Examining the Director of Nursing Role in Long-Term Care: An Integrative Review

Aim. To identify and examine the structures and processes that support the director of nursing role in long-term care homes. Background. The director of nursing in long-term care homes is central to overseeing and supporting the workforce and delivery of safe, quality resident care. With ongoing health human resource challenges and an aging population requiring care from long-term care homes, it is important to understand what individual and organizational factors support the director of nursing leadership in these settings. Evaluation. This review was guided by Cooper’s five stages of the integrative review process. Donabedian’s structure-process-outcome framework was applied to synthesize the literature. Key Issue(s). Five individual-level structures (years of experience, level of education, demonstrated leadership capabilities, completed certification and/or established linkages with a professional association, and completed continuing education); three organizational-level structures (physical presence of leadership across the organization, a clear job description, and salary); and four processes (nursing home administrators and the director of nursing relationship, availability of onsite continuing education opportunities targeting directors of nursing and support for continuing education, cultivating relationships and enhancing networks beyond the long-term care home, and orientation to the role) were identified across 11 articles to support the director of nursing role in long-term care homes. Conclusion(s). The findings indicate that there are individual characteristics that support the director of nursing in their role. Notably, there are organizational structures and processes that can be modified at the practice and policy level to better recruit, retain, and support the performance of directors of nursing. Implications for Nursing Management. There are actionable steps that leaders and decision-makers can take to support nursing leadership across long-term care homes and directly address health human resource challenges.