With the current shortage of staff and the high turnover of nursing leadership in facilities, staff development efforts have been significantly impacted. Hence the risk for deficient practices and civil monetary penalties is eminent in many facilities across the US.
Long-term care facilities spend millions of dollars annually in civil monetary penalties for quality care deficiencies. Between 2014 and 2016, serious quality violations were found in long-term care facilities resulting in 6,817 intermediate sanctions, including $135.9 million in civil monetary penalties and denial of 44,113 Medicare/Medicaid payment days. (CMS 2016)
As a former Director of Nursing Services (DNS) in long-term care facilities and a nurse educator, I can attest that many of these deficiencies are preventable if licensed nursing staff have in-depth knowledge of the CMS regulatory requirements and competencies needed in managing their work processes.
Often, facilities spend time educating staff on the mandatory education required for regulatory compliance, such as dementia training, abuse training, and fire drills. Though these are important, little emphasis is placed on the regular training of the licensed nursing staff to manage their clinical work processes. Such as assessments, medication administration, admission, care planning, acute transfers and discharge, infection control, workload management, time management, and customer service.
The staff’s ability to manage their clinical work processes is critical as they directly impact quality care outcomes, staff morale, staff recruitment and retention, resident admissions, and the facility’s star ratings. Consequently, reducing corporate revenue!
In these times, where nursing staff is limited, facilities must significantly invest in developing their nurses to be multi-skilled so they can seamlessly adapt to new roles, take on other challenging tasks, and manage their time and workloads efficiently.
The current practice of using self-directed training via online platforms does not work since the nurses do not find it engaging and worthwhile to devote the limited time they have in a shift to do these required pieces of training.
Staff education must be collaborative, engaging, exciting, and hands-on, with role plays, discussions, and simulated activities. In addition, education sessions must be collaborative, foster team building and collegiality, and incorporate self-care activities like mindfulness and resiliency.
Active learning strategies work for young and adult learners. It improves critical thinking and communication skills (Pivač et al., 2021) and facilitates learning difficult and complex concepts (Segul et al., 2022).
In-person staff training programs or facilitated online-based learning modules incorporating active learning strategies are highly recommended.
Our long-term care nurses must be empowered to grow and take on facility leadership roles.
Sylvia Abbeyquaye, Ph.D. MPA RN
Centers for Medicare & Medicaid Services (CMS). (2016). Nursing home penalty data 2014-2016. Baltimore, MD: CMS. https://data.medicare.gov/Nursing-Home-Compare/Penalty-Counts/t8q7-k6ku
Pivač, S., Skela-Savič, B., Jović, D., Avdić, M., & Kalender-Smajlović, S. (2021). Implementation of Active Learning Methods by Nurse Educators in Undergraduate Nursing Students’ Programs – A Group Interview. BMC Nursing, 20(1). https://doi-org.ezproxymcp.flo.org/10.1186/s12912-021-00688-y
Sengul, T., Shoqirat, N., Singh, C., Mahasneh, D., & Karadag, A. (2022). A Qualitative Evaluation of online Active Learning Modalities in the Chronic Wound Management Lecture of Nursing Students’ Experiences in Turkey. Journal of Tissue Viability. https://doi-org.ezproxymcp.flo.org/10.1016/j.jtv.2022.07.014