Large skilled nursing chains are finding it increasingly difficult to hire and retain regional staff as a nursing shortage and changing attitudes about work-life balance make the travel-intensive positions less attractive to many traditional candidates.

Labor challenges have forced some providers to assign more buildings or broader geographic areas to each regional leader in their organization. It’s not helping already stressful situations, experts and those holding such positions have told McKnight’s Long-Term Care in recent weeks.

“Coming out of COVID now and really the past year or two, we’re still seeing those mergers and acquisitions change ownership,” said Lisa Thomson, COO of Pathway Health. “With that, the role of the regional consultant regional support really has morphed and changed. Some are still following the traditional model where they base it upon certain size numbers and it’s really based upon the acuity and the distance between locations.”

But as more nurses are leaving the sector or are disinterested in jobs that demand more time and travel given the post-COVID demand for flexibility, some have just piled more work on those left behind.

Some companies, however, are starting to reimagine what mid-level management looks like.

While clinical staff remain a stalwart of the regional tier, many providers are recalling regional financial teams to their corporate offices. Others are sending financial or operational leaders on-site less routinely and limiting on-site visits to ownership or leadership transitions or after a poor survey, Thomson said.

But ultimately, anyone in a regional role is likely finding they’re being pulled in more often to plug building leadership holes and for other “constant fire-fighting,” said Denise Boudreau, president of Drive, a recruitment and retention firm specializing in healthcare and senior living.

Keeping people, especially those with a passion for caregiving, in those jobs may require more intentional conversations about the impact they have both on residents and staff.

“Caring and compassion is almost always on the list of personal values for people in our field,” Boudreau said. “You’re not only touching 120 residents’ lives like you did when you were a director of nursing, but you’re impacting now 1,200 residents’ lives. We have to tell them a little about the opportunities they have to make that value come alive.”

Thomson said she’s seen the regional role take on a more supportive tenor in recent years, with strapped administrators and DONs happy to have their regional partners in the building to address things they can’t fit into the daily workload.

“They’re taking some of the weight off of the shoulders of the site leadership that are not day-to-day operational needs,” Thomson said. “They’re going to be a partner, they’re going to help me with projects I have in my building or specific performance improvement areas. I just need that extra support because I’m still working on day-to-day operations.”

Understanding those shifting dynamics may help some potential job candidates step up into these roles, as could better leadership development, Boudreau said.

Both experts told McKnight’s providers should do more to develop pipelines of regional employees, recognizing early career leaders or those with special skills that might translate in the field. And it doesn’t hurt to consider recruiting other healthcare professionals to join the nursing home ranks at the regional level.

Thomson said med-surg and other acute nurses who have leadership experience could likely transfer some of their clinical expertise, in particular. Although they’d need training on regulatory and operational guidance, with mentorship or shadowing, such employees could bring new perspectives and tools to a facility’s bench.

Providers also need to ask lower level employees what they’d need to feel comfortable in a regional role, Boudreau added. Maybe it’s less travel, maybe it’s more training on a specific skill. Organizations could then adjust their operations based on their employees’ responses, rather than trying to shoehorn workers into positions as they’ve always been performed. 

“There’s just a huge opportunity here, but we don’t have a lot of pathways,” she said.

To get by while vacancies persist, Thomson said she’s seen many providers lean into technology and analytics that can empower regional staff, especially when it comes to getting them actionable insights remotely. And virtual meetings can also be a big improvement over phone calls, allowing regional leaders to see facial expressions that might cue them into a building leader’s potential burnout or need for extra support.

Still, Thomson says, it remains important to have eyes on the building and staff at some regular intervals. She said that at Pathway, she’s been fielding an increased number of calls seeking interim regional staff who can help chains maintain that in-person connection and lead initiatives.

“The eyes-on can just be, to me personally, those site leaders knowing that they’ve got that person,” she said. “And that person is there side by side with me, and they’re going to help me with the things that I need to work on.”