Leaders in Long-Term Care

Dr. Barbara J. Bowers and her team aim to reduce staff attrition and elevate practice perceptions with Geri-Res, an online long-term care nurse residency program.

In a time when skilled nursing facilities across the country struggle with nursing staff turnover, Lisa McGlynn is an anomaly. A two-decade veteran of Attic Angel Place, McGlynn is proof that nurses can and do make long-term careers out of long-term care nursing.

Yet McGlynn, the Attic Angel director of nursing services, recognizes the challenges that often discourage newer nurses from considering long-term care nursing. Patient loads can be high while care is technically and socially complex. While some clinical settings offer extended training programs, most facilities do not have the capacity to replicate the yearlong residencies that are standard at many hospitals. New nurses quickly find themselves in unfamiliar situations and often lack the critical thinking skills they need to identify solutions or resources.

Compounding this is the fact that nursing practice in long-term care settings is also more isolated than it is in hospitals, where extensive provider staffs give nurses access to medical specialists along with physical therapists, respiratory therapists, and more. “It’s a lot harder than people recognize,” McGlynn says. “There are no doctors here. There are no specialists. It’s you. You are each specialist.”

McGlynn credits an exceptional mentor for smoothing her transition 20 years ago, but she knows many new long-term care nurses are not that fortunate and struggle or leave as a result.

“The turnover rate in long-term care is dramatically higher than anywhere else in nursing, and nursing homes are the highest,” says School of Nursing Professor and Associate Dean Barbara J. Bowers, an expert in long-term care nursing workforce issues and policy. “This has remained unchanged since the late 1980s when I started looking at it.”

Dr. Bowers, who has studied ways to better support long-term care staff in order to improve care while controlling cost, says the long-term care model is fundamentally flawed. It relies heavily on Medicaid reimbursements, which are set lower than the cost of care. This creates a challenging environment for even the most dedicated and skilled administrators and nursing staffs, who are forced to operate with extraordinarily thin margins that pressure facility administrators to increase patient loads and minimize time spent away from resident floors for things like training.

“In hospitals, nurses get a year of orientation and take care of four or five patients,” Bowers says. “If you go to a nursing home, you’re lucky to get two days of orientation and you have 30 to 40 patients.”

It is a well-established fact that turnover is expensive and leads to a host of negative health outcomes for residents. According to a report from the Upjohn Institute, a private research organization studying unemployment, high turnover is linked to higher resident mortality rates, increased use of restraints, a higher number of quality of care citations, and more.

Bowers knew from her own research that investing in training and support for new nurses could increase longevity, improve care, and actually offset the cost.

That is what gave Bowers the idea for Geri-Res, a gerontological nurse residency curriculum. She turned to her colleagues in the Center for Aging Research and Education (CARE), which she established within the School of Nursing in 2011 to harness the school’s leadership in research, practice, and education to promote older adult health and support paid and family caregivers. Bowers and the CARE staff collaborated with local providers and experts in geriatric nursing to create a 16-module online curriculum with three separate tracks for skilled nursing, assisted living, and home-care organizations.

Kim Nolet, CARE research manager, believes the industry is ready for Geri-Res. “The evidence is strong. Current research supports a nurse residency program of some kind to help new nurses transition to practice, and anecdotal reports reveal that directors of nursing and administrators in long-term care are aware that they need to provide a more supportive onboarding process and environment for their new nurses,” Nolet says.

During the last testing phases, CARE offered Geri-Res to regional long-term care providers free of charge. McGlynn heard about the opportunity and arranged for Attic Angel to serve as a test site. As two nurses worked through the program, McGlynn noticed marked improvement in their critical thinking skills. She also saw immediate improvements in assessment, charting, and initiative. The nurses were going to their managers with fewer questions and more solutions.

But what really surprised McGlynn was the effect the program had on the rest of the nursing staff. Nurses were talking to each other more and seemed less afraid to ask questions. They began to perceive their uncertainty less as signs of inexperience or lack of skill and more as opportunities for learning and growth. Nurses also openly expressed interest in participating in the program in the future. “I thought we had a really good orientation program,” McGlynn says, “but Geri-Res has just been amazing.”

That kind of praise gives Bowers confidence as CARE readies to bring Geri-Res to market later this year. “I do expect nurses who complete the Geri-Res program to feel better about their work and to feel more confident in their practice,” she says. “I think it is going to take more than Geri-Res to fundamentally change attitudes about long-term care nursing, but I also think it is a very important step.”


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