Nursing challengessupport association

“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.

Improving LTC nursing image

It is hardly a secret that LTC nursing suffers from a negative image. Some colleagues in other specialties perceive LTC nursing to be “easy,” “boring,” and “for those who are not competent enough to work in acute care.” Consumers, influenced by the media who highlight rare abusive nursing home situations, often hold less than positive views of LTC staff. Reality contradicts these perceptions. As noted earlier, to competently care for residents, LTC nursing staff must possess knowledge from a wide range of specialties, be able to make clinical judgments without benefit of medical staff on the premises 24/7, understand age-related pathophysiology and unique responses to illness, be skillful in holistic interventions, be prepared to manage emergency situations, and be attentive to multiple regulatory requirements. Furthermore, nursing staff often become family surrogates, sharing close and meaningful relationships with residents.

AALTCN is committed to casting a more realistic and positive view of LTC nursing than what currently exists. The potential outcomes of this are improved recruitment efforts by making LTC nursing an attractive specialty for nurses and increased retention by recognizing and honoring the positive contributions of the current workforce. The importance of LTC settings attracting and maintaining nursing staff cannot be emphasized enough. In its recent report, Retooling for an Aging America: Building the Health Care Workforce, the Institute of Medicine emphasized that, by 2030, the United States will need an additional 3.5 million formal healthcare providers—a 35% increase from current levels—just to maintain the current ratio of providers to population. The gap between supply and demand will significantly widen, therefore action is needed to break down barriers that discourage people from entering this specialty.

AALTCN has been working to spread the facts about LTC nursing to consumers, other nurses, and nursing schools. By providing creative educational programming, being a strong advocacy voice, and promoting a realistic view of this challenging specialty, AALTCN is advancing excellence in LTC nursing.

Charlotte Eliopoulos, RN, MPH, ND, PhD, is Executive Director, American Association of Long Term Care Nursing. To learn more about AALTCN and to sign up to receive AALTCN’s monthly e-letter visit She can be reached at (410) 665-2158 or

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Long-Term Living 2009 February;58(2):8-10

Topics: Articles , Clinical