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Review of the literature suggests that the role of DONs in LTCNFs is complex and that nurses currently occupying the role are beginning to acknowledge an interest in seeking further education.
The accessible population consisted of the 945 DONs in LTCNFs in New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) as identified in state directories of nursing home facilities.
The Roles and Responsibilities Scale was developed from the ANF/ACHCA statement on the roles, responsibilities, and qualifications of nurse administrators in LTCNFs, a national survey of DONs, and a review of the literature and was used in two previous studies (Abedzadeh & Heine, 1992; Heine, 1995).
With society's concern for quality care, excellent leadership in LTCNFs is required.
This finding has ramifications for the future practice of DONs in LTCNFs with the introduction of the Federal Balanced Budget Act of 1997 because of the prospective payment system beginning in nursing homes in July 1998.
ANOTHER complicating factor is that DONs in LTCNFs need to know how to maximize reimbursement for long-term care residents.
These changes may also have an impact on professional staffing in these settings and could influence the financial viability of some LTCNFs.
Research implications call for further investigating the limited participative role of DONs in LTCNFs in professional nursing and long-term care leadership.
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