​You've just finished another one-on-one with one of your strongest department heads or charge nurses. You reviewed staffing ratios for the week, talked through a resident care concern, and confirmed priorities before the next survey window. Twenty minutes, clear action items, everyone knows what to do next.

They leave. You get back to the floor. Another productive meeting complete.

But here's what didn't happen: You didn't ask what energizes them about their work right now. You didn't ask what's wearing them down. You didn't ask what they're proud of this month—or where they want to go in their long term care career. You managed the operation. You didn't develop the person.

And six months from now, when they tell you they're leaving for another facility, the acute care side, or a different field entirely, you'll be genuinely surprised. It's one of the most consistent patterns in long term and post-acute care leadership today—and one of the most preventable.

Sound familiar?

Managing the Building vs. Developing People

Most skilled nursing and assisted living leaders are skilled at the former and underdeveloped in the latter—not from lack of care, but because the difference isn't obvious until it's too late.

Managing is about keeping the building running: staffing the floor, meeting regulatory requirements, monitoring quality indicators, managing Medicaid and Medicare reimbursement, preparing for surveys, and ensuring residents receive safe, high-quality care every single day. In a long term care environment where the clinical, operational, and regulatory demands never let up, this kind of management can consume everything.

Coaching is something different. It's about your team members' development—their growth as caregivers and leaders, their sense of purpose in this work, their commitment to the residents they serve, and their reasons for staying in a profession that is physically and emotionally demanding and has no shortage of other options pulling talented people away.

Workforce is the defining challenge facing long term and post-acute care providers right now. AHCA/NCAL's own advocacy and research make clear that staffing shortages, caregiver turnover, and the pipeline of future long term care professionals are among the most urgent issues in the sector. When experienced nurses, CNAs, and department leaders walk out the door, they take clinical knowledge, resident relationships, and the kind of team cohesion that directly affects care quality. The facilities that retain their best people aren't always the best-resourced—they're the ones where leaders invest in developing their people as deliberately as they invest in quality improvement and regulatory compliance.

The High-Performer Trap

Consider this: you have a solid team. Your most experienced nurses and department heads manage their responsibilities well, keep residents and families satisfied, and handle challenges without escalating everything to you. By every visible measure, things look fine.

Meanwhile, one of your most capable staff members has quietly disengaged. Less initiative in team huddles. Less enthusiasm for a quality improvement project you've invited them to help lead. Going through the motions on shifts they used to approach with real dedication. You notice, but tell yourself it's burnout from a difficult stretch or something going on outside of work.

Then comes the conversation you weren't expecting. They're leaving. Taking a position at another facility or stepping away from long term care entirely. And what they say stops you: "I stopped feeling like anyone here cared about where I was going about six months ago. I kept waiting for someone to ask. Nobody did."

You trusted them with your most complex residents. You put them in charge during your most demanding shifts. You relied on them to model your standards for newer staff. What more could they want?

The answer: someone invested in where they were going as a professional and a person, not just what they were delivering for the facility.

When Clinical Competence Becomes Your Blind Spot

Because your best people are skilled and experienced—they know the residents, they understand the care protocols, they navigate survey situations without falling apart—it's tempting to tell yourself that development isn't really your role. They know the work. What could you add?

This thinking is exactly backward.

Coaching your team isn't about second-guessing their clinical judgment. It's about helping them discover what they're capable of beyond their current role—in facility leadership, in quality improvement, in mentoring the next generation of caregivers this sector so desperately needs, in shaping how your community delivers person-centered care. And that requires questions, not performance evaluations.

Instead of defaulting to census updates and staffing issues, try asking:

• What part of your work right now is giving you the most energy?
• What's wearing you down that we haven't talked about?
• Is there an area of care or leadership you'd like to grow into?
• What do you think we could do better for our residents or our team?
• Where do you want to be in your career in a few years, and how can I help get you there?

These questions can't be answered with a care plan update. They require a real conversation. And they send a clear signal that you see this person as more than a body on a shift—you see them as someone with a future in this work.

The Shift from Best Clinician to Developer of Caregivers

Many skilled nursing and assisted living leaders built their credibility through strong clinical skills and a track record of delivering quality care. That expertise earned the trust of residents, families, and surveyors, and that trust earned leadership. But the skills that made you an exceptional clinician are not the same skills that make you an exceptional developer of people.

The longer you lead primarily from your own clinical depth—stepping in to manage resident situations before your staff gets the chance, making every call so your team never has to develop their own judgment, handling the hard family conversations yourself instead of coaching your nurses through them—the more you limit the people around you and your facility's long-term capacity to deliver consistent, high-quality care.

The most effective long term care leaders make a deliberate shift: from being the most capable caregiver in the building to being the person who builds more capable caregivers and leaders.

That looks like asking:

• What's your instinct on how we should approach this resident situation?
• What am I missing about this that you see from the floor every day?
• If this decision were yours to make, what would you do?

These questions build confidence and clinical judgment. They signal that you trust your people to think and lead, not just to execute. And they develop the long term care professionals your facility—and this sector—urgently needs.

What This Actually Requires

You don't need a coaching certification. You need genuine curiosity about your team members' growth—and the discipline to ask about it consistently, even when census pressure, survey windows, and staffing gaps are all demanding your attention at once.

It means treating one-on-ones as development conversations, not just staffing check-ins. It means asking "What are you proud of this month?" before diving into what went sideways on second shift. It means creating space for your nurses and caregivers to think out loud about their careers and their ideas, even when the next care conference is tomorrow and you're short on the floor.

Long term and post-acute care is navigating a genuinely difficult moment—workforce shortages, reimbursement pressure, evolving regulatory requirements, and an aging population that needs more from this sector than ever before. AHCA/NCAL's Caregivers for Tomorrow initiative reflects what providers on the ground already know: the future of long term care depends entirely on the quality, commitment, and sustainability of the workforce delivering it.

That workforce isn't built through advocacy alone. It's built one conversation at a time—in the hallways, in the break room, in the small moments where a leader asks a caregiver not just how the shift went, but where they want to go.

What's one question you could ask one of your best team members this week that's about them, not the census? And what becomes possible for your residents—and the future of long term care—when your caregivers and leaders know you're as invested in their growth as you are in five-star quality?

John Chilkotowsky, PCC, is an executive leadership coach and speaker with NorthStar Coaching, LLC. He holds an ICF Professional Certified Coach credential, along with certifications as an International Systemic Team Coach and Intensive Group Coach, and he is a member of the MacLean/Harvard Medical School Institute of Coaching.

Provider magazine includes information from a variety of sources, such as contributing experts. The views expressed by external contributors do not necessarily reflect the views of Provider magazine and AHCA/NCAL. Learn how to submit an article.