Experts Work to Transform Nursing Home Care

What are the best ways to improve nursing home care in the United States?

Original Source

By Jennifer Larson, contributor

What are the best ways to improve nursing home care in the United States?

That’s the question asked by a group of academics and nursing home industry executives who, over a year ago, decided it was time to collaborate with just that goal in mind.

Nursing home care

The Nursing Home Collaborative, which began in 2007 to study how to improve nursing home care, focused on the role of registered nurses and found nurse staff shortages are a common problem for nursing homes.

After all, 1.7 million people are in nursing homes on any given day in the United States, and that number will increase as the population ages. The quality of care and the public’s perceptions of the quality of care provided in the nation’s nursing homes are important and ongoing issues on this front.

With a $500,000 grant from Atlantic Philanthropies and the support of the American Academy of Nursing and its “Building Academic Geriatric Nursing Capacity” program, five John A. Hartford Centers of Geriatric Nursing Excellence launched the Nursing Home Collaborative in 2007. The centers included the University of Arkansas for Medical Sciences, the University of California, San Francisco, the University of Iowa, Oregon Health & Science University, and the University of Pennsylvania.

The collaborative’s participants started by deciding to examine the role of the registered nurse in the nursing home industry, said Cornelia Beck, Ph.D., RN, the collaborative’s national coordinator.

“We felt that there was not a lot of attention paid to the role of the registered nurse,” she said.

First, nursing homes, like many health care entities today, have challenges in nurse staffing. Turnover is very high. And many depend on licensed practical or vocational nurses to provide many services but need more registered nurses, especially registered nurses who are baccalaureate-prepared nurses with the appropriate knowledge and skill set to be leaders.

And beyond that, according to the collaborative, they could improve the ways in which nursing services are organized and provided, which requires good leadership, effective delegation of non-nursing activities and the appropriate utilization of non-nursing staff. The nurses must also be prepared with geriatric nursing knowledge and management skills.

“Sometimes, just adding more staff is not the only answer,” said Beck, who is also a professor at the University of Arkansas for Medical Sciences.

If having more RNs with the appropriate skills and training in nursing homes is one strategy to improving patient care in nursing homes, then how does the industry achieve that goal?

According to Beck, nursing homes might be able to entice more registered nurses if they make the setting more desirable to RNs.

The American Nurses Credentialing Center recently developed a Pathway to Excellence program for smaller health care institutions that is similar to its existing Magnet recognition program for larger institutions. The Magnet program was established to recognize excellence in nursing care and recognizes hospitals that have demonstrated a commitment to recruiting and retaining their nurses.

The Pathway to Excellence designation could work for nursing homes in the way that the Magnet designation has succeeded for hospitals, Beck said. And the collaborative hopes to work on helping nursing homes establish practices that would allow them to achieve that status.

“In a sense, it’s raising the bar,” she said.

Although the original grant money ran out in July, the collaborative is optimistic that they can keep the program going. Atlantic Philanthropies asked them to develop a business proposal, which they submitted and should hear soon if they have received funding for it.

If the group gets funding, they will be able to contract with a consulting firm to develop a business plan for selling products and services designed specifically to help nursing homes improve their care. For example, one product might be a gap analysis tool, a self-assessment product that would help nursing home administrators analyze the gaps in their staff’s skills and knowledge, and then find strategies to help fill those gaps. They could then develop a customized education plan for the nurses which would have the added benefit of making their continued education efforts more efficient.

Beck praised all the participants in the Nursing Home Collaborative for truly cooperating with each other. The participants shared their time, expertise and energy over months of conference calls, steering committee meetings and web seminars since the project launched.

“I think it’s been a real boost to our nurse colleagues who have spent their careers in nursing homes,” she added.

© 2008. AMN Healthcare, Inc. All Rights Reserved.