Since 2020, many nursing home workers have seriously considered quitting their jobs, with thousands even leaving the sector altogether.

But a new McKnight’s Long Term Care News Research shows that far fewer administrators and nurse leaders are considering leaving their current roles, a decline not seen since pre-pandemic times.

The 2024 from McKnight Mood of the Market’s survey found that 36.7% of administrators, nursing directors and other executives who responded to a summer survey had “seriously considered” leaving in the past three months. That’s a significant improvement from the 2023 survey, when nearly half (49.6%) said they had seriously considered a move.

It is also the lowest number since from McKnight launched the survey in 2019, when 37% of respondents said they had seriously considered quitting. That number peaked at nearly 56% in 2021, when the survey was conducted just after a major spike in nursing home deaths from COVID-19.

Now that the serious disease appears to be under control after the national peak in the number of infections this summer, nursing home workers are again focusing on typical, everyday challenges, such as staff shortages and regulatory pressure.

Among the 2024 survey findings was more good news: Nearly 76% of respondents said they were “very satisfied or somewhat satisfied” with their current job. That’s less than a 1 percentage point increase from 2023, but the share who said they were “very satisfied” rose 4.5 percentage points. Among executives, the share of very satisfied employees rose nearly 10% in one year, from 35.6%.

Matt Leach, a compensation specialist who helps nurse practitioners develop salary scales designed to recruit and retain staff, said from McKnight This week, he was surprised that the total numbers weren’t even higher, given what he was hearing from providers and their employees.

“What we’re seeing, and what your data confirms, is that it’s just a return to normalcy. I think a lot of people were doing that two years ago, but it looks like we’re finally there, in terms of stability of salary increases, stability of staffing,” said Leach, managing director and senior compensation consultant at Total Compensation Solutions. “I think that’s why these people are generally so happy.”

This year’s Mood of the Market survey drew 723 responses from nursing directors, assistant nursing directors, administrators and their assistants. The survey was distributed by email from late July to mid-August.

The survey found a growing sense of workplace optimism among nursing home managers across a range of categories, particularly when it came to managing workloads and getting paid well for the work they do. But the survey results also indicate that operators still have work to do to ensure they retain workers in the short term and the long term, especially as the full implementation of a federal staffing mandate approaches.

Nurses remain stressed

As for the shutdown, “loosening up staffing and staffing levels a little bit” likely helped improve the situation for some, as did getting used to some of the nursing home regulations and reporting requirements that were added during the pandemic, said Denise Boudreau, president of Drive, which helps senior care and health care companies address workplace culture.

But with more than a third of construction industry leaders surveyed still considering quitting, owners and operators should not settle for the status quo, she added.

“It’s great that it’s better, but how sad is that?” she said. “I just think our field in general needs to do a better job for people. There are a lot of people who could use support in all sorts of ways, whether it’s leadership development that would make them stronger leaders and make their jobs a little bit easier on themselves — and then also make the people around them do their jobs better — or stress management.

“When people are stressed, they don’t make the best decisions,” added Boudreau, a certified nursing home administrator. “They don’t treat the people who work there the best way, and so on. That’s just normal.”

Nursing home workers may be slightly happier with their jobs than their counterparts in other U.S. industries. A survey released in May found that 62.7 percent of U.S. workers were “satisfied” with their jobs, with even lower satisfaction levels in subcategories such as workplace culture, work-life balance, benefits and leave policies.

Who feels the pressure the most in long-term care? Nurse leaders are more likely to say they’ve considered quitting (39.5%) than administrators (34.3%). Yet the number of nurse leaders is down more than 14 percentage points from 2023.

Nurse leaders who responded to the Mood of the Market survey were also less likely to report being “very satisfied” with their jobs (31.8%) than respondents overall (38.8%) and were more than 13 percentage points lower than administrators (45.1%).

Amy Stewart, chief nursing officer at the American Association of Post-Acute Care Nurses, says the ongoing shortage of frontline staff, or the lack of competencies among new hires, may be partly to blame.

“One of the challenges we hear about at AAPACN is that nursing directors specifically are not as involved in the admission process,” she said. “We see that the facility staff makes a decision to admit and maybe the facility itself feels like they can’t handle the severity of the patient or they don’t have enough staff. We still hear that some facilities are admitting even though they don’t have the staff or the competence to care for the residents that are admitted.”

But Stewart says that’s not a general problem. She believes other research findings from 2024 will show a more positive side of the same coin.

Owners and operators who have closed their doors to new admissions due to staffing shortages 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 the ground coordinating patient care. And with more providers trying to address workplace culture, more nurse leaders have been able to take advantage of the shift and find places where they can find greater job satisfaction.

“It’s really a testament to culture, that it really matters more than anything else today for the frontline nurses,” Stewart said. “If they’re not happy with the way they’re being treated in their current facility, they can go somewhere else.”

Still too much work

To address concerns about workload, from McKnight respondents were asked whether “too much is expected of them at work.” This year’s results showed a mixed picture.

The share saying “very much yes” fell from 19.2% in 2023 to 17% in 2024. But the share saying “generally yes” is too much to ask of them rose from 36.5% to 39.8%, and the number saying “generally no” fell from 37.3% to 34.9%.

Again, nurse leaders felt more burdened with overwork, with 59.5% reporting that they had to do a great deal or generally too much. In comparison, 54.3% of administrators chose one of those two options.

Leach said it makes sense that nurse leaders, particularly nursing department directors, will continue to bear the brunt of the shortage, even though they no longer have to cover for CNAs as they did in 2020 and 2021. However, a nationwide nursing shortage increases the likelihood that DONs will be forced to pick up extra shifts.

“We haven’t even gotten to the elephant in the room with the staffing requirements that are coming,” Leach said. “But with the shortage of health care workers and nurses, they’re just expected to do more. (With) fewer people, they’re expected to do more because of that shortage and just because of budget constraints.”

Add to that the increased time spent on mandatory reporting, or learning new government manuals and payment systems for MDS nurses, and it’s clear that nursing leaders can feel overwhelmed.

“The regulatory aspect of their work, particularly the DON, is very negative,” Leach added. “It’s one of the worst things they have to deal with.”

Next: The 2024 from McKnight Mood of the Market examines wage satisfaction and the changes nursing home construction leaders want to implement to improve their work.