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Nursing challengessupport association

February 1, 2009
by Charlotte Eliopoulos, RN, MPH, ND, PhD
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“Do we really need another nursing association?” This question is raised occasionally as the number of long-term care (LTC) nursing associations proliferates. And, although there is reason for concern, new associations could reflect recognition of the increased complexity, specialization, and maturity of the profession.

Also, there is the risk that organizations that have existed for some time may have become comfortable with their historical way of operating and not address new or changing needs; new associations offer fresh approaches.

The American Association for Long Term Care Nursing (AALTCN) was formed to address unmet needs for the LTC nursing workforce. A review of some of the current challenges facing LTC nursing can yield insight to support the association's reason for existence.

Recognizing LTC nursing as a specialty

LTC nursing is significantly challenging and complex. Few clinical settings require staff to draw from such a wide range of specialties (cardiology, nephrology, psychiatry, and more). The population served in LTC settings is diverse, ranging from a 30-year-old gunshot victim who is quadriplegic, to a 50-year-old with HIV/AIDS, to a 75-year-old with Alzheimer's disease and other chronic conditions. Unlike acute care settings in which the relationship with patients is brief and focused on the diagnosis and/or treatment of a specific pathology, in LTC settings relationships are extended, and concern for the body, mind, and spirit is essential.

Furthermore, regulatory requirements in this setting are unique and permeate most activities. Specialized knowledge and skills are essential to provide competent nursing services in this setting. AALTCN actively defines, disseminates, and highlights the unique aspects of LTC nursing to promote improved recognition, rewards, and educational programs for its practitioners. The association believes that, unless LTC nursing is recognized as a distinct specialty, schools will not adequately offer specialized content and clinical experiences to prepare the required workforce, and the recognition and pay consistent with the responsibilities of nursing in this specialized setting will not be realized.

Identifying, promoting core competencies

For too long, LTC nurses were hired based on the license or certification that they held, rather than the specialized knowledge, experience, and skills they needed to competently function in this care setting. Likewise, there has been the practice of promoting a good bedside nurse to a director of nursing (DON) or staff development director, with little consideration that there were different bodies of knowledge and skill demanded by these specialized roles. AALTCN is attempting to help employers and nursing staff ensure appropriate role performance through the development of core competencies for major nursing roles.

These core competencies will outline the attributes and skills required in various positions and, hopefully, enable employers to better assess the ability of a job applicant to fulfill the responsibilities associated with the position and help job applicants understand the realities of the positions for which they are applying. Employees well-matched with positions can yield recruitment and retention benefits, along with improvements in the quality of care.

Accompanying the efforts to identify core competencies is the provision of affordable, accessible education to assist LTC nurses in upgrading their competencies. AALTCN provides educational programs and certification for LTC DONs, staff development specialists, LPNs, RNs, and culture change nurse coordinators, all accredited nationwide via the American Nurses Credentialing Center. Recently, AALTCN has begun offering its members nurse assessment coordinators certification through a special arrangement with NASPAC (the National Association for Subacute and Post Acute Care), which developed the original MDS coordinator certification program in 1995 and has certified thousands of nurses since. Educational programs will be available in print and CD, with accompanying webinars scheduled to train the trainers.

Moreover, recognizing that costs and replacement coverage for staff to attend live workshops and conferences preclude some nursing staff from attending educational programs, AALTCN will be rolling out online education soon. Practical, affordable, and convenient educational opportunities will support nursing employees in upgrading their knowledge and skills.

Changing the culture of LTC

The culture change movement is gaining momentum and empowerment of direct-care workers is a core feature of this profound transformation of nursing homes. Breaking down silos among various nursing staff fosters empowerment of direct care workers and supports strong teamwork. By representing and serving all members of the nursing department rather than a single category of worker, AALTCN supports this movement.

While recognizing unique differences among various levels of workers and lines of authority, AALTCN fosters staff unity. All members of the nursing staff are brought together to address common issues, such as implementing best practices, supporting resident-directed care, and contributing to shared goals. Conflict and resistance can be reduced, as each member of the team understands and appreciates the complementary roles they serve in achieving improved services.