Registered nurses who work in nursing homes have specific practices and standards that differ from serving elsewhere. That’s why a new report in the Journal of the American Geriatrics Society is pushing for specific staffing standards.
The Centers for Medicare and Medicaid Services (CMS) has proposed nurse staffing rules that would require 24-hour RN staffing seven days a week in nursing homes, regardless of the director of nursing being on site. The requirement might be accompanied by a minimum RN hours per resident day (HPRD).
“These professional nurse staffing requirements are long overdue and necessary,” the authors wrote in the March 29 report. “However, there are other dimensions to RN staffing in nursing homes beyond the numbers or HPRD that influence the quality of care.”
The authors said paying attention to the additional aspects of nurse staffing are key, even if that proposed rule goes into effect.
“Without attending to a broader focus on nurse staffing, the benefits of increased RN staffing levels will not be achieved,” the authors wrote.
Specifically, the authors advocated for a specific nursing framework for nursing homes that makes the most of the RN. This framework has four components: RN accountability (providing care specifically for older adults and training others), decision-making from all on staff, continuity of information (active information about the resident available), and continuity of the care provider (consistent staff coordination and resident care). Launching the model can vary depending on the nursing home, but all four parts must be addressed when doing so, the authors contended.
Additionally, RNs need ongoing leadership training to motivate staff, solve problems, allocate resources, delegate, supervise and make decisions, the authors stated.
Regardless of how people feel about the CMS proposal, nursing home leaders can take action now to focus on the nursing practice model to maximize the RN’s role and scope of practice, the report stated.
Part of this entails making sure that RN job descriptions reflect the full scope of practice of registered nurses and are complementary, yet separate from licensed professional nurse (LPN) job descriptions. Additional professional development can boost the RN’s leadership capabilities and expertise in gerontological nursing, the team wrote.
