More than 200 nursing homes in New York and New Jersey are improving residents care and quality of life through participation in the Advancing Excellence in Americas Nursing Homes campaign.
We joined the campaign because we believe in doing anything that will improve the quality of life for elders, says Marie Rosenthal, RN, MSN, director of nursing at Jewish Home Lifecare Manhattan Division in New York.
Advancing Excellence began in 2006 when 28 organizations representing nurses, facilities, medical directors, caregivers, quality improvement experts, government agencies and foundations came together to make nursing homes a better places to live, work and visit. Since the campaign began, participating nursing homes have demonstrated progress toward reducing the prevalence of pressure ulcers, decreasing the use of physical restraints and improving pain management for long-term and short-stay residents.
The campaign entered phase two this year, with some expanded and revised goals, including reducing staff turnover and providing consistent staffing assignments, both aimed at creating a more permanent staff, which in turn is expected to deliver higher quality care.
Before you can begin to make changes in the clinical arena, you need to stabilize the work force, says Carol Benner, ScM, national director of the Advancing Excellence in Americas Nursing Homes campaign in Washington, D.C. With a stable work force, you can work on clinical goals.
Shawnee Fucito, RN, director of nursing at Holly Manor Genesis Center in Mendham, N.J., agrees about the importance of maintaining employees and has worked on reducing turnover to achieve a 96% retention rate for certified nursing assistants. No nurses have left since the campaign started. Long-term care providers reported national average nursing assistant turnover rates as high as 71% and more than 52,000 vacant nursing positions, according to An Introduction to the National Nursing Assistant Survey, a 2007 report by the Center for Disease Control and Preventions National Center for Health Statistics.
Fucito demands that nurses deliver consistently high levels of care. She finds showing appreciation for employees efforts, as well as rounding to listen to nurses concerns and acting on them, has decreased turnover at Holly Manor. You need to retain the right nurses, and when you get the right nurses into place clinical excellence will follow, Fucito says.
Different Approaches to TurnoverElisabeth Micich-Otero, RN
Constancy of assignment and low turnover are the cornerstones of being able to advance excellence, Rosenthal adds. Without dedicated caregivers at the bedside who know the residents, you cannot advance in other areas.
Jewish Home Lifecare implemented programs to help individuals grow and develop career paths within the organization. The company offers scholarships and participates in a Service Employees International Union-supported program that allows employees to return to school while retaining their benefits and working flexible hours. In addition, a board member funds a program to provide money for books and lab fees.
Anything you can do for a staff member that allows them to further their education is going to pay you back in staff satisfaction and staff retention, Rosenthal says.
Christian Health Care Center in Wyckoff, N.J., welcomes ideas from employees and implements many of them, allowing staff to know their suggestions can influence care. The facility also supports staff to become the best they can be, says Elisabeth Micich-Otero, RN, MSN, BC, quality manager of long-term care and a clinical educator at Christian Health. The facilitys turnover rate declined to 9.5% in 2009.
Satisfied staff members deliver very good care to residents and families, and when people deliver good care, they want to stay, Micich-Otero says. It isnt always money. It has to be a supportive work environment where people feel they can accomplish [things], have open communication and real discussions about residents, and make positive changes in their care, with people working collaboratively to reach those goals.
Corine Zurlnick, RN, director of nursing at Cedar Manor Nursing and Rehabilitation Center in Ossining, N.Y., agrees that delivering quality care helps with retention. The facility has had to hire only two nurses in the past two years.
Maintaining Consistent StaffingShawnee Fucito, RN
Rosenthal says consistent staffing fosters quality care because staff members then know residents routines and preferences. Jewish Home Lifecare switched from centralized to unit-based scheduling so residents are assured coverage by consistent caregivers. She has found staff members prefer consistent staffing and scheduling. Residents also like the consistency, adds Zurlnick, saying they often become upset when their aide has a day off.
In addition, because aides know residents so well, they will alert the nurse to the slightest change, such as a reddened area of skin, and they have a good idea about what diversions might settle a restless resident. Over time, the resident gets comfortable with the aide, and often undesired behaviors will change, Fucito says.
Before attempting to modify the culture, schedules or benefits, Rosenthal says, facilities should develop partnerships with the collective bargaining groups because those groups must support practice changes. You need a foundation and partnership between labor and management to move forward, Rosenthal says.
Something for Everyone
The campaign posts implementation guides on its website, with step-by-step instructions for meeting each goal and monitoring outcomes; videos; fact sheets; and action plans. All are free and available to any long-term care provider. Participating homes benchmark against their prior results and other organizations. Nursing homes that participate can enter data in the computer, and we will track and trend their performance for them, Benner says. In addition, they can learn from each other.
Nationwide, 42% of nursing homes are participating in Advancing Excellence phase two. In New York, close to 20% are active, as are 23% in New Jersey. No one ever expected the campaign to take off like it did, Benner says. Nursing homes were hungry for the information we have.