Advancing Long-Term Care Nursing
In 2008, the Institute of Medicine (IOM) released a landmark report titled “Retooling for an Aging America: Building the Health Care Workforce,” which documented the critical shortage in the numbers and competencies of the workforce caring for the elderly and made recommendations to address these issues. A task force funded by the Atlantic Philanthropies and Hartford Foundation was subsequently formed to implement the recommendations outlined in the IOM report. This task force became the National Workforce Alliance to Care for an Aging America (NWACAA). The American Association for Long Term Care Nursing (AALTCN) has proudly participated in the NWACAA as part of the Coalition of Geriatric Nursing Organizations.
The NWACAA developed three basic principles that guided its work toward resolving the issues raised by the IOM report:
- Quality care requires quality of life for all those who care for older adults, including family caregivers.
- Resolving the workforce shortage crisis calls for a focus on recruitment, training, retention, compensation and reimbursement, and career development for direct care workers and professional service providers.
- Effective models of care require interdisciplinary teams with clear roles and respectful relationships between caregivers and consumers and among caregivers within the continuum of care across all settings.
Building on these principles and the recommendations of the IOM, AALTCN has taken leadership to fill a void in long-term care (LTC) nursing by defining the unique competencies of LTC nurses and providing educational opportunities to assist nurses in advancing their competencies. AALTCN recognizes that today’s LTC settings are significantly complex organizations. The population served represents a wide range of clinical conditions that often requires care measures that once were deemed sufficiently complex to be treated in hospital settings. The workforce comprises individuals of various cultural backgrounds and generations. In addition, there are considerable regulatory and legal issues that must be complied with, and these continue to change and grow.
With the clinical, managerial, and leadership challenges LTC nurses face, they must demonstrate competencies that surpass their basic nursing education. In addition, when they assume specialized roles, such as director of nursing or staff development instructor, they need to possess advanced competencies specific to the responsibilities they assume. For example, directors of nursing, who hold the most critical position in the nursing department, need to be more than experienced nurses. They are responsible for oversight of the daily clinical and administrative operations of the nursing department, ensuring the department’s philosophy and objectives incorporate evidence-based practice. While advocating for residents and staff, they foster high standards of resident care by promoting diligent orientation and continuing education efforts among the staff, maintaining adequate nursing personnel levels, ensuring nursing supervisors and managers are properly prepared to handle the tasks of the job, and ensuring policies and procedures remain current. Preparation beyond basic nursing education is crucial for directors of nursing to meet the executive functions of this role.
Staff development directors, who also fill specialized roles, are responsible for planning, directing, coordinating, and evaluating educational programs for Nursing Service and other departments, and for providing resident and family education. They need to have a grasp of adult education principles and be skilled in conducting educational programs for a diverse workforce. Here again, advanced preparation beyond basic nursing education is needed.
Another specialized role that requires more than basic nursing education is the Quality Assurance/Continuous Quality Improvement (QA/CQI) Coordinator. QA/CQI nurses are committed to maintaining and improving ongoing quality assurance and quality improvement programs to ensure care delivered to residents and their families is of high quality and consistent with the mission of the organization. This entails monitoring and evaluating the quality and appropriateness of care rendered to all residents. When opportunities to improve care and services are identified through a data-driven quality measurement process, they recommend actions to ensure that high-quality services are supported. A significant grasp of clinical standards and strategies for evaluating and improving performance is crucial to fulfill the demands of this role.
Even frontline positions for RNs and LPNs require competencies beyond basic nursing, as these individuals provide and direct primary nursing care to residents and delegate and supervise the care provided by nursing assistants. Although specific competencies accompany each position in the nursing department, leadership staff who hire nurses often lack knowledge of the role-specific competencies to seek in candidates. The result is that nurses are hired into roles that they are unable to fill, potentially resulting in job dissatisfaction for the nurse and quality deficits for the organization.
In an effort to address this issue, AALTCN has developed Standards and Core Competencies for LTC Nursing Staff, which outlines the major responsibilities, desired qualifications, and core competencies for every major position in the nursing department. The committee that developed this document consisted of LTC nurses with various backgrounds and educational levels. While AALTCN views this document as an important step in defining the unique roles filled by LTC nurses and improving the understanding and image of LTC nursing, it also recognizes that simply describing the unique competencies required does little to affect practice change. Nurses need education to assist them in achieving these competencies. To address this need, AALTCN has developed educational programs and certifications for various LTC nursing positions, including director of nursing; staff development specialist; culture change nurse coordinator; LTC safety specialist; LTC RN; and LTC LPN. Nurses can engage in these programs through workshops, Webcasts, and independent study materials.
The time has come to recognize the highly complex nature of the specialty of LTC nursing and assure nurses develop and demonstrate the competencies associated with their unique roles. AALTCN will continue to assume leadership for this effort and advocate for the highest quality of LTC nursing caregiver.
Dr. Eliopoulos is executive director, American Association for Long Term Care Nursing, Cincinnati, OH.
