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The Gerontologist 48:453-463 (2008)
© 2008 The Gerontological Society of America

Nurse Preparation and Organizational Support for Supervision of Unlicensed Assistive Personnel in Nursing Homes: A Qualitative Exploration

Elena O. Siegel, PhD, RN1, Heather M. Young, PhD, GNP2, Pamela H. Mitchell, PhD, RN3 and Sarah E. Shannon, PhD, RN4

Correspondence: Address correspondence to Elena Siegel, PhD, RN, Oregon Health & Science University School of Nursing, 3455 SW U.S. Veterans Hospital Road, Mail Code 615/SN-6S, Portland, OR 97239-2941. E-mail: siegele{at}

Purpose: Nursing supervision of the routine daily care (e.g., grooming, feeding, and toileting) that is delegated to unlicensed assistive personnel (UAP) is critical to nursing home service delivery. The conditions under which the supervisory role is organized and operationalized at the work-unit level, taking into account workloads, registered nurse/licensed practical nurse staffing, and role expectations, are not well understood. The purpose of this paper is to describe the organizational, managerial, and nurse-level factors associated with the nurse's role as supervisor of UAP in nursing homes. Design and Methods: An ethnographic approach to data collection included 31 interviews, 170 hr of observation, and organizational document review at three nursing homes. Analysis included micro-coding and content analysis.  Results: Findings revealed (a) considerable variation in organizational resources, systems, and processes to support organization and operationalization of the supervisory role; and (b) limited evidence of nurses' estimation of the potential benefits of training and organizational systems to support supervisory practice and the complexity of the supervisory role. Implications: Delivery of high-quality nursing home care is a matter of national importance, and these findings offer a call to action for nursing home leaders in policy, academia, and ownership and management positions. Nurses must be equipped with competencies and skills that reflect the complex organizational environments in which they work. Additionally, nursing home administrators and managers must be equipped with the competencies and skills needed to effectively and efficiently organize and operationalize care delivery practices to support nurses' role enactment.

Key Words: Long-term care • Nursing • Roles • Systems

All GSA journals Journals of Gerontology Series A: Biological Sciences and Medical Sciences Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Copyright © 2008 by The Gerontological Society of America.