By Robyn Stone
Providers of aging services are struggling to reduce turnover among nurses. Nurse residency programs may offer a solution, writes Robyn Stone.
For almost four decades, my friend and colleague Dr. Barbara Bowers has been conducting research on the needs of older adults and the needs of the professional workforce that provides these individuals with needed care. Given her dedication to these intertwined issues, it’s not surprising that Barb, a professor emeritus at the University of Wisconsin-Milwaukee School of Nursing, has always encouraged her nursing students to start their careers in the field of long-term services and supports (LTSS).
It hasn’t been an easy sell.
Generally, according to Barb, nursing students resist the idea of working in nursing homes and assisted living communities. They believe these settings offer only “custodial care,” and that their nursing skills are better suited to acute-care settings.
They’re wrong, of course.
Our research over many years tells us, in no uncertain terms, that the care provided in nursing homes and assisted living communities goes way beyond custodial care. Residents of these settings have increasingly complex health conditions. That’s precisely why our field needs a cadre of registered nurses (RN), licensed practical nurses (LPN), and licensed vocational nurses (LVN) who have the skills to provide the high-quality and increasingly sophisticated care that older adults need.
Clearly, our field must convince the students now enrolled in nursing programs around the country that the jobs we offer are highly skilled and highly valued. But, even more important, we need to make sure that nurses who join our teams are fully prepared to carry out their jobs—and fully supported in their work.
Aren’t nursing school grads already prepared to care for older adults?
Not necessarily. According to Barb, nursing students are prepared to be generalists, not specialists, as per nursing school accreditation requirements. That means nursing students graduate with basic knowledge about the care of older adults, but they still have a lot to learn. Even the most accomplished nursing school graduates can quickly become overwhelmed by the demands of LTSS nursing, especially if they don’t receive a robust orientation and strong support from their new employers. Without that support, new hires often start looking for—and finding—other jobs in other care settings within days or even hours of joining our teams.
The workforce crisis precipitated by high turnover among nurses isn’t limited to LTSS settings, of course. Acute-care settings experience it too and have taken an interesting approach to addressing it. Acknowledging that it takes time for even the most educated nurse to adapt to a new care setting, hospitals often require new nurses to enroll in residency programs that provide specific training, over several months, for the jobs they are expected to fill.
Nurse residency programs are surprisingly popular among nurses. Barb reports that many nursing students will not accept a job in an acute-care setting unless that setting offers a nurse residency program. This national trend convinced Barb that the LTSS field needs its own residency program, specifically designed for nurses who care for older adults.
Barb has spent the last five years working with a variety of stakeholders to develop and pilot-test such a program.
Geri-Res, now available online through the Pathway Learning Network, features 16 online modules that provide advanced, clinical knowledge about the care of older adults. Program modules explore such areas as skin health, pharmacology, nutrition, urinary incontinence, cognitive impairment, depression, pain, mobility, changes in condition, and care planning. Nurses work at their own pace and most complete the modules on their own time. Barb estimates that it takes about five or six hours, spread out over weekly sessions, to complete the online coursework.
Separate versions of the Geri-Res program have been designed for RNs and LPN/LVNs working in nursing homes and assisted living communities. The program also includes training modules for coaches who support nurses during the residency program and beyond.
I think it’s so great to have a new resource that acclimates nurses to our care settings, sets them up for success, and promises to help us prevent at least some of the turnover that is robbing our field of skilled nurses, impacting quality of care, and raising recruitment costs across our field.
But I’m most impressed with the important messages that residency programs like Geri-Res send to nurses considering our field:
- LTSS nursing is a highly skilled profession.
- The LTSS field values our nurses and is willing to invest in them.
- We’re committed to helping these nurses pursue meaningful, long-term careers in long-term services and supports.
These are precisely the messages we need to be sending to nurses right now. If they hear and respond to those messages, it could transform our field and, hopefully, help us put our nurse turnover crisis in the rear-view mirror.
Robyn I. Stone, DrPH, is senior vice president of research at LeadingAge, and co-director of the LeadingAge LTSS Center @UMass Boston. Her widely published work addresses long-term care policy and quality, chronic care for people with disabilities, the aging services workforce, affordable senior housing, and family caregiving.