How Do Managers Influence the Caring and Learning Environment in Nursing Homes? A Qualitative Study

Abstract: People in nursing homes (NH) become increasingly frail, suffering several chronic ill-nesses, high symptom severity, and short lifespan after admission; all these issues requires skilled, well-organised professional care. Little is known about NH managers’ strategies to handle the complex work of caring and learning in NHs. The aim of this study is to explore the strategies NH managers use in their efforts to ensure quality care, provide a good work environment, and facilitate the learning of relevant competencies. This study applies a qualitative design and uses multiple methods, focusing on NHs as a context of complex adaptive systems and on basic nursing as a complex issue. NH managers express a constant struggle to keep workloads manageable, and NHs come across as exhausted organisations with little surplus. NH managers use simplifying strategies to make their own work and care work manageable; although used with the best intentions, these strategies seem to negatively affect care quality, work environment, and achieved competencies. Embedded in organisational environment that is guided by a bureaucratical view of management, NHs managers seem to receive little relevant support in the complex work of managing NHs.