essay of the nursing home

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Reflection on an experience in a nursing home

Info: 1620 words (6 pages) Nursing Essay Published: 13th Feb 2020

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How to Write a Nursing Essay with a Quick Guide

Ever felt the blank-page panic when assigned a nursing essay? Wondering where to start or if your words will measure up to the weight of your experiences? Fear not, because today, we're here to guide you through this process.

Imagine you're at your favorite coffee spot, armed with a cup of motivation (and maybe a sneaky treat). Got it? Great! Now, let's spill the secrets on how to spin your nursing tales into words that not only get you that A+ but also tug at the heartstrings of anyone reading. We've got your back with nursing essay examples that'll be your inspiration, an outline to keep you on the right path, and more!

What Is a Nursing Essay

Let's start by dissecting the concept. A nursing essay serves as a focused exploration of a specific aspect of nursing, providing an opportunity for students to demonstrate their theoretical knowledge and its practical application in patient care settings.

Picture it as a journey through the challenges and victories of a budding nurse. These essays go beyond the classroom, tackling everything from tricky ethical dilemmas to the impact of healthcare policies on the front lines. It's not just about grades; it's about proving, 'I'm ready for the real deal.'

So, when you read or write a nursing essay, it's not just words on paper. It's like looking into the world of someone who's about to start their nursing career – someone who's really thought about the ins and outs of being a nurse. And before you kick off your nursing career, don't shy away from asking - write my essay for me - we're ready to land a professional helping hand.

How to Start a Nursing Essay

When you start writing a nursing essay, it is like gearing up for a crucial mission. Here's your quick guide from our nursing essay writing service :

Choosing Your Topic: Select a topic that sparks your interest and relates to real-world nursing challenges. Consider areas like patient care, ethical dilemmas, or the impact of technology on healthcare.

Outline Your Route : Plan your essay's journey. Create a roadmap with key points you want to cover. This keeps you on track and your essay on point.

Craft a Strong Thesis: Assuming you already know how to write a hook , kick off your writing with a surprising fact, a thought-provoking quote, or a brief anecdote. Then, state your main argument or perspective in one sentence. This thesis will serve as the compass for your essay, guiding both you and your reader through the rest of your writing.

How to Structure a Nursing Essay

Every great essay is like a well-orchestrated performance – it needs a script, a narrative that flows seamlessly, capturing the audience's attention from start to finish. In our case, this script takes the form of a well-organized structure. Let's delve into the elements that teach you how to write a nursing essay, from a mere collection of words to a compelling journey of insights.

Nursing Essay Introduction

Begin your nursing essay with a spark. Knowing how to write essay introduction effectively means sharing a real-life scenario or a striking fact related to your topic. For instance, if exploring patient care, narrate a personal experience that made a lasting impression. Then, crisply state your thesis – a clear roadmap indicating the direction your essay will take. Think of it as a teaser that leaves the reader eager to explore the insights you're about to unfold.

In the main body, dive into the heart of your essay. Each paragraph should explore a specific aspect of your topic. Back your thoughts with examples – maybe a scenario from your clinical experience, a relevant case study, or findings from credible sources. Imagine it as a puzzle coming together; each paragraph adds a piece, forming a complete picture. Keep it focused and let each idea flow naturally into the next.

Nursing Essay Conclusion

As writing a nursing essay nears the end, resist the urge to introduce new elements. Summarize your main points concisely. Remind the reader of the real-world significance of your thesis – why it matters in the broader context of nursing. Conclude with a thought-provoking statement or a call to reflection, leaving your reader with a lasting impression. It's like the final scene of a movie that leaves you thinking long after the credits roll.

Nursing Essay Outline

Before diving into the essay, craft a roadmap – your outline. This isn't a rigid skeleton but a flexible guide that ensures your ideas flow logically. Consider the following template from our research paper writing service :

Introduction

• Opening Hook: Share a brief, impactful patient care scenario.
• Relevance Statement: Explain why the chosen topic is crucial in nursing.
• Thesis: Clearly state the main argument or perspective.

Patient-Centered Care:

• Definition: Clarify what patient-centered care means in nursing.
• Personal Experience: Share a relevant encounter from clinical practice.
• Evidence: Integrate findings from reputable nursing literature.

Ethical Dilemmas in Nursing Practice

• Scenario Presentation: Describe a specific ethical challenge faced by nurses.
• Decision-Making Process: Outline steps taken to address the dilemma.
• Ethical Frameworks: Discuss any ethical theories guiding the decision.

Impact of Technology on Nursing

• Current Trends: Highlight technological advancements in nursing.
• Case Study: Share an example of technology enhancing patient care.
• Challenges and Benefits: Discuss the pros and cons of technology in nursing.
• Summary of Key Points: Recap the main ideas from each section.
• Real-world Implications: Emphasize the practical significance in nursing practice.
• Closing Thought: End with a reflective statement or call to action.

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Nursing Essay Examples

Here are the nursing Essay Examples for you to read.

Writing a Nursing Essay: Essential Tips

When it comes to crafting a stellar nursing essay, a few key strategies can elevate your work from ordinary to exceptional. Here are some valuable tips from our medical school personal statement writer :

Connect with Personal Experiences:

• Approach: Weave personal encounters seamlessly into your narrative.
• Reasoning: This not only adds authenticity to your essay but also serves as a powerful testament to your firsthand understanding of the challenges and triumphs in the nursing field.

Emphasize Critical Thinking:

• Approach: Go beyond describing situations; delve into their analysis.
• Reasoning: Nursing essays are the perfect platform to showcase your critical thinking skills – an essential attribute in making informed decisions in real-world healthcare scenarios.

Incorporate Patient Perspectives:

• Approach: Integrate patient stories or feedback into your discussion.
• Reasoning: By bringing in the human element, you demonstrate empathy and an understanding of the patient's experience, a core aspect of nursing care.

Integrate Evidence-Based Practice:

• Approach: Support your arguments with the latest evidence-based literature.
• Reasoning: Highlighting your commitment to staying informed and applying current research underscores your dedication to evidence-based practice – a cornerstone in modern nursing.

Address Ethical Considerations:

• Approach: Explicitly discuss the ethical dimensions of your topic.
• Reasoning: Nursing essays provide a platform to delve into the ethical complexities inherent in healthcare, showcasing your ability to navigate and analyze these challenges.

Balance Theory and Practice:

• Approach: Connect theoretical concepts to real-world applications.
• Reasoning: By bridging the gap between theory and practice, you illustrate your capacity to apply academic knowledge effectively in the dynamic realm of nursing.

Highlight Interdisciplinary Collaboration:

• Approach: Discuss collaborative efforts with other healthcare professionals.
• Reasoning: Acknowledging the interdisciplinary nature of healthcare underscores your understanding of the importance of teamwork – a vital aspect of successful nursing practice.

Reflect on Lessons Learned:

• Approach: Conclude with a thoughtful reflection on personal growth or lessons from your exploration.
• Reasoning: This not only provides a satisfying conclusion but also demonstrates your self-awareness and commitment to continuous improvement as a nursing professional.

As we wrap up, think of your essay as a story about your journey into nursing. It's not just about getting a grade; it's a way to share what you've been through and why you want to be a nurse.

Imagine the person reading it – maybe a teacher, a future coworker, or someone starting their nursing journey. They're trying to understand your passion and why you care about nursing.

So, when you write, remember it's more than just an assignment. It's your chance to show why nursing matters to you. And if you ever need help – there's always support from our essay writer online .

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How to Write a Nursing Essay?

How can a nursing essay effectively address ethical considerations, what are some examples of evidence-based practices in nursing essays.

Daniel Parker

is a seasoned educational writer focusing on scholarship guidance, research papers, and various forms of academic essays including reflective and narrative essays. His expertise also extends to detailed case studies. A scholar with a background in English Literature and Education, Daniel’s work on EssayPro blog aims to support students in achieving academic excellence and securing scholarships. His hobbies include reading classic literature and participating in academic forums.

is an expert in nursing and healthcare, with a strong background in history, law, and literature. Holding advanced degrees in nursing and public health, his analytical approach and comprehensive knowledge help students navigate complex topics. On EssayPro blog, Adam provides insightful articles on everything from historical analysis to the intricacies of healthcare policies. In his downtime, he enjoys historical documentaries and volunteering at local clinics.

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120+ Fresh Nursing Essay Topics (With FAQs and Essay Writing Tips)

Be it writing a nursing assignment or preparing an essay to get admission to a nursing school, choosing the right nursing essay topic is of utmost importance.

An essay can make or break your chance of getting into that school or your chances of scoring the highest in the assignment.

Considering the importance of nursing essays, we have got you some handpicked nursing essay topics that will help you ace the exams.

The article is divided into 3 sections according to the difficulty level. You can opt for them according to your convenience.

You’ll also find an interesting list of topics in the miscellaneous section. So make sure to check that as well.

The following part of the article includes some tips on framing a well-structured essay.

 Basic Level Nursing Essay Topics

• Describe the role of nurses in society.
• What are nursing ethics?
• According to you, what are the challenges associated with nursing?
• Discuss nursing ethics.
• Importance of nursing care for infants.
• What are the possible reasons behind a fewer number of male nurses?
• Throw some light on nurses’ practice act.
• Why is there a need for significant leadership in nursing?
• What are the steps you need to take to cure minor wounds?
• What are the steps you need to take to cure severe wounds?
• Discuss the steps that nurses should take to deal with hyperactive patients and their relatives?
• Are there any differences faced by nurses as compared to doctors when it comes to respect and value?
• What measures can nurses take to cure serious wounds when not having any instruments?
• What steps can nurses take to deal with patients in backward regions, where there is a lack of medical infrastructure?
• Analyze the problems with medical infrastructure.
• How to strengthen medical infrastructure?
• How to perform home nursing?
• Steps to improve mental health.
• Discuss the pitfalls of dieting.
• Importance of technology in nursing.

Moderate Level Nursing Essay Topics

• Throw some light on holistic nursing.
• Should we allow nurses to prescribe medication or antibiotics?
• Discuss the risks associated with nurses prescribing medication?
• Discuss the problems associated with the compensation of nursing jobs.
• How should nurses deal with abusive or rude patients?
• How can civilians be helpful to nurses in treating their patients?
• Infant mortality and its possible causes.
• How to prepare a nursing resume to apply for a job?
• Mental impact on nurses.
• Basic theories to apply in nursing.
• Nursing in India: from struggle to victory.
• Soft skills required in nursing.
• Reasons to choose nursing as a profession.
• How to teach nursing?
• How to deal with depression being a nurse.
• How to deal with patients with dementia initially?
• What efforts should be made to make patients’ stay in neonatal units more pleasant?
• Legalizing euthanasia.
• Importance of midwifery. Is it underestimated?
• How can we help pharmacies strike a balance between helping the patients and earning a profit?

Advanced Level Nursing Essay Topics

• Significance of psychological training to ensure efficient medical working.
• Has covid-19 impacted the chances of nursing being a chosen profession?
• How to avoid hospitalization in covid-19?
• Measure to enhance the efficiency of nurses as assistants of doctors.
• What can nurses do to treat patients with Alzheimer’s disease?
• Express your views on applying Henderson’s principles in the nursing area.
• How to convince people to donate organs?
• Chronic diseases and covid-19 pandemic.
• Discuss pediatric ethics.
• Explain acute coronary syndrome.
• Explain the cause behind anxiety disorders.
• Write on obesity and weight management programs.
• What precautions should be taken in the postnatal period?
• Dealing with gestational weight gain challenges.
• Precautions to be taken pre and post-delivery.
• Joint disorders study in elderly people.
• What are geriatrics ethics?
• Menarche and menopause challenges and symptoms.
• Explain reproductive endocrinology.
• Therapeutic injections: pros and cons.

List of Nursing Argumentative Essay Topics

• Are nurses more vulnerable to health risks than doctors?
• How does the increased number of working hours impact the working of nurses?
• Is nursing a female-centric profession?
• How important is the role of a nurse when compared with that of a doctor?
• Difference in the salary paid to day shift nurses vs. night shift nurses
• What should be the adequate amount of nursing staff to have in a hospital?
• Should more emphasis be laid on home nursing?
• How is racial discrimination a problem in nursing?
• Are nurses more empathetic than doctors?
• How important is it for a nurse to work on her emotions?

Miscellaneous Topics for Students Nursing Research

• Nursing Theory: 
• Nursing theory history and significance
• Strategies for theory construction in nursing
• Nursing theory vs. nursing practice
• Person-centered nursing: theory and practice
• Areas of agreement in nursing theory development
• Nursing Education:
• Critical thinking in nursing education : Literature review
• Future challenges for nursing education
• Curriculum development in nursing education
• New nursing education structure in US/UK/Asia
• Creating innovative models of clinical nursing education
• Nursing Care: 
• Transcultural concepts in nursing care
• Basic principles of nursing care
• Factors influencing why nursing care is missed
• Measuring patients’ satisfaction with nursing care
• Spiritual nursing care: state of the art
• Pharmacology for nursing care
• Nursing Interventions:
• The systematic development of nursing interventions
• The impact of nursing interventions
• Nursing interventions for smoking cessation
• Nursing interventions for patients with chronic conditions
• Nursing interventions for premature infants
• Nursing interventions to promote functional feeding
• Nursing Homes:
• Nursing homes in developed and developing nations: a comparison
• Characteristics of nursing homes that affect resident outcomes
• Infections among patients in nursing homes
• Nursing homes and COVID‐19: What has changed?
• Abuse of patients in nursing homes
• Family involvement in nursing homes
• Nursing Leadership 
• Factors contributing to nursing leadership
• Nursing leadership and patient outcomes
• Leadership and management in nursing
• Transformational leadership in nursing
• ethical leadership in nursing
• Nursing Diagnosis:
• Nursing diagnosis process and it’s relation with critical thinking skills
• Application of nursing process and nursing diagnosis
• Do staff nurses use nursing diagnosis effectively?
• Methods to validate nursing diagnoses
• Accuracy of nursing diagnoses: How effective are they?
• Nurse Burnout:
• Nurse burnout and quality of care
• Nurse burnout: personal and environmental factors
• Impact of nurse burnout on organization
• Predictors of burnout among nurses in US, UK, India
• Pediatric nurse burnout
• Nurse Staffing: 
• Nurse staffing and inpatient hospital mortality
• Hospital nurse staffing and quality of care
• Nurse Patient Ratios
• The effects of nurse staffing on medical costs
• Nurse staffing in critical care and how it affects patient outcome
• Nurse Practitioner Role
• Barriers to developing nurse practitioner role
• Analyze nurse practitioner role in acute care settings
• How case-study research can better implement nurse practitioner role
• Practice and clinical leadership: The core role of the nurse practitioner
• Neonatal nurse practitioner role
• 200+ Great Ideas of Nursing Research Topics to Get Started

Frequently Asked Questions

1. how do you start writing a nursing essay.

The following section includes some tips on how to write a well-curated nursing essay.

• Plan your essay- you need to have a well-planned outline of the essay to write an outstanding one.

Spend a good amount of time in research and shortlist the things that you would want to include, things that you would want to highlight or your personal story if any.

• Start writing- Start your essay with a statement that is catchy and strong. Include an adequate amount of research and evidence to support your point in the body. End it with a conclusion stating a summary of the essay.
• Revision- go through the content and look for grammatical or spelling errors, if any. Focus on the structure of the essay.

2. List tips on how to write a nursing school application essay.

• Focus on being informative- while framing the essay, be mindful of the information you include. Make sure it is backed by some evidence.
• Select the best essay topic- go for such a topic that makes the officers remember you after they have read the essay. At the same time, make sure you are comfortable writing on it.
• Check the structure- the essay should be divided into 3 parts- introduction, body and conclusion. Make it readable and easy to understand.

To sum it up, when you kick-start writing a research paper, make sure you move ahead step-by-step.

Since research is the first step in writing the essay, you first have to gather all the essential list of information that is relevant to your nursing essay topic.

Next, handpick the information and come up with an essay that is well-curated and backed by evidence.

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Welcome to a unique top-rated database of nursing college essay examples. For years, we’ve collected the most successful samples by students to help others create their own pieces of work. You’re free to find an example related to your topic in your subject. Doubting the legality of the examples we post here? All samples of a nursing essay are uploaded by authors voluntarily and may be used for informational purposes only, not for copying.

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Should you have the opportunity to receive specialized funding for your studies, our nursing scholarship essay examples could help you. These free samples of a nursing essay demonstrate how you can advertise your candidacy, including examples of your skills and attainments, and persuade the committee to choose you over other applicants.

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Insights you might get from a nursing essay sample

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The primary objective of one more nursing essay sample type is to convey to the reader the substance of any fact or example in an understandable language. In these examples, you may notice that the author doesn’t seek justifications. So, from such samples of an essay, you’ll simply understand how to research the subject appropriately and then retell it using your own words. Similar examples of tasks are required for another kind of nursing essay, but you’ll also learn to develop a plot and provide samples of information on specific cases. These free examples will teach you to imply the key point rather than state it explicitly.

Quality sample essay nursing is our database priority

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• Examples for an essay to sound credible.
• Resources of literature samples and online sources.
• Conclusions that support the author’s statements.
• Both theory and practice.

Finding ideas for a nursing essay is also simpler with successful examples published in the database. Moreover, due to clear essay frameworks and thesis statements in free samples from the database, you will see how you can captivate the reader and guarantee yourself a high result. Whether you need a nursing entrance essay sample or any other example, it doesn’t matter.

Why you should use our nursing essay writing examples

When you’re writing your nursing essay , examples are quite helpful since they provide a visual representation of how this piece of writing should be formatted. With a sample essay, nursing students are more aware of the format, examples of key components, and objectives. Using a sample as a guide is essential, because failing to do so could result in you making certain common errors that can affect your grade.

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Examples on the platform include all the details required to write a top performing nursing essay: the thesis, motivation, arguments, supporting points, samples of relevant literature, appropriate style, and referencing. The key notion of examples is the thesis. From examples, you’ll learn how to make it debatable, acknowledged at the outset of the essay, and constantly controlled by samples of nursing academic material. Motivation in samples can teach you to highlight the significance of the essay and supports the author’s personal interest in investigating the topic.

Since one example of argumentation in a nursing essay won’t suffice to persuade the reader, from examples, you’ll get to know how to provide specific references or citations as proof. Finally, you’ll learn how to examine relevant examples of nursing evidence and write using the many samples as they combine to create a complete picture that was previously hidden.

Don’t hesitate to follow our examples of a nursing essay – that’s your key to excellence!

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How to Write a Nursing Essay

School work can be demanding. The career path you pick requires educational background. Yet, most students do not get enough time to balance between school and personal work. Learning how to write a nursing essay can go a long way. Acing your assignment can help you clinch better grades. Without good grades, your dream career […]

Posted: July 28th, 2022

School work can be demanding. The career path you pick requires educational background. Yet, most students do not get enough time to balance between school and personal work. Learning how to write a nursing essay can go a long way.

Acing your assignment can help you clinch better grades. Without good grades, your dream career may remain a dream. Essays are a common way to test knowledge. A quick lesson on how to write one can help you attain good grades. Alternatively, you can buy a nursing paper to avoid the hustle.

In this article we look at how to write a nursing essay and give three samples to help you.

What is a Nursing Essay?

A nursing essay is a type of paper in which you are required to prove your thorough knowledge of a certain healthcare topic and show your outstanding writing skills. I usually write nursing essays as part of Nursing School admission requirements or for academic advancement.

They can also ask you to write a nursing essay as part of a scholarship application process. A nursing essay is a challenging assignment which can become a real headache if you don’t have the writing skills or enough time to complete it. Learning how to write a nursing essay can help you kick-start your dream career.

Nursing Essay Outline

Before you write your nursing essay, it is crucial to create an outline that will serve as a roadmap for your paper. An outline will help you organize your thoughts and structure your paper in a logical, easy-to-follow manner. A good nursing essay outline should include the following elements:

– Introduction : An overview of the main topic of your nursing essay.

– Body paragraphs : A detailed discussion of the evidence, arguments, and examples you will use to support your thesis statement.

– Conclusion : A summary of the main points of your nursing essay and a restatement of your thesis.

How to write a Nursing Essay- A step-by-step guide

Now that you have a good understanding of what a nursing essay is and how to create an outline, it’s time to write. Follow the simple steps below on how to write a nursing essay, to write an impressive essay:

1. Choose a topic

The first step in writing a nursing essay is to choose a topic. Nursing essays can be written on a wide variety of topics, from the role of nurses in society to the importance of empathy in nursing. When choosing a topic, pick one that is both interesting and relevant to the Nursing profession.

2. Do your research

Once you have chosen a topic, it’s time to do your research. Nursing essays require a solid foundation of medical knowledge and a thorough understanding of the topic at hand. Be sure to consult with nursing experts and read nursing journals to get a well-rounded view of your chosen topic.

3. Create a thesis statement

After you have done your research, it’s time to create a thesis statement. A thesis statement is a one-sentence summary of the main point of your nursing essay. For example, your thesis statement could be: “Empathy is an essential quality for all nurses.”

4. Write your introduction

Introducing your nursing essay should briefly introduce the reader to your topic and provide a roadmap for the rest of the paper. Be sure to include your thesis statement in the introduction. An introduction should be powerful and captivating to keep the reader interested in reading your essay.

While we are not yet done on how to write a nursing essay, you already know how to handle the hard parts.

5. Write your body paragraphs

The body paragraphs of your nursing essay should be where you dive into a more detailed discussion of your topic. Be sure to support your arguments with evidence from your research. Nursing essays are usually fairly short, so you won’t need over three or four body paragraphs.

Write clear and concise language to keep the reader interested. Writing a good body for your essay will earn you more marks.

6. Write your conclusion

The conclusion of your nursing essay should briefly summarize the main points of your paper and reinforce your thesis statement. Be sure to end your nursing essay on a strong note that will leave the reader with a positive impression.

Now that you have the guide above on how to write a nursing essay, it is time to practice. Practice writing until you have several essay drafts. Experts recommend trying as many topics as you can to get you warmed up for the task.

Now that you know how to write a nursing essay, let us look at how to make your essay stand out.

Editing Your Essay

After you have written your nursing essay, it’s important to edit and proofread it to ensure that it is free of any grammatical or typographical errors. Nursing essays are usually short, so you won’t need to spend too much time on this step. However, it’s still important to take the time to edit and proofread your essay to ensure that it is error-free.

If you need help to edit or proofreading your nursing essay, consider hiring a professional editor or proofreader. Professional editors and proofreaders can help improve the quality of your nursing essay and increase your chances of getting accepted into nursing school.

Nursing Essay Examples

Check out the Nursing essay examples below to get a better understanding of how to write a Nursing essay.

Nursing Essay Example 1: The Importance of Nursing Empathy

“Empathy is an essential quality for all nurses. Without empathy, nurses could not understand the needs and feelings of their patients. Empathy allows nurses to build trust with their patients and provide the best possible care.

Empathy is more than just feeling sorry for someone. It’s about understanding their feelings and experiences and sharing in their emotional journey. Empathy allows us to see the world through another person’s eyes and understand their perspective.

Nursing is a demanding profession, and empathy is an essential quality that all nurses need in order to be successful. Empathy allows nurses to connect with their patients on a deeper level and provides the best possible care. Nursing is a profession that requires both compassion and empathy, and without these qualities, nurses could not effectively care for their patients.”

Nursing Essay Example 2: The Role of Nurses in Society

“Nurses play a vital role in society. They are the front line of healthcare, and their work is essential to the well-being of society. Nurses provide care for the sick and injured, and they promote health and wellness. Nurses are also advocates for their patients, working to ensure that they receive the best possible care.

Nurses play a crucial role in society, and their work is essential to the well-being of society. Nurses provide care for the sick and injured, promote health and wellness, and are advocates for their patients. Nursing is a demanding profession, but it is also a rewarding one. Nurses make a difference in the lives of their patients, and their work is essential to the health of society.”

Nursing Essay Example 3: Nursing Careers

“There are many nursing careers available to those interested in this field. Nurses can specialize in a particular area of healthcare, or they can choose to work in a generalist capacity. There are also many settings in which nurses can work, from hospitals to clinics to nursing homes.

Nurses have a wide range of career options available to them. They can specialize in a particular area of healthcare, or they can choose to work in a generalist capacity. Nurses can also choose to work in a variety of different settings, from hospitals to clinics to nursing homes. Nursing is a demanding profession, but it offers a wide range of career opportunities for those interested in this field.

Nurses play a vital role in society, and their work is essential to the well-being of society. Nurses provide care for the sick and injured, promote health and wellness, and are advocates for their patients.

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A Nursing Home Working Scenario Essay

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• As a template for you assignment

Ireland is among the nations that have a rapidly growing aging population as people live longer today. While walking down the streets in main cities of the country one can easily notice more elderly people in comparison with previous times. When the number of older people increases in an area, it brings challenges to the nursing homes, as there is a rise in demand for quality care. Working in nursing homes has its opportunities and challenges; therefore, the paper will cover the multidisciplinary teams’ working scenario, their interaction and diversity, communication in client care, and support accorded to clients considering their family, culture, and diversity.

Events and Interactions with Members of the Multidisciplinary Team

A multidisciplinary team (MDT) comprises a group of health care personnel belonging to different disciplines such as psychiatric nurses, social workers, psychiatrists, and occupational therapists, among many others. Each team member provides particular services to the patient, and they independently intervene in numerous issues a client may have (Health Service Executive, 2020 ). The team’s actions are usually brought together using a care plan that coordinates services accorded to nursing home residents. In some instances, a patient has a key worker who manages all their needs and contacts.

Professionals from multidisciplinary teamwork in different areas of expertise combine their knowledge sets necessary to confront challenging and complex conditions. This team frequently meets to deliberate their work, so each patient has a befitting care plan according to their requirements. Some of the duties and roles performed by MDT include:

• A social worker who offers support to patients by providing talking therapies
• A psychiatrist who prescribes medication and examines physical illness
• Psychiatric Nurse (PMHN), who administers drugs, monitors medication and examines challenges.
• An occupational therapist whose main task is to formulate rehabilitation plans both for group or individual patients.

Review of the Interaction in Respecting Diversity and Individuality of Coworkers

Workplace diversity has become increasingly essential in the Ireland health care settings. As the nursing and other health workforce and demographics change, it is significant for the nursing home administrators to influence and understand personnel with multiple values. Globalization provides more cultural diversity between clients and staff in aged care settings, with a substantial number being born overseas. It is not only the nursing home residents who outline multiculturalism but even their employees due to inward and outward doctors and nurses migration (Wals, Matthews and Brugh, 2018 ). The experience calls for tolerance among different cultures.

Linguistic and cultural interaction between residents and home employees are viewed as enabling the building of relationships and a favorable working environment. Increased diversity in the nursing home workers has some implications for the facilities managers concerning managing the diversity and harnessing its opportunities. Furthermore, divergent employees may act differently as a result of their cultural beliefs.

Arising Conflicts and Challenges

Cultural, demographics, education, language, generation differences, race, and gender increase challenges and conflicts within nursing home teams. Some conflicts occur due to decreased job satisfaction and burnout among staff, which leads to misinterpretations, and misunderstanding linked to generational and cultural variances. In performing daily duties in a nursing home, people with different professional and personal backgrounds will mostly have diverse opinions on best care functioning. Misunderstanding, particularly in busy health, will always occur, adding stress inherent between professionals in their working stations (Trusted, 2019 ). In some instances, issues will just arise, while in other moments, it results from accumulated tensions.

Since disharmony and conflicts are not inevitable in the working place, the best strategies to de-escalate and deal with conflict situations include: being respectful to the coworkers and residents in the facility, staying in one’s lane whereby the main role is helping clients, and honoring other people’s decision, being approachable and friendly to build relationships with clients and other team members, communicating openly, and assuming the best from coworkers.

Importance of Communication in Client Care

In most nursing homes, clients suffer from complicated conditions, including dementia, which makes proper communication in advance care planning (ACP) important. The key purpose of effecting ACP intervention and communication among facility workers, family, and patients is to allow the facility’s smooth running (Aasmul et al., 2018). A facility with robust communication strategies enriches their client’s health and ensures the workflow and deliberations are smooth.

Health care institutions and personnel have a duty of revamping their communication policies for the best patient outcome. It is noteworthy that poor communication is responsible for several patients’ morbidity and mortality as important interventions are not communicated. Furthermore, malpractice resulting from ineffective communication costs billions of Euros in Ireland, which is detrimental for facilities, patients, and employees. The main focus of adequate communication in a nursing home is to improve patient safety; therefore, effective communication channels are paramount.

Supporting the Client Needs by Considering their Cultural, Family, and Individual Aspects

The number of culturally and ethnically diverse groups in Ireland is growing, and each has different cultural traits. Moreover, some ethnic groups show some unique health problems specific to them. From triage to discharge, health workers spend considerable time with a client, which calls for cultural competencies in the care. Courts in Ireland have recognized advance healthcare directives, thereby establishing that an individual with capacity has a constitutional right to refuse treatment (NMBI, 2021). As a worker in a nursing home, one needs to:

• Respect every individual as a unique person
• The dignity of every phase in life should be maintained and respected
• Support clients who are in end-of-life care to dying in dignity while taking into account the family cultural values and norms
• There should be promotion and protection of the patient’s autonomy: respecting their choices, beliefs, priorities, and values
• The decisions to decline treatment or care should open up further debate and be appreciated in contexts of an individual’s capacity.

Reflection on Professional and Personal Performance, Strengths, and Weaknesses

On the professional front, there is a need of possessing all the necessary education and skills needed to work as a social worker in a nursing home. Moreover, having a good communication skills and the capability to embrace people of all ages, gender, race, and ethnic group is essential. My strengths include being flexible while working in a dynamic organization and am a team player. On the other hand, my weakness is that I have too much compassion and empathy while assisting aged people nearing their end-of-life, to the extent of breaking down due to their plight. Working in a nursing home is also fulfilling, as it offers an opportunity to serve communities, especially the most vulnerable in society. When treated in dignity, order people feel respected, and they cooperate better.

Reference list

Aasmul, et al. (2018). ‘Advance care planning in nursing homes – improving the communication among patient, family, and staff: Results from a cluster randomized controlled trial (COSMOS)’. Frontiers in Psychology , 9.

Health Service Executive (HSE), 2020. Multi-disciplinary team – HSE.ie. [online] HSE.ie. Web.

Nursing and Midwifery Board of Ireland (NMBI).NMBI, 2021. NMBI – The Code – Principle 1: Respect & dignity. [online] Nmbi.ie. Web.

Trusted, 2019. Conflict in Nursing: types, strategies, and resolutions – Trusted Health . [online] Trustedhealth.com. Web.

Wals, A., Matthews, A. and Brugh, R., 2018. From brain drain to brain gain: Ireland’s nursing and midwifery workforce. [online] Healthworkforceireland.com. Web.

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Nursing Essay Examples

Nursing Essay Examples That Will Help You Write a Stellar Paper

Published on: May 6, 2023

Last updated on: Jan 29, 2024

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Many nursing students struggle with writing effective nursing essays, which are an essential part of their education and professional development.

Poor essay writing skills can lead to low grades and an inability to effectively communicate important information.

This blog provides a comprehensive guide to writing nursing essays with examples and tips for effective writing. Whether you are a nursing student or a professional looking to improve your writing skills, this blog has something for you. 

By following the tips and examples provided, you can write compelling nursing essays that showcase your dedication to the field.

Let’s get started.

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What is a Nursing Essay?

A nursing essay is a type of academic writing that aims to explore a particular topic related to nursing. It also presents a clear and concise argument or viewpoint supported by evidence. 

Nursing essays can take many forms, including:

• Descriptive essays
• Reflective essays
• Analytical essays
• Persuasive essays

What is the Importance of the Nursing Essay?

Nursing essays are important for several reasons. First, they help nursing students develop critical thinking skills by requiring them to analyze and evaluate information.

Second, they help students develop research skills by requiring them to locate and use credible sources to support their arguments. 

Third, nursing essays help students develop communication skills by requiring them to present their ideas clearly and concisely in writing. Finally, nursing essays are important for nursing education because they prepare students for the types of writing.

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To help students better understand how to write nursing essays, it can be helpful to review examples.

Below are some examples of nursing essays.

Nursing School Essay Examples

College Nursing Essay Examples

Graduate Nursing Essay Examples

Nursing Scholarship Essay Examples

Nursing Essay Conclusion Examples

Nursing Essay Examples of Different Fields

Nursing is a diverse field with many different specialties and areas of focus. As a result, nursing essays can take many different forms and cover a wide range of topics. 

Given below are some examples of different types of nursing essays:

Personal Philosophy Of Nursing - Essay Examples

Cal State Fullerton Nursing Essay Examples

Evidence Based Practice Nursing In Medical Field - Essay Examples

Leadership In Nursing And Healthcare Professionals - Essay Examples

Principles Of Professional Practice Of Nursing Professionals And Pharmacists

If you're seeking additional examples of nursing essays, you're in luck! 

Below are some more examples that can help you gain a better understanding of nursing essays:

Health Care And Reflective Models For Nursing - Essay Examples

History Of Nursing Essay Examples

Ethical Dilemma In Nurses Work - Essay Examples

Mental Health Nursing Essay Examples

Why I Want To Be A Nurse Essay

Working In A Team And Collaboration In Nursing

How to Write a Nursing Essay

Writing a nursing essay can seem daunting, but with the right approach, it can be a rewarding experience.

Here are the key steps involved in writing a nursing essay:

Understanding the Topic and Question

The first step in writing a nursing essay is to carefully read and understand the topic and question. 

This will help you determine what information you need to research and include in your essay. Make sure you understand any key terms or concepts related to the topic. Consider different perspectives or viewpoints that may be relevant.

Researching the Topic

Once you have a clear understanding of the topic and question, it's time to research. 

Start by gathering information from credible sources such as academic journals, textbooks, and government websites. 

Consider both primary and secondary sources, and make sure to take detailed notes as you read.

Organizing and Outlining the Essay

Once you have completed your research, it's time to organize your ideas and create an outline for your essay. 

Start by identifying the main points or arguments you want to make, and then organize them into a logical order that flows well. 

Your outline should include an introduction, body paragraphs, and a conclusion.

Writing the Essay

With your outline in place, it's time to start writing your essay. Make sure to follow your outline closely, and use clear and concise language that effectively communicates your ideas. 

Use evidence from your research to support your arguments, and cite your sources appropriately.

Editing and Revising the Essay

Once you have completed a first draft of your essay, take some time to edit and revise it. Look for any errors in grammar, spelling, or punctuation, and make sure your essay is well-organized and flows well. 

Consider asking a peer or instructor to review your essay and provide feedback.

What To Include In Your Nursing Essay

When writing a nursing essay, there are several key elements that you should include. Here are some important things to keep in mind:

• Introduction

Your introduction should provide a brief overview of the topic and purpose of your essay. It should also include a clear thesis statement that presents your main argument or point of view.

• Background Information

Provide some background information on the topic to help the reader better understand the context of your essay. This can include relevant statistics, historical information, or other contextual details.

• Evidence and Examples

Use evidence and examples from your research to support your arguments and demonstrate your knowledge of the topic. Make sure to cite your sources appropriately and use a variety of sources to strengthen your argument.

• Analysis and Evaluation

Provide analysis and evaluation of the evidence and examples you've presented. This can include discussing strengths and weaknesses, comparing and contrasting different viewpoints, or offering your own perspective on the topic.

Your conclusion should summarize the main points of your essay and restate your thesis statement. It should also offer some final thoughts or suggestions for further research or action.

Nursing Essay Topic Ideas

Choosing a topic for your nursing essay can be challenging, but there are many areas in the field that you can explore. Here are some nursing essay topic ideas to consider:

• The role of technology in nursing practice
• The impact of cultural diversity on healthcare delivery
• Nursing leadership and management in healthcare organizations
• Ethical issues in nursing practice
• The importance of patient-centered care in nursing practice
• The impact of evidence-based practice on nursing care
• The role of nursing in promoting public health
• Nursing education and the importance of lifelong learning
• The impact of nursing shortages on healthcare delivery
• The importance of communication in nursing practice

These are just a few ideas to get you started. You can also explore other topics related to nursing that interest you or align with your academic or professional goals. 

Remember to choose a topic that is relevant, interesting, and feasible to research and write about.

Tips for Writing an Effective Nursing Essay

Writing a successful nursing essay requires careful planning, research, and attention to detail. Here are some tips to help you write an effective nursing essay:

• Writing Concisely and Clearly

Nursing essays should be written in clear and concise language, avoiding unnecessary jargon or technical terms. Use simple language and short sentences to help ensure that your ideas are communicated clearly and effectively.

• Stating a Clear Thesis Statement

Your thesis statement should clearly state your main argument and provide a roadmap for the rest of your essay. It should be clear, concise, and located at the end of your introduction.

• Using Proper Citation and Referencing

Citing and referencing your sources is crucial in any academic writing, including nursing essays. Make sure to use proper citation and referencing styles, such as APA or MLA. Include a reference list or bibliography at the end of your essay.

• Seeking Feedback and Revising

Before submitting your nursing essay, seek feedback from peers, professors, or writing tutors. Use their feedback to revise and improve your essay. Make sure that it is well-structured, coherent, and effectively communicates your point of view.

By following these tips, you can write a nursing essay that demonstrates your knowledge and skills in the field.

In conclusion, writing a successful nursing essay requires careful planning, research, and attention to detail. 

To showcase your knowledge in the field of nursing, it is important to have a clear understanding of the topic at hand. When writing your nursing essay, be sure to include relevant examples, incorporate current research, and use proper citation and referencing. 

And remember , seeking feedback and revising your essay is key to ensuring that it effectively communicates your ideas and arguments.

If you need help with your nursing essay or any other type of academic writing, consider using our AI essay writer . 

Our nursing essay writing service can provide personalized support to help you succeed in your academic goals.

So, why wait? Contact us to get college essay writing help today! 

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Home — Essay Samples — Nursing & Health — Nursing Home — How working at a nursing home can change your perspective of life

How Working at a Nursing Home Can Change Your Perspective of Life

• Categories: Nursing Home

About this sample

Words: 969 |

Published: Jan 4, 2019

Words: 969 | Pages: 2 | 5 min read

Works Cited

• Caffrey, C. (2015). Reasons given by certified nursing assistants for staying in or leaving the nursing home: A qualitative descriptive study. Journal of Nursing Home Research Sciences, 1, 8-15.
• Castle, N. G., Engberg, J., Anderson, R., & Men, A. (2007). Job satisfaction of nurse aides in nursing homes: Intent to leave and turnover. The Gerontologist, 47(2), 193-204.
• Centers for Medicare & Medicaid Services. (2019). Nursing Home Data Compendium 2019 Edition.
• Gruber-Baldini, A. L., Zimmerman, S., Boustani, M., Watson, L. C., Williams, C. S., Reed, P. S., & Sloane, P. D. (2005). Characteristics associated with depression in long-term care residents with dementia. The Gerontologist, 45(Suppl_1), 50-55.
• Harrington, C., Choiniere, J., Goldmann, M., Jacobsen, F. F., Lloyd, L., McGregor, M., & Stamatopoulos, V. (2012). Nursing home staffing standards and staffing levels in six countries. Journal of Nursing Scholarship, 44(1), 88-98.
• Kane, R. L., Lum, T. Y., Cutler, L. J., Degenholtz, H. B., & Yu, T. C. (2007). Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial Green House program. Journal of the American Geriatrics Society, 55(6), 832-839.
• Kelley, S. J. (2007). Providing a therapeutic environment in nursing homes. Journal of Gerontological Nursing, 33(11), 48-55.
• Mor, V., & Wiener, J. M. (2018). Nursing home staffing: Who's minding the residents? Journal of Health Politics, Policy and Law, 43(2), 225-252.
• Zimmerman, S., Shier, V., Saliba, D., & Schnelle, J. F. (2014). Resident outcomes across 2 years in Green House and other small‐home nursing homes compared with traditional nursing homes. Journal of the American Geriatrics Society, 62(12), 2297-2304.
• Zisberg, A., Shadmi, E., Sinoff, G., Gur-Yaish, N., & Srulovici, E. (2011). Secrets of the trade: On the management and organization of nursing work in elderly care. Health Services Research, 46(6pt1), 1770-1789.

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Writing an Outstanding Application Nursing Essay

Embarking on the path to a nursing career involves navigating through various challenges and significant moments, with the nursing application essay standing out as a key component. This essential part of your application transcends mere formality; it presents a special chance for you to highlight your character, commitment, and aptitude for the nursing profession. In this detailed guide, we aim to explore the intricacies of creating a standout nursing application essay. Whether you’re just starting to explore the nursing field or are ready to submit your application, this article is your roadmap to success.

Understanding the Purpose of the Essay

What do nursing schools seek in your essay.

Nursing schools are looking for candidates with the academic qualifications and personal qualities essential for nursing. Your essay should reflect your compassion, empathy, commitment to the profession, and understanding of the nursing role.

The Essay’s Role in Your Application

Your application essay is your voice in the admission process. It’s where you can speak directly to the admissions committee, tell your story, and explain why you are drawn to the nursing field. This essay can be the deciding factor in your application, setting you apart from other candidates.

Preparing to Write

• Research: Aligning with the School’s Values

Prior to beginning your essay, it’s essential to familiarize yourself with the fundamental ideals and beliefs of the nursing school you’re applying to. Spend time browsing their website, absorbing their mission statement, and comprehending their perspective on nursing education. This crucial insight will help you tailor your essay to resonate with the school’s philosophy. This research will help you tailor your essay to resonate with their ethos.

• Self-reflection: Your Nursing Journey

Reflect on your experiences and why you chose nursing. Think about moments in your life that led you to pursue this career. These reflections will help you create an authentic and personal narrative.

• Brainstorming: Crafting Your Story

Take time to brainstorm ideas for your essay. Think about your strengths, experiences, and what aspects of nursing excite you. Make sure to note down these key points; they will be the essential framework for your essay.

Structuring Your Essay

• Introduction: Making a Strong First Impression

The introduction of your essay is your first chance to capture the reader’s attention. Begin with an engaging story, a meaningful personal experience, or a statement that makes the reader think. This approach will offer a window into your personality and highlight your enthusiasm for nursing.

• Body: Building Your Narrative

Organize the body of your essay around a few key experiences or ideas. Each paragraph should focus on a specific aspect of your journey or a particular quality you possess. Use examples from your life to demonstrate your commitment, compassion, and ability to overcome challenges.

• Conclusion: Leaving a Lasting Impression

Your conclusion should wrap up your essay by summarizing the key points and reaffirming your interest and readiness for a nursing career. This is your final chance to remind the admissions committee why you are a suitable candidate.

Writing Tips and Best Practices

• Clarity and Conciseness

Keep your writing clear and concise. Avoid unnecessary jargon and be direct in your storytelling. Remember, the admissions committee reads many essays, so getting your point across quickly is crucial.

• Authenticity: Be Yourself

Your essay should reflect your true self. Don’t try to be someone you’re not. Honesty and sincerity will resonate more than trying to fit a certain mold you think the school wants.

• Using Specific Examples

Provide specific life examples rather than general statements about your passion for nursing. This might include volunteering, personal experiences with healthcare, or moments of inspiration from other nurses.

• Attention to Technical Details

Proofread your essay multiple times for grammar, spelling, and punctuation errors. Also, adhere to the nursing school’s formatting guidelines, such as word count and font size.

Common Mistakes to Avoid

• Steering Clear of Clichés and Generalities

Clichés and overused phrases can make your essay sound generic. Instead, focus on providing unique insights and personal experiences that highlight individuality.

• Directly Answering the Essay Prompt

It’s crucial to stay on topic and answer the essay prompt directly. Deviating from the prompt can lead the admissions committee to question your attention to detail and ability to follow instructions.

• Avoiding Excessive Jargon

Revising and Refining Your Essay

• The Importance of Drafts and Revisions

Your first draft is just the beginning. Be prepared to revise and refine your essay several times. This process helps fine-tune your message and improve the overall flow and clarity.

• Seeking Feedback

Get feedback on your essay from mentors, teachers, or peers. They can provide valuable insights and suggest improvements you might not have considered.

• Final Proofreading

Before submitting your essay, do a thorough proofreading. Check for grammatical errors or typos, and ensure your essay adheres to the specified word limit and formatting requirements.

Crafting your nursing application essay is an opportunity for self-reflection and a chance to convey your zeal for nursing. It’s important to remain authentic, be truthful in your narrative, and allow your sincere passion for nursing to be evident. With careful preparation, thoughtful structure, and attention to detail, your essay can prove your readiness for a nursing career.

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How to Write a Winning Nursing Application Essay

Not everyone dreads writing their nursing application essay. Some consider writing a strong suit. But others definitely don’t. If you fall in the latter category, take heart; submitting a well-crafted, winning essay isn’t as difficult as it may seem.

It may help to keep in mind that a bad essay probably won’t ruin your chances of becoming a nurse. But a good essay could mean the difference between getting accepted into a program of your choice, at a time of your choosing, or not. That’s because admissions personnel often turn to the application essay to differentiate among candidates who might otherwise seem equivalent. A good application essay can set you apart from the pack and help your application stand out.

Of course, if writing were your passion, you’d probably be pursuing a different career. Admissions staff for nursing programs throughout the U.S., including those at the Denver College of Nursing , understand this. In addition to giving you a chance to reveal a bit about yourself and your motivation for becoming a nurse, admissions personnel view the essay as a way to assess skills that go beyond writing ability. For example, it can be a quick way to assess whether you’re capable of following instructions carefully.

Importance of the Nursing Application Essay

The nursing school application essay is an important part of the admissions process. It not only provides insight about an applicant that goes beyond grades and test scores, but also gives the applicant an opportunity to discuss personal and professional aspirations and explain why they’re passionate about becoming a registered nurse (RN).

An application essay provides a glimpse into an applicant’s character and values. It also helps applicants demonstrate their ability to convey thoughts coherently, a vital skill for nurses who must communicate effectively with patients, families, and healthcare teams, among others.  

The admission essay also presents students with an opportunity to highlight unique experiences they’ve had, challenges they’ve overcome, and impactful moments in their lives that have motivated them to pursue a nursing degree. Whether it’s a story about a transformative volunteer experience or a story about how an intensive care unit (ICU) nurse helped care for a family member, these narratives help differentiate candidates by showcasing their potential contributions to the profession.

Writing a compelling nursing school application essay is about more than drafting words onto a page. It’s about crafting a final product that enables admissions counselors to see applicants as more than their GPA, educational history, and academic achievements. It can be an equally important skill for students looking to apply for grants and scholarships to help them pay for nursing school .

Tips for Your Nursing Admission Essay

Writing a nursing school application essay requires finesse and clarity. Below are just a few of the tips students can use to craft an essay they can be proud of.

1. Follow Instructions Carefully

Think of your essay as another type of screening tool. For example, applicants who fail to follow instructions properly are easily weeded out of the pile. This makes sense when you consider the ultimate importance of following instructions and staying on task in nursing school.

Managing your workload, meeting expectations, and making deadlines will be crucial to your success. It’s far too easy to fall behind — and never catch back up — if you don’t practice self-discipline during nursing school.

If the expected length of your nursing application essay isn’t spelled out, assume that you should submit no more than two pages of text. If you’re assigned a specific topic, be sure to address it, even if you only use it as a springboard to launch your essay in a new direction.

2. Don’t Procrastinate

Writing a strong essay may take more time than you realize. Accordingly, it makes sense to allow plenty of time to complete your essay. Unless you’re already an accomplished writer, assume that crafting a polished essay will take considerable time for brainstorming, drafting, editing, and rewriting.

It may be helpful to create an outline first. But try not to overthink it. Writing that comes from the heart — not the head — is often some of the most compelling writing there is. But even heartfelt sentiments require a bit of effort to shine on the page. Clear phrasing and attention to detail matter.

3. Don’t Be Intimidated

The idea of creating an outline and writing one or more drafts can sound daunting, but it doesn’t need to be. A rough draft can simply be a bunch of words strung together that capture your stream of consciousness. It’s OK not to worry about grammar, structure, transitions, or other technical details when writing a rough draft.

Remember, it’s called a rough draft for a reason. The point is to gather your thoughts, ideas, and even feelings, and give them voice. Once you’ve done this, you’ll likely find that making revisions; fixing grammar and spelling errors; and eliminating unclear, unnecessary, or inappropriate words or phrases comes more easily. Writers used to do this by hand. Today’s technology makes it remarkably easy to edit on the fly, and numerous digital proofreading tools are available to help you fine-tune your writing.

4. Make the Essay Yours

Lastly, avoid the obvious, the expected, or the banal. Recognize that there are certain sentiments that virtually every applicant will be tempted to express. Try to avoid the expected and do something a little different. That doesn’t mean you should be different for the sake of being different. But sharing something that other writers haven’t already discussed can be valuable.

Attempt to craft a strong, compelling opening sentence or paragraph. In any piece of writing, it’s important to hook your reader early for optimal impact.

You and your experiences are unique. Take the plunge and dare to bare a bit of your soul and bring some of the emotion that motivates you into your writing. As noted earlier, writing that comes from the heart is invariably more gripping than writing that appears to follow a template. Allow your essay to tell a story: the story of you. But keep it succinct and keep it honest. 

Pursue Your Dream of Becoming a Registered Nurse

Aspiring nurses across the U.S., whether they’re interested in earning an Associate Degree in Nursing (ADN) , a Bachelor of Science in Nursing (BSN) , an RN to BSN , or a Master of Science of Nursing (MSN) , must start their educational journey by applying to an accredited nursing program and crafting a nursing application essay.

Are you ready to take the next step toward your dream of pursuing a nursing job at a hospital, community care clinic, or group medical practice? Discover how completing a nursing degree with the Denver College of Nursing can prepare you for the next step in your career.

Recommended Readings Celebrating Important Women in Medicine and Healthcare Making a Difference in Texas as a Rural Healthcare Safety Net Provider Nurse What Does an OR Nurse Do?  

Sources BigFuture, Tips for Writing an Effective Application Essay  Indeed, Writing an Application Essay for Nursing School Admission IntelyCare, "Tips to Write a Personal Statement for Nursing School” 

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What working in a nursing home taught me about life, death, and America’s cultural values

by Valery Hazanov

The first thing I noticed when I began working in a nursing home was the smell. It's everywhere. A mix of detergent and hospital smell and, well, people in nursing homes wear diapers. It's one of those smells that takes over everything — if you're not used to it, it's hard to think about anything else.

Being in the nursing home is tough. People weep and smell and drool. Sometimes you can go on the floor and hear a woman in her 90s scream, "I want Mommy."

But it's also ordinary — just people living together: gossiping, daydreaming, reading, watching TV, scratching their back when it itches.

For the past eight months I have been working as a psychotherapist with dying patients in nursing homes in New York City. It's an unusual job for a psychotherapist — and the first one I took after graduating with a PhD in clinical psychology. My colleagues were surprised. "Why not a hospital? Or an outpatient clinic? Do the patients even have a psychiatric diagnosis?"

The short answer is that I wanted to see what death looks and feels like — to learn from it. I hope that I can also help someone feel a little less lonely, a little more (is there a measure to it?) reconciled.

I haven't gotten used to the smell yet. But I have been thinking a lot about the nursing home and the people who live and die there, and wanted to share what I learned.

1) At the end, only the important things remain

"This is all I have left," a patient recently told me, pointing to a photograph of himself and his wife.

It made me notice the things people bring to the nursing home. The rooms are usually small, so what people bring is important to them. If they have a family, there will be photos of them (most popular are the photos of grandchildren). There might also be a few cherished books, a get-well-soon card, a painting by a grandchild or a nephew, some clothes, maybe flowers. And that's about it. The world shrinks in the nursing home, and only a few things remain: things that feel important — like they're worth fighting for, while we still can.

2) Having a routine is key to happiness

More on dying well.

It's never too early to start thinking about your own death

I'm a little lazy. My ideal vacation is doing nothing, maybe on a deserted beach somewhere. I look in terror upon very scheduled, very planned people. Yet I have been noticing that doing nothing rarely fills me with joy, while doing something sometimes does. Hence, the conflict: Should I push myself to do things, or should I go with the flow and do things only when I feel like doing them? Being in a nursing home changed my perspective somewhat: I noticed that all the patients who do well follow a routine. Their routines are different but always involve some structure and internal discipline.

I am working with a 94-year-old woman. She wakes up at 6:30 am every day, makes her bed, goes for a stroll with a walker, eats breakfast, exercises in the "rehabilitation room," reads, eats lunch, naps, goes for another walk, drinks tea with a friend, eats dinner, and goes to bed. She has a well-defined routine. She pushes herself to do things, some of which are very difficult for her, without asking herself why it is important to do them. And, I think, this is what keeps her alive — her movement, her pushing, is her life.

Observing her, I have been coming to the conclusion that it might be true for all of us. And I often think about her when I am debating whether to go for a run or not, whether to write for a couple more hours or not, whether to finally get up from the couch and clean my apartment or not — she would do it, I know, so maybe I should, too.

3) Old people have the same range of emotions as everyone else

"You are so handsome. Are you married?" is something I hear only in extended-family gatherings and in nursing homes. People flirt with me there all the time. This has nothing to do with their age or health — but rather with whether they are shy. When we see someone who is in his 90s and is all bent and wrinkled and sits in a wheelchair, we might think he doesn't feel anything except physical pain — especially not any sexual urges. That's not true.

As long as people live, they feel everything. They feel lust and regret and sadness and joy. And denying that, because of our own discomfort, is one of the worst things we can do to old people.

Patients in nursing home gossip ("Did you know that this nurse is married to the social worker?"), flirt, make jokes, cry, feel helpless, complain of boredom. "What does someone in her 80s talk about?" a colleague asked me. "About the same things," I replied, "only with more urgency."

Some people don't get that, and talk to old people as if they were children. "How are we today, Mr. Goldstein?" I heard someone ask in a high-pitched voice of a former history professor in his 80s, and then without waiting for a response added, "Did we poopie this morning?" Yes, we did poopie this morning. But we also remembered a funny story from last night and thought about death and about our grandchildren and about whether we could sleep with you because your neck looks nice.

4) Old people are invisible in American culture

People at the nursing home like to watch TV. It's always on. How strange, then, that there are no old people on TV.

Here's a picture I see every day: It's the middle of the day and there is a cooking show or a talk show on, and the host is in her 50s, let's say, but obviously looks much younger, and her guest is in his 30s or 50s and also looks younger, and they talk in this hyper-enthusiastic voice about how "great!" their dish or their new movie is, or how "sad!" the story they just heard was. Watching them is a room full of pensive people in their 80s and 90s who are not quite sure what all the fuss is about. They don't see themselves there. They don't belong there.

I live in Brooklyn, and I rarely see old people around. I rarely see them in Manhattan, either. When I entered the nursing home for the first time I remember thinking that it feels like a prison or a psychiatric institution: full of people who are outside of society, rarely seen on the street. In other cultures, old people are esteemed and valued, and you see them around. In this manic, death-denying culture we live in, there seems to be little place for a melancholic outlook from someone that doesn't look "young!" and "great!" but might know something about life that we don't.

There isn't one Big Truth about life that the patients in the nursing home told me that I can report back; it's a certain perspective, a combination of all the small things. Things like this, which a patient in her 80s told me while we were looking outside: "Valery, one day you will be my age, God willing, and you will sit here, where I sit now, and you will look out of the window, as I do now. And you want to do that without regret and envy; you want to just look out at the world outside and be okay with not being a part of it anymore."

5) The only distraction from pain is spiritual

Some people in the nursing home talk about their physical pain all the time; others don't. They talk about other things instead, and it's rarely a sign of whether they are in pain or not.

Here's my theory: If for most of your life you are concerned with the mundane (which, think about it, always involves personal comfort) then when you get old and feel a lot of pain, that's going to be the only thing you're going to think about. It's like a muscle — you developed the mundane muscle and not the other one.

And you can't start developing the spiritual muscle when you're old. If you didn't really care about anything outside of yourself (like books, or sports, or your brother, or what is a moral life), you're not going to start when you're old and in terrible pain. Your terrible pain will be the only thing on your mind.

But if you have developed the spiritual muscle — not me, not my immediate comfort — you'll be fine; it will work. I have a couple of patients in their 90s who really care about baseball — they worried whether the Mets were going to make the playoffs this year, so they rarely talked about anything else; or a patient who is concerned about the future of the Jewish diaspora and talks about it most of our sessions; or a patient who was worried that not going to a Thanksgiving dinner because of her anxieties about her "inappropriately old" appearance was actually a selfish act that was not fair to her sister. Concerns like these make physical pain more bearable, maybe because they make it less important.

6) If you don't have kids, getting old is tough

The decision to have kids is personal, and consists of so many factors: financial, medical, moral, and so on. There are no rights or wrongs here, obviously. But when we are really old and drooling and wearing a diaper, and it's physically unpleasant to look at our wounds or to smell us, the only people who might be there consistently, when we need them, are going to be either paid to do so (which is okay but not ideal) or our children. A dedicated nephew might come from time to time. An old friend will visit.

But chances are that our siblings will be very old by then, and our parents will be dead, which leaves only children to be there when we need it. Think about it when you are considering whether to have children. The saddest people I see in the nursing home are childless.

7) Think about how you want to die

José Arcadio Buendía in One Hundred Years of Solitude dies under a tree in his own backyard. That's a pretty great death.

People die in different ways in the nursing home. Some with regrets; others in peace. Some cling to the last drops of life; others give way. Some planned their deaths and prepared for them — making their deaths meaningful, not random. A woman in her 90s recently told me, "Trees die standing tall." This is how she wants to go: standing, not crawling.

I think of death as a tour guide to my life — "Look here; pay attention to this!" the guide tells me. Maybe not the most cheerful one, slightly overweight and irritated, but certainly one who knows a lot and can point to the important things while avoiding the popular, touristy stuff. He can tell me that if I want to die under a tree in my backyard, for example, it might make sense to live in a house with a backyard and a tree. To you, he will say that if you don't want any extra procedures done to you at the end, it might make sense to talk about it with the people who will eventually make this decision. That if you want to die while hang-gliding over an ocean, then, who knows, maybe that's also possible.

My father, who has spent the past 30 years working in an ICU as a cardiologist and has seen many deaths, once told me that if he had to choose, he would choose dying well over living well — the misery of a terrible, regretful death feels worse to him than a misery of a terrible life, but a peaceful death feels like the ultimate reward. I think I am beginning to see his point.

I am 33. Sometimes it feels like a lot — close to the end; sometimes, it doesn't. Depends on the day, I guess. And like all of us, including the people in the nursing home, I am figuring things out, trying to do my best with the time I have. To not waste it.

Recently, I had a session with a woman in her 90s who has not been feeling well.

"It's going in a very clear direction," she told me. "Toward the end."

"It's true for all of us," I replied.

"No, sweetheart. There is a big difference: You have much more time."

Valery Hazanov, PhD , is a clinical psychologist in Brooklyn. He is writing a book about his training to become a psychotherapist.

First Person is Vox's home for compelling, provocative narrative essays. Do you have a story to share? Read our submission guidelines , and pitch us at [email protected] .

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Appropriate leadership in nursing home care: a narrative review

Nick zonneveld.

1 Tilburg University, TIAS School for Business and Society, Tilburg, The Netherlands, and Vilans, National Centre of Expertise in Long Term Care, Utrecht, The Netherlands

Carina Pittens

2 Vrije Universiteit, Athena Institute, Amsterdam, The Netherlands

Mirella Minkman

3 Tilburg University, TIAS School for Business and Society, Tilburg, The Netherlands, and Vilans, National Centre of Expertise in Long Term Care, Utrecht, The Netherlands

The purpose of this paper is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors.

Design/methodology/approach

A narrative review was performed in three steps: the establishment of scope, systematic search in five databases and assessment and analysis of the literature identified.

A total of 44 articles were included in the review. The results of the study imply that a stronger focus on leadership behaviors related to the specific context rather than leadership styles could be of added value in nursing home care.

Research limitations/implications

Only articles applicable to nursing home care were included. The definition of “nursing home care” may differ between countries. This study only focused on the academic literature. Future research should focus on strategies and methods for the translation of leadership into behavior in practice.

Practical implications

A broader and more conceptual perspective on leadership in nursing homes – in which leadership is seen as an attribute of all employees and enacted in multiple layers of the organization – could support leadership practice.

Originality/value

Leadership is considered an important element in the delivery of good quality nursing home care. This study provides insight into leadership behaviors and influencing contextual factors specifically in nursing homes.

1. Background

Leadership is seen as essential for the creation of cultural and structural change within organizations and the delivery of good quality nursing home care ( Anderson et al. , 2005 ; Martin and Learmonth, 2012 ). Various studies confirm that leadership affects e.g. business management, information flows, health-related quality indicators, long-term vision, organizational structure, organizational culture, work environment and quality of care in nursing homes ( Anderson et al. , 2005 ; Castle and Decker, 2011 ; Cummings et al. , 2010 ; Jeon et al. , 2015 ). Therefore, more insight is needed into how leadership should look to contribute to organizational and cultural change in nursing home care.

Leadership can be defined as “a process whereby individual influences a group of individuals to achieve a common goal” ( Hunt, 2004 , p. 3). Based on a review of leadership literature, Hunt (2004) distinguishes four common features of leadership. Leadership: is a process, involves influence, occurs in a group context and involves goal attainment. Leadership theory still divides leadership styles into two main groups: relationship-oriented leadership styles and task-oriented leadership styles. While relationship-oriented leadership focuses on individual persons and relationships, task-oriented leadership aims at the accomplishment of tasks. This division could also be interpreted as transformational leadership and transactional leadership ( Avolio et al. , 1999 ). Transformational leadership is reflected in a process, in which a leader connects with his/her followers, with the aim of increasing intrinsic motivation to enhance performance. The driving force is a shared vision. Transactional leadership is a more top-down style, focusing on transactions between the leader and followers. There are clear structures, rules and procedures and the extrinsic motivation of employees is addressed ( Avolio et al. , 1999 ). An example of transactional leadership is giving a personal reward for employees that achieve a certain goal, like a financial bonus. In our study, the two main streams of transformational and transactional leadership are used as an ordering framework, supplemented with a contingency approach category: context-dependent leadership styles. These styles assume that there is no universal leadership style and that different contexts and circumstances require different leadership styles ( Northouse, 2018 ).

Various publications have been written about leadership in nursing home care. In most of these studies relational and transformative-related leadership styles are considered to be most appropriate in a nursing home and aged care ( Anderson et al. , 2005 ; Corazzini et al. , 2015 ; Jeon et al. , 2015 ). The focus of most studies is the relationship between particular leadership styles and desired outcomes rather than understanding the behaviors and context behind them. However, as leadership is a process that takes place between people ( Hunt, 2004 ), it consists of many components and influencing factors. It could also take place at multiple places in an organization, both formally and informally. The relationship between how leadership is executed and the outcomes achieved are, therefore, not simple or linear ( Northouse, 2018 ). Therefore, more in-depth knowledge is required regarding leadership behaviors, the effects and the factors influencing them.

This study aims to provide a deeper understanding of what leadership is appropriate in nursing home care, also considering the changing context. To this end, various leadership behaviors, their effects and their influencing factors are examined by performing a narrative literature review with a systematic search.

The objective of this study is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors. A narrative review with a systematic search was conducted, drawing on the principles of hermeneutic review ( Boell and Cecez-Kecmanovic, 2014 ). A hermeneutic review has two main characteristics:

• accessing and interpreting the literature and
• developing an argument.

The literature search is not only systematic but also flexible and iterative. As the identified literature increases, initial insights and ideas arise and less relevant literature could be rejected through progressive focus. It is argued elsewhere that a narrative review like a hermeneutic review should be the method of choice for interpreting a large and diverse set of literature in which authors have approached the topic differently ( Greenhalgh et al. , 2018 ), as is the objective of our literature review. The review was executed in three steps: definition of scope, systematic search and assessment and analysis of the literature identified. To structure these three steps, a search protocol was developed beforehand.

2.1. Step 1: Establishment of scope

Definition of the search area included the formulation of a set of inclusion criteria. Manuscripts were included if they:

• studied leadership;
• targeted long-term care, nursing home/facility care or elderly care and were thereby applicable to the current nursing home care context;
• behavioral characteristics of leadership;
• effects of leadership; and/or
• factors influencing leadership;
• were published between 2007 and December 2019 (because of the rapidly changing context);
• were written in English; and
• presented research findings of empirical work or reviews.

The search terms were developed through an iterative process in which three researchers were involved. Based on the two main elements of the study objectives – leadership and nursing home care – multiple search terms and combinations were explored in two databases (Pubmed/Medline and EBSCO).

2.2. Step 2: Systematic search

Using the terms described, systematic searches were performed in the PubMed/Medline, Cochrane, Cinahl, PsycInfo and Google Scholar databases. The snowballing technique was also applied: i.e. the reference lists of all articles included were studied to identify any additional relevant literature. After identifying all potentially relevant literature, assessment and analysis of the articles took place.

2.3. Step 3: Assessment and analysis of the literature identified

Assessment and analysis of the literature took place in three steps: the articles were screened based on the title, abstract and full-text to determine inclusion, data extraction took place and analysis was carried out on the articles that had been included.

• Screening on the title, abstract and full-text: All titles and abstracts were screened independently by two researchers to decide whether articles met the inclusion criteria. If the two researchers assessed the article differently, a third researcher was consulted. The full-text of the selected articles was then independently assessed for eligibility by two researchers. Again, a third researcher was consulted if there was any disagreement. For this, the principles of the hermeneutic review were applied, meaning that the inclusion of articles in a later stage (for instance, full-text screening) was stricter due to progressive insights.
• Data extraction: Two types of data were extracted from the articles. First, for each article the author(s), year of publication, journal, title, country, study design and applied methods, sector and organizational level were noted. Second, the main findings of the articles were extracted. The data extraction took place by two researchers, supervised by a third researcher. A fourth researcher was consulted if there was any disagreement.
• Analysis: Descriptive analysis was chosen, as a large and diverse set of articles was included in which leadership was approached and studied differently. As the aim was to build an understanding of leadership, the analysis focused on interpreting the findings of the articles included. Reflection on the content analysis took place with a fourth researcher.

The systematic database search resulted in the identification of 2,332 scientific articles. After removal of duplicates, 2,031 records were screened on title and abstract, based on the formulated inclusion criteria. After this screening 76 scientific articles remained for full-text assessment. During the full-text screening, 36 papers were excluded due to the following reasons: no focus on leadership ( n  =   20), not applicable to the nursing home care context ( n  =   3), leadership only focuses on external stakeholders ( n  =   2), articles report only opinions or vision ( n  =   6), no full text available ( n =  3) and no focus on the interaction between leaders and professionals ( n  =   2). As a result of the “snowballing” technique, 3 extra scientific articles were included. This resulted in a total of 44 included articles. Figure 1 shows the PRISMA flow chart, which displays the systematic literature search process. Table 1 presents the characteristics of the articles, including an overview of study design: 17 qualitative, 16 quantitative, 4 mixed methods and 7 (systematic) reviews were included.

PRISMA flow chart

Characteristics of the articles included

3.1. Leadership behaviors

The articles included in this review describe many sorts of leadership behaviors. In most articles, the studied set of leadership behaviors is given a name/title/term such as “partnered leadership,” “connective leadership” and “adaptive leadership.” In the articles, they are often connected to one of the main leadership styles. Descriptions of leadership behaviors identified are, therefore, distributed over three main categories: relationship-oriented leadership, task-oriented leadership and context-dependent leadership.

Especially more recent articles move away from leadership styles and focus more on behaviors essential for new developments in nursing homes. In the articles of Brodtkorb et al. (2019) and Backman et al. (2018) , important leadership characteristics were identified to support the implementation of person-centered care. Havig and Hollister (2018) focused on the interplay of independent workgroups (resembling self-organization) and appropriate supportive leadership.

3.1.1. Relationship-oriented leadership behavior.

In total, 15 different sorts of leaderships related to relationship-oriented leadership were identified in 34 articles. Transformational leadership was studied the most ( n  =   16), followed by relational leadership ( n  =   7) and the resonant, coaching, consensus and consultative autocratic behavioral styles ( n  =   3). Although “partnered leadership” ( Jennings et al. , 2011 ; Leutz et al. , 2010 ), “individualized consideration” ( Cummings et al. , 2010 ), “authentic leadership” ( Hakanson et al. , 2014 ) and “connective leadership” ( Jennings et al. , 2011 ) were also mentioned as research objectives, no outcomes regarding these behaviors were given in the articles.

When looking more closely at behaviors, the leadership types identified shows a lot of overlap. In relationship-oriented leadership behaviors identified, leaders focus on relationships, using emotional skills such as listening and empathy, to increase the involvement of employees ( Cummings et al. , 2008 ; Forbes-Thompson et al. , 2007 ; Havig et al. , 2011 ; Havig et al. , 2011 ; Jeon et al. , 2015 ). As Havig et al. (2011) describe: “relationship-oriented style constitutes the behaviors of supporting […], developing […] and recognizing” ( Havig et al. , 2011 , p. 2). Transformational leadership aims to create awareness and involvement of employees in line with the objectives of the organization ( Nielsen et al. , 2010 ).

3.1.2. Task-oriented leadership behaviors.

Task-oriented leadership behaviors were studied less extensively. Furthermore, they were often contrasted with relationship-oriented leadership behaviors. In total 9 task-oriented types of leadership were mentioned as study objectives in 9 of the articles included in the review. In most of the articles, no specific characteristics were described.

The similarity between task-oriented and transactional leadership behavior is that it is rational, concise and business-like. Task-oriented leadership deals with the management of tasks and activities (who does what, when and how), distribution of roles, objectives, monitoring and results ( Havig et al. , 2011 ; Havig et al. , 2011 ). Transactional leadership takes transactions between leaders and employees as a starting point ( Cummings et al. , 2010 ). In terms of behavior, this is reflected in rewarding and “punishing” employees. “Shareholder management” is characterized by behavior in which minimal attention is paid to the development of relationships between people ( Havig et al. , 2011 ). Employees work relatively autonomously, there is not much communication and decisions are made centrally. Autocratic leaders also make their own decision, but their employees face a relatively low amount of autonomy ( Castle and Decker, 2011 ; Donoghue and Castle, 2009 ; Havig et al. , 2011 ).

3.1.3. Context-dependent leadership behaviors.

Although the studies in this review focus predominantly on relationship-oriented leadership behaviors, the literature also recommends interpreting with caution. Various studies emphasize that leadership is a complex phenomenon that depends on situations and individuals ( Jennings et al. , 2011 ). Some of the articles conclude that a combination of leadership behaviors is needed. Havig et al. (2011) conclude that a combination of both relationship-oriented and task-oriented leadership behaviors is preferred in their study of job satisfaction in nursing homes ( Havig et al. , 2011 ). Nursing homes with a more hierarchical structure and more mutual interdependence could benefit from task-oriented leadership and vice versa. The authors conclude that leadership is context-dependent. Jennings et al. (2011) state:

The strongest statement that can be made based on empirical studies is that it is unwise to view transformational leadership as a preferred style, particularly when this style is assessed independently of other leadership styles and organizational variables ( Jennings et al. , 2011 , p. 15).

Some leadership behaviors identified in this review embrace this context-dependency and represent a combination of leadership behaviors. Lynch et al. (2011) describe the application of situational leadership to residential care. This is characterized by multiple behaviors of a leader, depending on the situation and the individual. Corazzini and colleagues focus on “adaptive leadership,” which makes a distinction between technical and adaptive challenges ( Corazzini et al. , 2015 ; Corazzini and Anderson, 2013 ). In this context, technical challenges refer to issues that can be easily defined and solved with the appropriate expertise or resources. Adaptive challenges, on the other hand, require new and innovative solutions which may also require a change in values or attitudes. Issues often include both technical and adaptive challenges, in which different leadership behaviors are needed ( Corazzini et al. , 2015 ; Corazzini and Anderson, 2013 ).

Both situational and adaptive leadership is built on the belief that appropriate leadership behaviors should be chosen based on situation and context ( Corazzini and Anderson, 2013 ; Lynch et al. , 2011 , 2018 ). Situational leaders exhibit leadership behavior, which fits with a particular situation and adapts this behavior accordingly to achieve results in a planned way. Central to adaptive leadership, which has roots in complexity theory, is the belief that there are no fixed solutions for complex issues. The behavior of adaptive leaders can, therefore, be characterized as highly flexible and adaptive, to cope with (sudden) changes and developments in complex environments ( Table 2 ).

Leadership styles and their associated characteristics and behaviors

3.2. Reported effects of leadership

In 38 articles effects of leadership were described. The effects of leadership were measured quantitatively in 15 of the articles identified. In 4 articles effects were studied using mixed-methods, in 13 articles effects were measured using qualitative methods and effects were described in 6 reviews. The described effects in the qualitative articles are less “hard” and were not taken into consideration in the table. Reported effects can be separated into five categories: the effects of leadership on:

• quality of care;
• quality of life;
• person-centered care; and
• innovation processes.

Table 3 presents the effects studied in these articles.

Reported effects of leadership

Most studies report that relationship-oriented leadership has a positive impact on employees. Relationship-oriented leadership leads to higher job satisfaction ( Cummings et al. , 2010 ; Donoghue and Castle, 2009 ; Havig et al. , 2011 ; Nielsen et al. , 2010 ), a better relationship with work (for example, a higher organizational commitment) ( Cummings et al. , 2010 ; Donoghue and Castle, 2009 ; Lundgren et al. , 2016 ; Nielsen et al. , 2010 ), higher productivity and effectiveness ( Buljac-Samardzic and van Woerkom, 2015 ; Cummings et al. , 2010 ) and more empowerment and development opportunities ( Cummings et al. , 2014 , 2010 ; Lundgren et al. , 2016 ; Nielsen et al. , 2008 ). Among the articles is one systematic review ( Cummings et al. , 2010 ), in which 53 articles are studied. This study concludes that relationship-oriented leadership is more likely to have positive effects on employees.

In 11 of the articles, the relationship between leadership and quality of care was studied. In these articles, different effects were observed. In four articles no effects were found ( Jeon et al. , 2015 ; Marotta, 2010 ; Olinger, 2010 ; Westerberg and Tafvelin, 2014 ). Four papers conclude that relationship-oriented leadership results in a higher quality of care ( Castle and Decker, 2011 ; Harvath et al. , 2008 ; McKinney et al. , 2016 ; Westerberg and Tafvelin, 2014 ), while in one article it is concluded that a combination of task-oriented and relationship-oriented leadership leads to a higher quality of care (with the emphasis on task-oriented leadership) ( Jennings et al. , 2011 ). Based on their study in Sweden, Westerberg and Tafvelin (2014) present an indirect positive relationship between transformational leadership and quality of care, via mediating variables such as organizational support, support by experienced colleagues, workload and control ( Westerberg and Tafvelin, 2014 ). In all articles quality of care is either not defined consistently or not defined at all. One article studied the impact of leadership on quality of life in the USA. McKinney et al. (2016) report that consensus leadership behavior is “associated with a lower likelihood of deficiencies for quality of life” ( McKinney et al. , 2016 , p. 230).

Furthermore, in three articles a relationship between leadership and person-centered care is described ( Backman et al. , 2016 ; Brodtkorb et al. , 2019 ; Lynch et al. , 2011 ). Backman et al. (2016) for instance conclude that there is a significant relationship between the leadership behavior (of older managers) and person-centered care and psychosocial climate. In this Swedish study, the most appropriate type of leadership and the associated behavior is not specified. Concerning the implementation of person-centered care, Backman et al. (2016) mention “Person-centered care moderates the relationship between leadership behavior” ( Backman et al. , 2016 , p. 8). The authors conclude that leadership is more important in organizations that offer less person-centered care. In these organizations, leaders need to provide direction toward a more person-centered way of working. In line with this, Brodtkorb et al. (2019) revealed: “a close connection between leadership style [participative leadership] and culture change processes toward PCC” ( Brodtkorb et al. , 2019 , p. 134).

On the other hand, a number of studies present contrasting findings or caveats (weak or even no evidence) with respect to the positive effects of relationship-oriented leadership ( Harvath et al. , 2008 ; Havig et al. , 2011 ; Jennings et al. , 2011 ; Jeon et al. , 2015 ; Marotta, 2010 ; Olinger, 2010 ). In a Norwegian study, Havig et al. (2011) report that task-oriented leadership has a more significant impact on the job satisfaction of employees. Also, Jennings et al. (2011) conclude that there is little empirical evidence to relate impacts to certain leadership because leadership is multidimensional and complex: leaders use combinations of leadership behaviors and styles in practice. Olinger (2010) found no statistical significance for nursing home administrator and nursing director leadership styles on care quality.

3.3. Factors influencing leadership

Out of all articles included in this review, 22 articles describe factors that could influence leadership. The influencing factors were identified at three levels: the leader, the team(s) and the organization. Table 4 presents these factors.

Factors influencing leadership

A number of influencing factors – found in seven articles – can be related to the leader him/herself: personal characteristics of the leader ( Cummings et al. , 2008 , 2014 ; Nielsen and Cleal, 2011 ), leadership competencies ( Cummings et al. , 2008 ), educational activities ( Cummings et al. , 2008 ; Hakanson et al. , 2014 ; Vesterinen et al. , 2009 ) and distance to practice ( Havig and Hollister, 2018 ; Kristiansen et al. , 2016 ). The systematic review by Cummings et al. (2008) provides particular insight into the influence of these factors on relational leadership. Cummings et al. state that the personal characteristics of effective leaders relate to openness, extraversion and management motivation. “Significant positive relationships were reported between the leaders’ motivation and their leadership behaviors.” ( Cummings et al. , 2008 , p. 244). Education of leaders, both in relation to professional knowledge and to leadership skills, is mentioned as a positive influencing factor in three articles ( Cummings et al. , 2008 ; Hakanson et al. , 2014 ; Vesterinen et al. , 2009 ). In a Swedish case study, Hakanson et al. (2014) found that leaders identify their own shortcomings and needs for personal development by following educational activities. The specific content of the different educational activities or programs were not described in the articles. A distance to practice was found to be a constraining factor ( Havig and Hollister, 2018 ; Kristiansen et al. , 2016 ). As illustrated by Havig and Hollister (2018) :

They also spent less time at the ward and did not have the same knowledge about their employees’ work situation as the leaders in the high-quality wards. The result of this lack of leadership was often poor work environments, with interpersonal conflicts and frustration, which distracted the care workers and turned their focus away from their daily work duties and the residents ( Havig and Hollister, 2018 , p. 379).

Ten studies showed that team-related factors could influence leadership:

• turnover and absence ( Cloutier et al. , 2016 ; Havig et al. , 2011 );
• interpersonal relations ( Corazzini et al. , 2015 ; Havig and Hollister, 2018 );
• workload ( Corazzini et al. , 2015 ; Westerberg and Tafvelin, 2014 );
• willingness to be coached ( Cummings et al. , 2014 ; Havig et al. , 2011 );
• employee well-being and satisfaction ( Cummings et al. , 2014 ; Nielsen et al. , 2008 );
• self-efficacy ( Nielsen et al. , 2009 ; Nielsen and Munir, 2009 ); and
• interdependent workgroups ( Havig and Hollister, 2018 ).

Two articles relate a high turnover and/or absence rate of employees to less effective leadership ( Cloutier et al. , 2016 ; Havig et al. , 2011 ). In a Western Canadian case study, Cloutier et al. (2016) report that “With greater staff mobility and change, the leadership had less knowledge of their staff to mobilize existing skill sets, use the expertise and build cohesion” ( Cloutier et al. , 2016 , p. 12). Close interpersonal relations – staff/staff, leader/staff and staff/resident – were found to be positively related to leadership ( Corazzini et al. , 2015 ; Havig and Hollister, 2018 ). In turn, a high workload was negatively related ( Corazzini et al. , 2015 ; Westerberg and Tafvelin, 2014 ). Also, the (un)willingness of teams to be coached was mentioned as an influencing factor ( Cummings et al. , 2014 ; Nielsen et al. , 2008 ). Cummings et al. illustrate this as follows:

“Some managers reported out that some of their staff have little interest in learning new things and updating their skills and knowledge,” as per the following quote: “They just want to do their job and go home.” […] A manager, who considered coaching uninterested staff to be undesirable, reported: “Not wanting to rock the boat (don’t have time to risk losing that staff)” ( Cummings et al. , 2014 , p. 205).

Furthermore, employee well-being and satisfaction were stated as potential influencers of leadership. Although there is limited evidence of the direct relationship between leadership behavior and well-being ( Nielsen et al. , 2008 ), two articles mention that a higher level of job satisfaction corresponds to more effective leadership ( Cummings et al. , 2014 ; Nielsen et al. , 2008 ). Finally, Havig and Hollister (2018) found that independent workgroups (or teams) of caregivers, which had their own meetings, reports and administrator, could have a possible influence on nursing home quality. Their analysis revealed that workgroups were fostered by three mediators, namely, psychological ownership, perceived insider status and shared mental models.

In total, 20 articles described factors that influence leadership at an organizational level. The following factors were identified in this category:

• organizational structure ( Corazzini et al. , 2015 ; Cummings et al. , 2008 , 2014 ; Lundgren et al. , 2016 ; Rokstad et al. , 2015 );
• the extent to which person-centered care has been implemented ( Backman et al. , 2016 , 2020 );
• organizational culture ( Ali and Terry, 2017 ; Backman et al. , 2020 ; Corazzini et al. , 2015 ; Havig and Hollister, 2018 ; Jeon et al. , 2010 ; Nielsen et al. , 2008 ; Vesterinen et al. , 2009 );
• the available information and information flow ( Forbes-Thompson et al. , 2007 ; Hakanson et al. , 2014 ; Jeon et al. , 2010 ; Vesterinen et al. , 2009 );
• previous leaders ( Vesterinen et al. , 2009 );
• available budget and time ( Ali and Terry, 2017 ; Cummings et al. , 2014 ; Hakanson et al. , 2014 ; Nielsen et al. , 2010 ; Rokstad et al. , 2015 );
• tasks and responsibilities ( Hakanson et al. , 2014 ; Jeon et al. , 2010 ; Kristiansen et al. , 2016 ; Nielsen et al. , 2008 );
• the leadership team ( Hakanson et al. , 2014 ; Vesterinen et al. , 2009 );
• organizational dynamics and stability ( Jeon et al. , 2010 ; Nielsen et al. , 2010 ; Nielsen and Cleal, 2011 );
• support from superiors ( Jeon et al. , 2010 ; Westerberg and Tafvelin, 2014 ); and
• openness to change and innovations ( Brodtkorb et al. , 2019 ; Jeon et al. , 2010 ; Lynch et al. , 2011 ; Nielsen et al. , 2008 ).

First, the structure of an organization was found to influence the way in which leadership is performed. In bigger organizations, for instance, there is often more distance between managers and the work floor than in smaller organizations and this creates challenges to performing direct, relational leadership ( Lundgren et al. , 2016 ; Rokstad et al. , 2015 ). As Lundgren et al. state:

Physical distance between leaders and subordinates reduces the opportunity for leaders to supervise, organize and optimize nursing assistants’ work situations, which may have negative effects in the field of home help services ( Lundgren et al. , 2016 , p. 51).

In a Finnish qualitative study, Vesterinen et al. (2009) report that organizational culture and information available for employees influence leadership:

The managers said that their leadership style was influenced by the flow of information in the organization. It was difficult to lead others toward a vision when there was a lack of information ( Vesterinen et al. , 2009 , p. 508).

Other influencing factors include tasks and responsibilities of leaders ( Hakanson et al. , 2014 ; Kristiansen et al. , 2016 ) and available budget and time. Although they emphasize that leadership depends on situations and people, Nielsen and Cleal (2011) relate a stable organization (low staff turnover, financially stable, no reorganizations) positively to (transformational) leadership.

4. Discussion

As a result of analysis of the academic literature currently available, the findings of this study provide insight into leadership behaviors, their effects and factors influencing them. When looking into what kind of leadership is considered appropriate in the nursing home care context, also considering its current developments, our analysis does not provide an unambiguous answer. Our review shows that leadership in nursing home care is a complex and multidimensional undertaking, influenced by multiple internal and external factors. On the one hand, there is a tendency toward relationship-oriented and transformational leadership in particular. Our search identified 15 different sorts of leadership related to relational leadership with many reported positive effects on health-care professionals, quality of care, quality of life and person-centered care. However, a diversity of measures was used, with a variety in quality. Both quantitatively and qualitatively observed effects were considered. On the other hand, contrasting findings have also been reported, for example, both positive and negative effects on job satisfaction associated with task-oriented leadership ( Cummings et al. , 2010 ; Havig et al. , 2011 ). Also, various studies emphasized that “good” leadership cannot be achieved by applying only one type of leadership behavior. Both relationship-oriented and task-oriented leadership have resulted in positive effects, as demonstrated by the evaluation of job satisfaction in nursing homes ( Havig et al. , 2011 ). Furthermore, as a broad scope was used to comprehensively identify insights applicable in nursing home care, the studies compared in this review were carried out in different contexts (for example, nursing homes, long-term care, facility care, etc.) in different countries using different methodologies. For example, in the studies included in which a relationship between leadership and quality of care was reported, different definitions of quality of care were used and there was no differentiation between specific aspects of quality of care ( Castle and Decker, 2011 ; Havig et al. , 2011 ; Marotta, 2010 ; McKinney et al. , 2016 ; Olinger, 2010 ; Westerberg and Tafvelin, 2014 ). Therefore, it is also difficult to interpret and compare the results of these studies. This makes it hard to draw any meaningful conclusions about the effects of certain leadership. Another complicating factor in the identification of appropriate leadership is that leadership is a product of multiple influencing factors. Our review identified 22 influencing factors at the individual, team and organizational levels. This shows that leadership in nursing home care is not only complex and multidimensional but may also be influenced by internal and external factors. As a consequence, when looking for appropriate leadership, the answer does not lie in one type of leadership.

This observation is also reflected in some of the articles included in the review. Although a relationship-oriented style was the basis for investigation in most of the studies analyzed, some of them report that certain contexts and situations demand more task-oriented behaviors. Furthermore, literature also shows that the combination of both styles may be appropriate. A balanced mix of leadership styles, for instance, a relationship-oriented focus combined with task-oriented behaviors, is also advocated in other sectors outside nursing home care. Mintzberg (2009) , for example, cites the broad variety of leadership styles in the literature and emphasizes that the application of one style may lead to management that is not in balance ( Mintzberg, 2009 ). Furthermore, in their study on leadership patterns and their effects on employee satisfaction and commitment, Gavan O’Shea et al. (2009) conclude that effective leaders use a combination of styles ( Gavan O’Shea et al. , 2009 ). This was also the conclusion reached by Aarons (2006) specifically with respect to the mental health sector ( Aarons, 2006 ).

While our analysis shows a tendency in favor of combinations of elements from different types of leadership to deal with different situations and contexts, many included studies explore relationships between relational and task-oriented leadership only in a bivariate way. As Cummings et al. (2010) conclude:

In our analyzes, we had simplified the pattern of two approaches to leadership styles and their impact on specific outcomes for nurses, the nursing environment and the nursing workforce. In reality, leadership practices, behaviors and styles and outcomes are not that clean-cut ( Cummings et al. , 2010 , p. 17).

This awareness demonstrates that a greater focus on leadership behaviors in relation to contextual factors rather than leadership styles could provide more valuable insight into appropriate leadership in nursing home care. In most of the literature reviewed, however, leadership behavior is not described or explained precisely. Fortunately, more recent literature is moving away from studying solely leadership styles and is focusing more on appropriate leadership behavior for new developments, like the implementation of Dementia Care Mapping and person-centered care ( Backman et al. , 2020 ; Lynch et al. , 2018 ; Quasdorf and Bartholomeyczik, 2019 ).

Another point worthy of reflection is that the results of our study show a broad variety of leadership terms, styles and names and a large degree of overlap between their characteristics. This is especially the case in the field of relationship-oriented leadership. It is debatable whether these different definitions of leadership really encompass different behaviors or only use different terminology.

Considering that a focus on leadership behaviors could provide more insight into effective leadership in nursing home care, it is interesting to ask what leadership behaviors will be appropriate with respect to the current developments in nursing home care. First of all, the nursing home care sector could be considered as a complex adaptive system (CAS), in which the connected elements of the system evolve and adapt continuously ( Meadows, 2008 ). The current developments, with tendencies toward decentralization, self-organization and person-centered care, are examples of this evolving and adapting system. While the nursing home care sector consists of many different entities and a high level of interactivity, nursing homes can also be considered as systems in which organizational dynamics take place ( Ashmos et al. , 2000 ). The consequence of leadership behavior is that it is important to be aware that employees are part of a complex system, both in the organization and in the health system as a whole. As complexity scientists ( Lichtenstein et al. , 2006 ) reflect: “leadership is a dynamic that transcends the capabilities of individuals alone; it is the product of interaction, tension and exchange rules governing changes in perceptions and understanding.” ( Lichtenstein et al. , 2006 , p. 2). In this complex environment, it is important to reflect continuously and analyze the suitability of leadership behaviors in different contexts and situations. Corazzini et al. (2015) elaborate on this in their study about adaptive leadership and they conclude that problems in nursing homes are mostly complex and cannot be solved by one type of leader.

Furthermore, current developments toward flat organizations, decentralization and self-direction, show a tendency toward more collective responsibility and ownership at all layers of organizations. Most papers included in this review addressed a specific organizational level. A number of studies focus on leadership in middle management ( Buljac-Samardzic and van Woerkom, 2015 ; Corazzini and Anderson, 2013 ; Hakanson et al. , 2014 ; Leutz et al. , 2010 ; Nielsen et al. , 2010 ; Nielsen and Cleal, 2011 ; Oldenhof et al. , 2016 ; Vesterinen et al. , 2009 ) and only one article is specifically taking independent workgroups (teams) into account ( Havig and Hollister, 2018 ). Other articles cover board/management level and some do not focus on a specific organizational level. In the light of current developments in nursing home care, taking new organizational structures with decentralized collective responsibilities such as self-directed teams, into account, a focus on leadership across multiple layers of nursing homes would provide more detailed insights into leadership behaviors and the complex interaction between people and situations. It is striking that the current review did only identify one article that focused specifically on these issues.

4.1. Research limitations and implications

The literature review was carried out in a structured and systematic way. Six systematic reviews were used in this study, which included 255 articles in total (including several studies published before January 1, 2007). This provided a strong theoretical basis, including insights into a broader context. Because the leadership literature is extensive, only articles applicable to nursing home care were included. On the one hand, the current tendencies and insights in leadership literature are well represented in the literature applicable to nursing home care. On the other hand, the leadership literature in this sector is still relatively new. This may yield articles that take an exploratory approach. Also, the definition of “nursing home care” may differ between countries as will the services or care which are captured under this term. Furthermore, relevant insights in nursing home care are often shared in non-academic documents or grey literature. This study only focused on the academic literature. This “publication delay” could explain that literature on relatively new leadership-related tendencies such as self-organization, self-management and autonomous teams, was not available.

The results of this study show that a broad range of leadership behaviors is evident in nursing home care. Further investigation of behaviors that match particular contexts or situations would be relevant. The behaviors identified in this review provide insight into leadership in nursing home care, but more research is needed on how this is reflected in practice. Characteristics such as involvement and appreciation mainly focus on the result of leadership behavior, while more knowledge could be gained about how to actually achieve this. Future research should focus on strategies and methods for the translation of leadership into behavior in practice. Another relevant avenue of research is the impact of cultural aspects on leadership. Research demonstrates that leadership-related culture and values may differ across settings and countries ( Ardichvili and Kuchinke, 2002 ; Chhokar et al. , 2007 ; Hofstede, 2011 ). Examples are power distance, masculinity, uncertainty avoidance and long-term orientation ( Hofstede, 2011 ). These core values could influence leadership approaches and behaviors in practice. Our review includes studies from various, mainly Western, countries such as the USA, Canada, Australia, England and multiple Scandinavian countries. The included articles do not explicitly reflect on the cultural aspects of leadership. More insight into what the exact impact of these aspects is would be relevant. Finally, an interesting research question would be to compare how leadership behavior is perceived by the different people involved. The role of informal leadership and the dynamics in collaborating networks could also be interesting topics for further research.

5. Conclusions

In conclusion, because leadership in nursing home care is multidimensional and influenced by multiple factors, no specific type of leadership can be considered as most appropriate. Furthermore, this review showed a high level of overlap between the behaviors of the many types of leadership presented in the articles included. It is, therefore, questionable whether leadership styles are a useful vocabulary in the debate on leadership in nursing homes. Moreover, the current tendency toward flat organizations, decentralization and self-direction transforms leadership into a more collective undertaking that transcends hierarchy and encompasses behavior, context and people. Tendencies toward networks of collaborating organizations require new leadership competencies that transcend organizational boundaries and interests. Therefore, a stronger focus on leadership behaviors in relationship to specific contexts instead of the application of leadership styles could provide more insight into what is needed when and what works.

The findings of this study show that leadership is a complex and multidimensional phenomenon, which is determined by multiple internal and external factors. Employees of nursing homes have to be aware that the success of leadership is determined by the interplay between behavior and several contextual factors and the various people involved. Furthermore, the study findings suggest focusing more on leadership behaviors instead of styles. Although thinking in leadership styles could be helpful in terms of categorization and framing, a broader and more conceptual perspective on leadership could be helpful in providing more insight into the underlying mechanisms and behaviors that play a role in leadership. First, a broader perspective implies that leadership should be seen as more than merely a function for managers and team leaders ( Martin and Learmonth, 2012 ). It should be constructed as something to be enacted by all employees across an organization. Second, the broader perspective also means that one has to be aware that leadership processes take place at multiple layers in an organization, e.g. in the care setting, in professional interaction or at the board level. Third, people in organizations could benefit from more awareness of their leadership behavior and how this fits with the current context, circumstances and developments.

Acknowledgments

Funding : The research is funded by the Dutch Ministry of Health as part of the W&T Program. The Ministry of Health had no role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript.

Competing interests : The authors declare that they have no competing interests.

Availability of data and materials: The data sets used during the current study are available on request.

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Missing Oregon nurse found dead days after returning home from her wedding, neighbor arrested

Beaverton police confirm melissa jubane, 32, was found dead after not showing up for work following a 3 day search.

Missing Massachusetts man seen leaving South Carolina beach rental in Ring video before disappearance

Missing Massachusetts man Stanley Kotowski can be seen leaving his family's Hilton Head rental house on Friday, Aug. 16 – the day he disappeared.

The search for a missing nurse in Oregon, who disappeared days after returning home from her wedding, has come to a tragic end after police found her body and charged her neighbor with the murder. 

Beaverton Police confirmed on Saturday that the remains of Melissa Jubane, 32, were found after a three-day search and just two weeks after she tied the knot with Bryan Llantero, a native of Kalihi, Hawaii. 

Relatives told KHON2 that the couple had dated for nearly a decade before tying the knot. 

Imelda Llantero, Bryan's mother, told KHON2 that the newlyweds flew back to the Pacific Northwest on Aug. 31, and landed in the early morning hours of Sept. 1 after their August 24 wedding in Hawaii. 

NEWLYWEDS KILLED IN CRASH DAYS AFTER WEDDING WHEN SEMI OVERTURNS ON COLORADO INTERSTATE

Oregon nurse Melissa Jubane was found dead days after marrying her longtime boyfriend Bryan Llantero.  (KHON2)

Imelda Llantero said the couple spent Labor Day together before Jubane had to return to work on Sept. 3. She said she showed up for her shift on the 3rd, but never showed up for her morning shift on Sept. 4. 

Coworkers, friends and family of Jubane, who was a nurse at St. Vincent Hospital in Southwest Portland, became concerned when she didn't show up for work. 

Officers responded to her residence and after a search of the property, her absence and lack of communication was deemed "unusual and alarming." 

"There was no Melissa," said Imelda Llantero. "Her bag, wallet, and keys are missing, and her car is still parked in the parking garage."

Efforts by officers and family members to contact Jubane throughout the day were unsuccessful, as her phone appeared to be turned off, police said.

FAMILY OF SOUTH CAROLINA BRIDE KILLED ON HER WEDDING NIGHT AWARDED $1.3M SETTLEMENT

An Oregon nurse who vanished days after she returned home from her Hawaii wedding was found dead Saturday amid a 3-day search as police accused her 27-year-old neighbor of murder. (Beaverton Police Department)

Officials said that as a result of an extensive investigation, it was determined that one of Jubane's neighbors, 27-year-old Bryce Johnathan Schubert of Beaverton, was involved in her disappearance. 

Police said Schubert was arrested and charged with Jubane's murder. His first court appearance is expected on Monday, according to Washington County officials. 

"We extend our heartfelt gratitude to the community members who have assisted with the search for Melissa. Our deepest condolences go out to Melissa’s family, friends and coworkers," Beaverton Police said in a statement. 

"While we acknowledge the significant community interest and concern, we must withhold further details to preserve the integrity of the investigation," the statement continued. 

MISSOURI COUPLE'S WEDDING GOES AWRY WHEN GROOM IS SHOT IN HEAD, CRITICALLY INJURED DURING ATTEMPTED ROBBERY

Police confirm the search for Melissa Jubane, the missing nurse in Oregon, has finished after officers found her remains days after she disappeared.  (Beaverton Police Department)

Imelda Llantero said her son is completely destroyed and devastated, and has asked her to fly to Oregon to be by his side.

"I miss her," said Imelda Llantero. "I’m so happy Bryan met her, I told Bryan to always love her. They were happy, very happy."

Providence St. Vincent, where Jubane worked, released the following statement on Saturday to Fox 12 regarding her death. 

"Our hearts are broken at the news of the death of our Providence St. Vincent nurse and colleague, Melissa Jubane. This comes as a shock to us all and she is mourned by her co-workers. Melissa was an exceptional nurse, committed to our Providence Mission and daily demonstrating our values of compassion, excellence and integrity," the statement read. 

The University of Portland School of Nursing and Health Innovations, the school Jubane attended and graduated from, also issued a statement and shared their condolences.

"The School of Nursing and Health Innovations mourns the loss of Melissa Jubane, a 2018 graduate. We send our deepest condolences to her family, friends, and colleagues for this unspeakable tragedy. She exemplified UP Pilot Nurse values, and the entire SONHI community will miss her greatly," the school said in a statement. 

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"We stand in support of her loved ones and those who worked so closely with Melissa. We appreciate all the expressions of concern from the community. Melissa was a person of Providence, and we will miss her."

Officials added that this is an active investigation and are encouraging anyone with information on Jubane's case to contact the police department at 503-526-2280.

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A family says a relative's body was found in the closet of a Florida nursing home

A family in Florida is demanding answers after they said their loved one's decomposed body was found in the closet of a nursing home more than a week after he was reported missing.

Elin Etienne, 71, was found dead Monday morning at North Dade Nursing and Rehab in North Miami, his niece Kimberly Etienne said Tuesday.

The nursing home patient had been receiving care at the facility since early August after suffering a brain aneurysm, she said.

North Miami police confirmed that a person was found dead at the center but did not release a name. A cause and manner of death are pending the medical examiner's findings, Maj. Kessler Brooks said Tuesday.

The family's nightmare began on Aug. 22 when Kimberly said someone they believe works at the facility reached out and said Elin was missing.

"We received a message from someone's personal phone that said we can't find him. So we called the nursing home and spoke to a nurse and they said he checked himself out," she said. "When they said he checked himself out, we pleaded with them for the form to verify his signature. They refused. So we called the police to do a formal missing persons report."

In an Aug. 23 Facebook post , police asked for the public's assistance in finding Elin.

According to Kimberly, the facility refused to let the family search the premises for their missing relative. She said family members "were driving around the entire city" for over a week trying to find him.

On Monday, they were told that a body was found at the nursing home wearing a bracelet with Elin's name on it and the same clothing he had disappeared in.

"A detective came ... and said that he was found in a closet, decomposed to the point of no recognition," Kimberly said.

A person who answered the phone Tuesday at the facility hung up without answering questions. NBC News also tried contacting the facility through its website but did not immediately receive a response.

Elin, a chef, was remembered by his niece as a "loving, selfless" family man.

"There’s no such thing as him coming around and not lighting up a room with a joke, with laughter, with humor," she said. "He was just an honest person, and this is not the way we wanted to send him off."

He was supposed to be at the facility for 12 weeks to undergo rehabilitation and physical therapy, she said.

Kimberly said Elin had wanted to be buried in Haiti, where his mother is buried, but because of the condition of the body, the family doesn't know if that is still possible.

"It’s like a movie, a terrible horror film," she said. "Now we have to seek justice because we can’t even give him a proper burial."

Minyvonne Burke is a senior breaking news reporter for NBC News.

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News Release

US Department of Labor recovers $375K in back wages, damages for 806 workers denied overtime by Rochester-based nursing homes

BUFFALO, NY  – The U.S. Department of Labor has recovered $375,649 in back wages and liquidated damages for 806 current and former employees of nursing homes in upstate New York that denied them overtime pay in violation of federal law.

The department’s  Wage and Hour Division found that Hurlbut Health Consulting LLC – doing business as Hurlbut Care and Hurlbut Care Communities – violated provisions of the  Fair Labor Standards Act when it failed to pay workers time-and-one-half rates for hours over 40 in a workweek. 

Specifically, the investigation found Hurlbut failed to combine hours worked when employees, including certified nursing assistants, licensed practical nurses and some non-nursing employees, worked at multiple locations in a week. The employer also miscalculated the weighted average when paying overtime and failed to include bonuses and shift differentials in calculating employees’  required rates of pay . 

“Nursing home employees, including nurses and nursing assistants, provide essential care for patients that helps maintain their dignity and support their ongoing needs. They absolutely deserve the wages they have rightfully earned for their hard work and dedication,” said Wage and Hour Division District Director Michael Milazzo in Albany, New York. “Despite previous experience and knowledge of the law’s requirements, Hurlbut Health Consulting has allowed new violations to occur, resulting in costly consequences.”

In addition to the back wages and liquidated damages, Hurlbut has paid $69,519 in civil money penalties to the department for their willful and repeated violations. The division identified similar violations in previous investigations of this employer.

The back wages and liquidated damages cover affected former and current workers in Rochester at Brightonian Nursing & Rehabilitation,  Hamilton Manor Nursing & Rehabilitation, The Hurlbut, Latta Road Nursing Home East, Latta Road Nursing Home West, The Shore Winds Nursing Home and Woodside Manor Nursing Home; in Avon at Avon Nursing & Rehabilitation; in Hornell at Hornell Gardens; in Livonia at Conesus Lake Nursing & Rehabilitation; in Newark at Newark Manor; in Penfield at Penfield Place Nursing & Rehabilitation; and in Waterloo at Seneca Nursing and Rehabilitation . 

Headquartered in Rochester, Hurlbut Health Consulting LLC was founded in 2010 and operates skilled nursing home facilities in Livingston, Monroe, Seneca, Steuben and Wayne counties.

In fiscal year 2023, the Wage and Hour Division recovered more than  $31.7 million in back wages for more than 24,000 workers in the healthcare industry nationwide.  The Wage and Hour Division offers resources for health care workers and employers on its website.  

Learn more about the Wage and Hour Division , including the  Workers Owed Wages search tool to use if you think you may be owed back wages collected by the division. The division offers confidential compliance assistance to anyone with questions about how to comply with the law by calling the agency’s toll-free helpline at 866-4US-WAGE (487-9243). The division can speak with callers in more than 200 languages, regardless of their immigration status. Download the agency’s  Timesheet App  for iOS and Android devices – free and available in English and Spanish – to ensure hours and pay are accurate.

Decomposing body found in nursing home closet

by Associated Press

NORTH MIAMI, Fla. (AP) — A family believes a body found in a Florida nursing home's closet is a 71-year-old man who went missing from the facility nearly two weeks earlier.

The family of Elin Etienne believes it was his decomposing body that was found Monday in a closet at the North Dade Nursing & Rehabilitation Center, 11 days after he went missing. He had been a patient at the facility after suffering a brain aneurysm earlier in August, the family said. North Miami Police issued a missing person alert for him Aug. 23, a day after he disappeared.

Ruth Keisha Etienne, his granddaughter, told WTVJ-TV that nursing home administrators never notified them a body had been found. She said an anonymous caller told them, so they contacted administrators.

"They said they found him in a closet and he was already decomposing, and they refused to let us see the body," Etienne told the station. "And we tried to speak to the nursing home people, but they refused to speak to us. They don't want to talk to us. I wonder why?"

The nursing home declined comment Wednesday. The Miami-Dade County Medical Examiner's Office said Wednesday that the body still had not been identified. Police said they are conducting a death investigation.

State nursing home regulators did not immediately return a call Wednesday seeking comment.

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Caring for seniors in rural America

The cost of senior care: why aging farmers fear the nursing home.

Juliana Kim

Why farmers worry about the costs of long-term care

Cindie Haakenson is seen through a window of her home as the family farm is reflected before her on May 21 in Willow City, N.D. Despite a preference to remain at home, Cindie's husband, Sherwood Haakenson, needed to move to a 24-hour long-term care center. Tim Evans/for NPR hide caption

RUGBY, N.D. — Cindie Haakenson was relieved when a room opened up at the Heart of America long-term care center this past spring.

About this story

This story was supported by the Pulitzer Center on Crisis Reporting.

Her 74-year-old husband, Sherwood, had been suffering from multiple fainting episodes in recent months due to issues with his heart and kidney. Finally, he could receive the 24-hour supervision he desperately needed.

But soon a new anxiety crept in: how to afford it.

“We’ve got enough tucked away to keep him for about a year. After that, I’m not sure,” Cindie said. “We’ve got farmland that we own we could sell, but it’s like giving away part of your legacy.”

Rain clouds gather near the Haakenson family farm in Willow City, N.D., on May 21. Most of the small cattle and wheat farm has been in Sherwood Haakenson’s family for over 130 years. Tim Evans/for NPR hide caption

The Haakensons own about 2,600 acres in North Dakota's Willow City area. Most of the small cattle and wheat farm has been in Sherwood’s family for over 130 years. It survived brutal winters and the farm crisis of the 1980s. Now, the couple confronted a situation many aging family farmers fear: being forced to sell or break up the farm to pay for long-term care.

It was a gut-wrenching position to be in, but woefully familiar. Years earlier, Cindie watched as her parents’ health issues nearly cost them their farm.

Sherwood Haakenson sits in his room at the Heart of America Medical Center long-term care facility in Rugby, N.D., on May 14. Tim Evans/for NPR hide caption

“I’ve known forever that this is the way it is,” Cindie said. “And you just kind of hope that you don’t have to face it in the future.”

A third of Americans 65 and older will need a year of nursing home care in their lifetime, according to the Department of Health and Human Services . A semiprivate room today can cost some $8,700 per month — and it’s generally not covered by Medicare. Long-term care insurance exists, but it's deeply unpopular with older Americans. So, many seniors dip into their retirement or savings to get the care they need, while others apply for Medicaid, which has its own challenges.

The choices are especially daunting for small farmers, according to Robert Moore, an attorney and researcher at Ohio State University’s Agricultural & Resource Law Program.

“I tell farmers all the time: There are no easy solutions to long-term care planning,” he said.

Moore called long-term care needs one of the biggest threats today to small family farms. He said farmers go to great lengths and years of planning to protect their land in their golden years. But with soaring costs and an aging boomer population, he expects the problem to only grow.

Leaving the farm isn't easy, even when long-term care becomes a necessity

A person makes their way into the Heart of America Medical Center in Rugby, N.D., on May 21. The cost of long-term care can be challenging for some small family farmers to afford, especially if their assets are tied up in their farm and equipment. Tim Evans/for NPR hide caption

Sherwood’s health took a turn for the worse in October, when he collapsed at home and was airlifted from the local hospital to an emergency room in Fargo, N.D., some 200 miles away. Over the course of four months, he was taken to the ER six times, according to Cindie.

Each time felt like a close call. It’s not easy for EMT crews to find the couple’s home — especially at night. It was also impossible for Cindie, who’s a foot shorter than her husband, to try to lug him to the hospital herself.

In March, it was clear Sherwood needed to be closer to medical care in the likelihood he fainted again.

Although the nursing home was just a 20-minute drive from their home, it was hard for him to settle in. The Haakensons never did well far from home. They preferred the quiet, and although they had traveled across the country, their favorite views came from their family room window.

Sherwood and Cindie Haakenson sit in Sherwood’s room at the Heart of America Medical Center long-term care facility in Rugby, N.D. Tim Evans/for NPR hide caption

Sherwood had lived and worked at his farm for the past five decades. It was the ground his great-great-grandfather homesteaded.

“In June of 1890, that’s when they got their first land up there by Willow City. And I still have it,” Sherwood said back in April. 

His family was among hundreds of Norwegian immigrants who helped shape Willow City. By the time he was born, the town had nearly 600 residents. Now, it's just shy of 150 people and the grocery store, the high school, and two bars he once enjoyed are all closed.

“Everyone says it’s a dying little community,” he said.

Why long-term care costs are a threat to farmers

Cindie Haakenson drives an ATV out of her garage in Willow City, N.D., on May 21. Tim Evans/for NPR hide caption

Small family farmers are often “land rich, cash poor,” meaning their assets are tied up in their farm and equipment, according to Moore from Ohio State University.

“Most farmers live very frugally,” he said. “They don't have living expenses of $100,000 a year. So when they get a $100,000 bill from the nursing home every year, that's just not in their budget.”

There are about 1.9 million farms in the United States — 40% of which are owned by farmers 65 and older. Despite a trend of consolidation , as of 2022, about three-quarters of farms earned $50,000 or less in sales a year , according to the Department of Agriculture.

The average farmer can afford a year or two of long-term care by using their savings, or by selling their crops, livestock and machinery, Moore added. The situation can become dire when an aging farmer needs more than the average three years of care.

"What may keep farmers up at night is the possibility that they can be in a nursing home for many years and use up available resources and jeopardize the family farm operation for themselves and future generations," Moore said.

Cindie Haakenson drives an ATV between her family farm and a neighboring property in Willow City, N.D., on May 21. Tim Evans/for NPR hide caption

The Haakensons sold their tools and machinery years ago. The only significant thing left to sell, according to Cindie, was their Chevy pickup truck, which would have helped pay for two months of care.

Ray German, the lead attorney at German Law in Grand Forks, N.D., said that in his experience, farmers with land that’s worth less than $1 million are at the greatest risk of losing their entire farm over long-term care costs.

“They are very concerned they could lose the whole farm. They could lose everything,” German said.

Medicaid is far from a solution

Registered nurse Susan Eback checks in on Sherwood Haakenson in his room at the Heart of America Medical Center in Rugby, N.D., on May 14. Haakenson had been suffering from multiple fainting episodes in recent months. Tim Evans/for NPR hide caption

Long-term care insurance is rife with its own problems, from complex underwriting to rising premiums. German, who has worked with thousands of older farmers to help preserve their estates in North Dakota and Minnesota, said only a tiny fraction of his clients use it.

“It's expensive, and many times, you've got to jump through so many hoops depending on the policy,” he said.

Short-term care policies are a newer alternative to long-term care insurance, said Lance Boyer, a sales director at Farmers Union Insurance in North Dakota. But their benefits usually last no more than a year.

“They are really affordable and underwriting is pretty simple,” he said. But “it's yet to be determined how impactful they are in the market because they’re still so new.”

Another option is Medicaid, which is the largest single payer for long-term care in the U.S. In North Dakota, while the program completely covers nursing home costs, enrollees can only have a few thousand dollars to their name. They can keep some additional cash and their home and car if it's in their spouse's name, but generally no other property. That’s especially troubling for farmers, whose livelihood and families are often intertwined with their land.

The Haakensons made arrangements to transfer their land to their son and daughter, who plan to continue their legacy of farming. Tim Evans/for NPR hide caption

“Owning farmland, particularly that's been in the family for generations, is very different than owning a stock portfolio that may need to be liquidated,” Moore said. “There's usually family heritage involved, and continuing that legacy is really important for a lot of farmers.”

One way farmers work around the Medicaid restrictions is to transfer their farm into an irrevocable trust and name their children as beneficiaries.

Even if farmers qualify for Medicaid, it can still take five years before Medicaid will pay for long-term care. That’s because in most states, Medicaid looks to see if any improper financial transactions were made in the five years leading up to seeking assistance. The requirement is called a “look-back period.”

Cindie made arrangements to transfer their farmland to their son and daughter three years ago. At the time, she thought she was being proactive — believing that she would be the one needing long-term care in the future. But because the Haakensons were within Medicaid’s five-year look-back period, they were unable to receive government assistance for Sherwood’s care.

The Haakensons' farmhouse is pictured in Willow City, N.D., on May 21. Tim Evans/for NPR hide caption

A grim stroke of fate lets them keep the farm in the family, for now

Boyer of Farmers Union Insurance added that Medicaid should not be the end-all-be-all and there should be better solutions for aging farmers facing high long-term care costs.

Farming is not easy or predictable, he said. Overnight, a hailstorm can destroy months of labor invested in a crop. But farmers work the land anyway.

“They work their whole life, they pay their own bills,” he said. “Then, all of sudden, when they need the most help to get to the finish line, they literally have to wipe out everything they’ve accumulated in life to get that help.”

Cindie Haakenson is pictured at her home in Willow City, N.D. Sherwood Haakenson is pictured at the Heart of America Medical Center long-term care facility in Rugby, N.D. Sherwood died on June 17. Tim Evans/for NPR hide caption

On June 17, Sherwood died in his room at the long-term care center.

Friends near and far, both old and new, attended his service. Weeks later, Cindie said fellow farmers continued to reach out to give their condolences and share stories about her husband — many of which were new to her.

“I've said it this way: He’s cut a wide swath over his years,” Cindie said in July.

It was strange for her to talk about Sherwood without also worrying about him. For the better part of the last decade, Cindie’s life centered around being her husband’s caretaker and, more recently, protecting their farm. She felt some peace knowing she had done her part. But a little anxiety remained.

“If I can stay healthy for two years, the land is safe,” she said.

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