McKnights survey ties culture to LTC retention

Long-term care staffing is still a workforce story, but this week’s survey says the real hinge may be culture. AAPACN and LTC 100 released new findings on April 28 showing that nurses and CNAs in nursing homes often stay because of purpose, residents, and team relationships — not because the job has gotten easier. In fact, most respondents said the opposite. They’re still in the field, but the work has become harder, and that makes frontline leadership matter a lot more. (aapacn.org) ### What actually came out? The survey came from AAPACN and Long Term Care 100 and was presented at the LTC 100 Leadership Conference. It was fielded in November 2025 and drew responses from nearly 500 nurses and certified nurse aides working in long-term care. The headline finding is simple: decisions to stay or leave are closely tied to workplace culture and relationships with frontline supervisors. (aapacn.org) ### If people are unhappy, why are they still there? Turns out many aren’t broadly unhappy. About 65.2% said they’re happy in their current role. But that number sits next to a harder truth — 73.8% said the job has become more difficult over the last 18 months. So this is not a story about a workforce that hates the work. It’s a story about a workforce that still finds meaning in the work while feeling more strain around it. (aapacn.org) ### What keeps them in long-term care? The strongest retention driver was meaningful relationships with residents, cited by 31% of respondents. Next came a sense of purpose at 28%, then team and work culture at 15%. That ranking matters. It suggests people are not mainly staying because of abstract loyalty to an employer. They’re staying because the work feels human, mission-driven, and shaped by the people around them every day. (aapacn.org) ### So where is the pressure coming from? The strain looks operational. Respondents pointed to regulatory burden, staffing shortages, and leadership gaps as contributors to dissatisfaction and burnout. A separate trade report on the survey added more texture: about 22% said not having enough staff made the job harder, and 16% pointed to heavier workload. Tha(aapacn.org)tem wrapped around it is getting more exhausting. (aapacn.org) ### Why do supervisors matter so much? Because in nursing homes, the supervisor is the job. A frontline manager controls scheduling, coaching, recognition, conflict handling, and whether problems get solved or just pile up. The survey frames that relationship as a major retention lever, and Amy Stewart of AAPACN called culture “low-hanging fruit” — basically(aapacn.org)or-market shortages. (aapacn.org) ### Is this really about money? Not mainly, at least in this dataset. Pay is always part of retention in long-term care, but these findings push attention toward management quality and day-to-day experience. If workers feel respected, supported, and connected to residents, they may tolerate a lot. But once documentation piles up, staffing runs thin, and supervisors feel absent, that cushion disappears fast. (aapacn.org) ### Why is this landing now? Because nursing homes are caring for sicker residents while still dealing with workforce shortages and compliance pressure. Skilled Nursing News noted that overlapping documentation tied to Medicaid, PDPM, and managed care is adding friction beyond normal regulatory work. So the survey lands at a moment when operators need retent(aapacn.org)atch. (skillednursingnews.com) ### What’s the bottom line? The useful takeaway is almost annoyingly practical. Long-term care providers may not be able to erase regulation or instantly solve staffing shortages, but they can improve hiring, recognition, supervisor training, and team culture. This survey says those “soft” factors are not soft at all. They’re one of the clearest reasons people stay. (aapacn.org)