I sat in classrooms enough when I was going to nursing school … After working for 30 years, I don’t think there is much a 35-year-old instructor can teach me … I don’t have time to read journals and go to workshops after I punch out …

I heard these comments from different nurses in nursing homes that I had visited as part of a Quality Indicator and culture change project I am involved in.

Having participated in meetings and presented education to these nurses, I recognized that they not only were not utilizing best practices, but didn’t even know what the term meant, and their actions were driven more by completing scheduled tasks and responding to crises than the use of critical thinking skills and goal directed actions.

Their knowledge and clinical competencies had grown little since they completed their basic nursing programs. I wish I could say they were atypical, but these nurses, unfortunately, represent too many of the current LTC nursing workforce. 

Baccalaureate and higher degrees are under-represented among LTC nurses. More than half of the directors of nursing, who represent the highest position in the nursing department, hold an associate degree or diploma in nursing; less than one-third hold a BSN.

Certification associated with higher levels of professionalism is held by only one-third of the DONs. With so few nursing leaders in nursing homes holding baccalaureate and higher education, it is no surprise few members of the entire nursing department in LTC settings have college preparation.

Overcoming obstacles
Now, let me clearly state that there are some outstanding nurses in leadership positions in LTC with ADN preparation who perform excellently, have advanced their competencies, obtained certification, read professional journals, and can run circles around many people who have a long list of letters behind their names. And there are realities that have influenced so few highly credentialed nurses being employed in LTC, such as noncompetitive salaries, and administrators’ lack of appreciation of various types of nursing preparation. 

But that doesn’t mean LTC nurses should be satisfied with the current state of affairs.

Currently, in nursing homes, nursing assistants constitute nearly half of the workforce and provide 2.3 hours of care per resident day, compared with 0.5 hours per resident day provided by registered nurses (RNs) and 0.7 hours per resident day by licensed practical nurses (LPNs).

Thus, persons with minimal education provide most of the direct care services. This is all the more reason why it is important that the nurses who are present have sound credentials to provide the leadership, education, coaching, and mentoring to assure that the direct caregivers are providing the highest quality of services.

LTC in the 21st century is significantly different from that of the last century. The resident population has a wide range of medical and psychiatric conditions that once would have been cared for in specialized hospital units.

Today’s LTC nurse must know the current best practices for persons with diabetes, congestive heart failure, renal dialysis, dementia, ventilator-support, schizophrenia, developmental disabilities, and a long list of other conditions and treatments.

Time to change
To think that the information learned in nursing school years ago is sufficient to competently provide the nursing care of a today’s complex population is unrealistic. (To appreciate the need for ongoing learning, consider that 25 years ago we didn’t even have Google, GPS, iPods, debit cards, or flat panel TVs.)

Having college education puts nurses on a level playing field with other healthcare professionals, thereby enabling them to have greater credibility and influence. This education also can offer nurses a wider range of competencies in such arenas as health policy, health care financing, program leadership, quality improvement, and systems thinking that can enable them to serve in positions of influence which ultimately can be of benefit to all LTC nursing.

In the Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,” a recommendation for a more highly educated nurse to meet the demands of today’s healthcare was offered. This is a recommendation that must be taken seriously by LTC nurses.

Nurses must assume personal responsibility for being lifelong learners and invest in their own continuing education via attendance at workshops, participating in webinars, achieving certification, being active in professional associations, and independent reading and study. LTC nurse leaders, while respecting the diversity of educational backgrounds, should encourage their nursing staff to advance their education.

In addition, while recognizing that there are some outstanding ADN and diploma prepared nurses, LTC nursing administrators need to refrain from promoting the view themselves — and correct others who hold the view — that advanced credentials don’t make a difference. Advanced education does make a difference and evidence supports it!

Employers must demonstrate leadership in valuing and supporting education and rewarding educational advancements of staff.

It is time LTC nurses recognize the significant demands, sophistication and value of our specialty by supporting and promoting higher educational preparation of our nurses.

Charlotte Eliopoulos, RN, MPH, PhD, is the executive director of the American Association for Long Term Care Nursing.