This article describes the first year outcomes of a novel new continuing education activity with enormous potential to help long term care facilities tackle the thorniest problems they face – patient safety, customer satisfaction, and staff turnover – and meet all four core goals of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Quality Initiative. By March 2015, long term care facilities are expected to:
- Safely Reduce Hospital Readmissions
- Increase Staff Stability
- Increase Customer Satisfaction
- Safely Reduce the Off-Label Use of Antipsychotics.
Gero Nurse Prep is a web based, nationally accredited, continuing education course created expressly for RNs employed in long term care (LTC). Gero Nurse Prep is designed for RNs with full-time jobs and busy lives, but only basic computer proficiency. Its dual purposes are to provide RNs with the latest clinical knowledge, skills and competencies for care of older adults, and to prepare them to successfully complete the ANCC Certification Exam in Gerontological Nursing and become board certified (RN-BC).
Course content includes professional topics, such as leadership, management, and communication; clinical problems that afflict older adults; and test-taking tips and test questions to prepare for the certification exam. Board certified nurses have been shown to have a significant positive impact on quality; yet, less than 1% of the nation’s RNs are board certified in Gerontological Nursing.
Gero Nurse Prep is a partnership with facility owners and administrators who are keenly aware of the need for quality improvement in LTC. The message is clear. System-wide efforts to educate RNs in LTC and facilitate their successful board certification will have system-wide positive outcomes.
Gero Nurse Prep encourages facility owners and administrators to sponsor as many RN employees as possible, whether that is two or 200, and to set goals with those RNs for course completion and certification. Gero Nurse Prep encourages the sponsorship of at least two RNs from their facility. This approach addresses a chief barrier to success faced by RNs, many of whom want to become certified but lack the employer and peer support to remain motivated while they prepare for the rigor of the certification exam. When two or more RNs from a facility are enrolled, they are encouraged to collaborate informally and support one another through course completion. They develop team relationships that extend to the clinical environment.
Impact on Quality
In its first nine months, Gero Nurse Prep enrolled 593 RNs who were employed in over 200 different long term care facilities in 34 states. Fifty-five RNs successfully completed the course. Responses from those RNs are good news for long term care employers who hope to improve the quality of care given to their patients and retain RN employees who are committed to improving quality.
On every measure, RNs reported more positive perceptions after completing the course than before the course. For example, RNs reported greater satisfaction with the kind of work they do in long term care facilities. They also reported thinking less often about quitting their current job and looking for a new job in the coming year. They reported that their work was more important and meaningful to them at the end of the course than at the beginning.
When asked about their professional skills, these RNs reported increased confidence about their ability to do their job, a conviction that they had mastered the necessary skills for their job, and a feeling that the impact they had in their job was greater than before taking the course.
RNs reported that they would be making improvements in three major areas: patient assessment, patient management, and leadership. RNs noted that their assessments would be more thorough and systematic in a variety of areas, including cognitive changes, medication interactions, and fall risk. RNs noted that their management of complex patient problems, such as sleep disorders, incontinence, cognitive impairment, and pressure ulcer prevention had already changed. RNs identified the need for more staff education around clinical issues and better communication between staff, patients and families, indicating that they would be playing more proactive roles in both these areas.
The outcomes of Gero Nurse Prep indicate that when facility administrators and owners invest in their RN staff, partnering with them through the process of preparing for and achieving board certification, progress can be made toward achieving the goals of the AHCA/NCAL Quality Initiative.