the facility, like the nursing assis­tants, CNAs, facility kitchen staff, cleaners, and senior leadership. 

On the clinical side, they have to coordinate with different healthcare professionals to ensure proper care, such as physicians, home health agency staff, pharmacists, and medical equip­ment staff. This is why having a nursing home charting software where all resident data is accurately stored and easily accessible for authorized personnel is critical. For nurses who need to create detailed care plans, they need reliable care plan software to pull up relevant data tailored to a resident’s needs and condition. 

Because of the interconnected nature of long term care, facilities need to enforce a robust organizational culture where the team and residents are supported. Jenkins mentioned that, at Ridge Care, “It’s not only the residents we care for, but our team, too. If our team doesn’t have a culture where they’re feeling supported and empowered, they’re not going to stay.” This, she noted, can be achieved in various ways, like giving the team a “true voice” to speak out when issues arise. 

One of the greatest ways to create a strong culture at your facility is to promote from within. Jenkins’ facility empowers her staff by “fostering self-growth” to build confidence and leadership qualities within the team. This can be reinforced with additional methods of showing appreciation like giving bonuses or encouraging self-care, which is vital for nurses’ mental health under constant stress. Studies show that when caregivers are suffering from burnout, the level of care given to residents drops. Therefore, integrating self-care into organizational policies not only results in resilience but also better care.

  1. Long term care is less desirable than other nursing work.

Historically, in 20th century America, long term care housing was referred to as ‘poorhouses’ because society’s most vulnerable, like the mentally ill and elderly, would go there to find refuge. These social outcasts were subjected to stigma and shame, as they could not care for or financially support themselves. Some of these negative associations have survived to this day. 

The nursing life is a rewarding career path.
Professional issues in nursing can often be resolved by discussion.

Facilities, though, are now quite different. They provide a wealth of social activities, services, and amenities,  giving residents a new lease of life. In fact, many facilities are luxurious places that allow residents to regain their independence with the added support that comes from having long term care readily available. “Just because you’re at that point in life where you can’t be in your personal home, it doesn’t mean it can’t be home,” Jenkins said. After all, a home is what you make it, with nurses and staff contributing towards the vibrant and friendly community for residents who live there. 

To some, it may seem unglamorous to care for the elderly and chronically ill, especially when compared with working in an NICU unit. That is why the nursing profession is a calling of the heart. Those working in the long term care industry see it from the perspective of a self-fulfilling job that they love and appre­ci­ate. To them, it is as glamorous as any other field of nursing. For people like Jenkins, who goes to work every day doing something that she loves, long term care provides contentment. She shared that she enjoys “being there, being with the team, being with the residents.” 

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What Are Some Key Leadership Challenges in Nursing?

There are undoubtedly some significant leadership challenges in nursing that impact nursing life or the nature of what nurses do every day. A severe problem that needs addressing is the continued staffing shortage, which affects the daily lives of nurses, causing professional issues in nursing and the residents who are under their care.  

With the demand for long term care services being higher than what facilities can provide, some facilities have to turn away prospective residents. In more dire situations, some facilities have to close altogether, which causes significant disruptions to the residents living in those facilities and their families. 

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Staff shortages also affect the quality of care given to residents, thus bringing out possible legal, ethical, and professional issues in nursing. Nurses are already overloaded with residents and are limited to the amount of time they can spend with them. That impacts care, as studies show that when nurses engage and interact more with residents, resident outcomes and satisfaction are directly affected. Thus, staffing shortages put added pressure on nurses who are already working overtime to compensate for being short handed. 

Another issue is that long term care offers lower salaries than other sectors like the Neonatal Intensive Care Unit (NICU). A typical long term care nurse earns between $66,097 to $83,258 per annum, whereas a NICU nurse will typically take home between $80,010 to $120,560, averaging $47.06 per hour. Long term care facilities need to offer competitive wages to encourage and boost their staff levels. 

This poses its own set of problems, as Mark Parkinson, the president, and CEO of AHCA/NCAL highlights the need for additional funding from the government, which has the means to solve the crisis. “Budget reconciliation and meaningful investments in long term care will help address key staffing challenges,” he said. “Our caregivers are the backbone of long term care, and they deserve the full support of our lawmakers. We cannot allow facilities to close because of these challenges, which will directly impact residents and their families.”

How To Start a Nursing Life in Long Term Care

While there are many misconceptions about long term care nursing life, what is undeniably clear is that there are ample opportunities for nurses who want to progress in their professional careers. 

Like any specialized field, a nurse will need to earn a series of different qualifications in becoming a qualified long term care nurse. To begin with, potential nurses need to complete a nursing degree or diploma obtained from the National Council Licensure Examination for Registered Nurses (NCLEX-RN), which will make them a Licensed Practical Nurse (LPN) or Registered Nurse (RN). 

Once nurses have their licenses, they can look for employment in long term care facilities, hospitals, and rehabilitation facilities. Of course, as a long term care nurse primarily cares for elderly residents, it is advisable for nurses to continue with additional education programs specializing in long term care or gerontology. As Jenkins said on the podcast, “You need to own your own growth by taking the growth of your potential to the next level.”

Therefore, nurses must first complete one of the following certification programs that are designed to give them more practical and specialized skills for providing long term care:

  • Long term care nursing (common duties)
  • Care for elderly and younger patients with disabilities
  • Create long term patient care plans
  • Educate the patient’s family on the patient’s medical condition

Afterwards, they can further their studies and qualifications by obtaining a professional certification to specialize in long term care. While these certificates are not mandatory, they are desired, especially for RNs and LPNs who want to develop professionally in long term care:

Whatever the course upon which a nurse decides will likely be followed by career stability, developing enriching and fulfilling relationships, and professional experience and growth. Joining the long term care sector is a rewarding experience that is ideal for anyone with an analytical mind, a commitment to care, a high level of patience, and a compassionate nature.


While long term care tends to focus on how care is delivered and outcomes, it is also worth noting that long term caregivers—nurses, the nursing assistants, and the CNAs—play a critical role in the outcome of care. Not only do they serve as the mediator between clinical and non-clinical personnel, but they also ensure the smooth and efficient running of the floor, while providing tailored care and engagement with residents.

Their contributions to the cultural environment of the facility is pivotal, as they provide care, support and friendship to residents. Therefore, facilities should prioritize the welfare of their current staff by retaining them as much as possible while recruiting new staff who are committed to the culture and positive atmosphere in the facility. 

For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast