Since 2020, many care home workers have seriously considered the prospect of leaving their jobs, with thousands leaving the sector altogether.

But new McKnight’s Long-Term Care News survey found that significantly fewer administrators and nurse leaders are considering leaving their current positions — a drop to levels not seen since before the pandemic.

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

This is also the lowest number recorded since McKnight launched the survey in 2019, when 37% of respondents said they were seriously considering quitting. That figure peaked at nearly 56% in 2021, when the survey was conducted just after a large increase in nursing home deaths from COVID-19.

Amid a nationwide surge this summer that brought the serious disease under control, nursing home workers returned to focusing on typical, everyday challenges, including staffing shortages and regulatory burdens.

There was more good news in the 2024 survey results: Nearly 76% of respondents said they were “very satisfied or fairly satisfied” with their current jobs. That’s less than 1 percentage point more than in 2023, but the share of those who said they were “very satisfied” rose 4.5 percentage points. Among administrators, the share of very satisfied employees rose almost 10% in one year, from 35.6%.

Matt Leach, a compensation specialist who helps nursing providers create pay scales to help recruit and retain staff, said: McKnight this week he was surprised the total wasn’t even higher, given what he’s hearing from suppliers and their workers.

“What we’re seeing, and what your data confirms, is just a return to normal. I think a lot of people were giving up on it two years ago, but it looks like we’re finally there in terms of payroll stability, job stability,” said Leach, a principal and senior compensation consultant at Total Compensation Solutions. “I think that’s why these people are, for the most part, so happy.”

This year’s Mood of the Market survey surveyed 723 people: nursing directors, assistant nursing directors, administrators and their assistants. The survey was sent 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 comes to managing workloads and being well-compensated for the work they do. However, the survey results also indicate that operators still have work to do to ensure employee retention in both the short and long term, especially as the full implementation of the federal hiring order approaches.

Nurses remain stressed

When it comes to resignations, “some easing of staffing and workforce issues” likely helped improve things for some, as did getting used to some of the nursing home regulations and reporting requirements added during the pandemic, said Denise Boudreau, president of Drive, which helps senior care and health care companies address workplace culture issues.

But she added that with more than a third of building managers surveyed still considering leaving, owners and managers should not accept the status quo.

“It’s amazing that it’s better, but it’s still so sad,” she said. “I just think that our field in general needs to do better for people. There are so many people who could benefit from support in so many different ways, whether it’s leadership development that would make them stronger leaders and make their jobs easier—and also the people who work around them who also make their jobs easier—or how to manage stress.

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

Nursing home workers may actually be slightly more satisfied with their jobs than their peers in other industries in the U.S. A study published in May found that 62.7% of American workers were “satisfied” with their jobs, even though satisfaction with subcategories like workplace culture, work-life balance, benefits and leave policies declined.

Who is feeling the pressure the most in long-term care? Nursing leaders are still more likely to say they have considered leaving (39.5%) than administrators (34.3%). Yet the number of nursing leaders has fallen by more than 14 percentage points since 2023.

Nurse leaders who participated in the Mood of the Market study were less likely than the general population (38.8%) to say they were “very satisfied” with their jobs (31.8%), and their response was more than 13 percentage points lower than that of administrators (45.1%).

Part of the reason may be ongoing front-line staffing shortages or a lack of competencies among new hires, said Amy Stewart, chief nursing officer at the American Post-Operative Care Nurses Association.

“One of the challenges we hear about at AAPACN is that the directors of nursing are not as involved in the admission process,” she said. “We see corporate staff making the decision to admit, or maybe the facility itself feels it can’t handle the acute care of the patient or doesn’t have the staff. We still hear that some facilities are admitting when they don’t have the staff or the competency to care for the residents they’re admitting.”

Stewart said, however, that this is not a universal problem and believes that the results of other studies from 2024 show a brighter 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 nurse leaders who are on the ground coordinating patient care. And as more providers try to address workplace culture, more nurse leaders have been able to leverage this change and find places where they can derive greater job satisfaction.

“It’s really a testament to the culture that this really matters more than anything else today for nurses on the front lines,” Stewart said. “If they don’t like the way they’re treated in their current facility, they can go somewhere else.”

I’m still doing too much work

To solve workload problems, McKnight respondents were asked if “too much is asked of them at work.” This year’s results were mixed.

The percentage of people who answered “definitely yes” fell from 19.2% in 2023 to 17% in 2024. However, the percentage of people who answered “generally yes” who were asked to do too many things rose from 36.5% to 39.8%, while the number who answered “generally no” fell from 37.3% to 34.9%.

Again, nurse leaders were more likely to feel overworked, with 59.5% saying they were very much or generally asked to do too much. In comparison, 54.3% of administrators chose one of these two options.

Leach said it makes sense that nurse leaders, especially directors of nursing, will continue to bear the brunt of the shortage, even if they are no longer filling in for CNAs on the floor as they were forced to do in 2020 and 2021. But the national nursing shortage makes it more likely that DONs will be forced to make additional shifts.

“We’re not even talking about the elephant in the room, which is the staffing requirements that are coming,” Leach said. “But because of the shortage of health care workers and nurses, they’re just being asked to do more. (With) fewer people, they’re being asked to do more because of that shortage and just because of budget constraints.”

Add to that more time spent on mandatory regulatory reporting—or MDS nurses learning new manuals and state payment systems—and it’s easy to see why nurse leaders might feel overwhelmed.

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

Next: 2024 McKnight The Mood of the Market report examines the level of satisfaction with salaries and the changes that care home managers expect to improve the quality of their work.