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"Nurses have got to start thinking about ownership...." (interview with American Nurses Association President Beverly Malone)(Interview)

This year's meeting of the National Association of Directors of Nursing Administration (NADONA) had a noteworthy visitor and guest speaker - specifically, the president of the American Nurses Association (ANA). What made this significant was that Dr. Beverly Malone was there to reach out to NADONA members, to encourage them to join in a closer working relationship with the ANA. It was the first official attempt within recent memory by this very active medical/political organization to bring its long-term care colleagues into the fold. What motivated Dr. Malone - who has held top positions in the ANA for several years and is a professor of nursing at the North Carolina Agricultural and Technical State University - to take this initiative? How does she envision the new partnership? How do her views match up with the pressing issues of today's long-term care? Recently Nursing Homes/Long Term Care Management Editor Richard L. Peck explored these questions with Dr. Malone in an attempt to gauge the significance of NADONA's invitation to the "political dance."

Peck: Why did you reach out to NADONA, and how do you envision the new relationship?

Dr. Malone: Joan Schleue-Warden (NADONA executive director) invited me to the conference, and I readily agreed. We in nursing tend to split up our power base in funny ways and, in fact, we downplay our power by not working together effectively. Also, we need more visible leadership at the national level from our long-term care colleagues, because the Baby Boomers are coming and long-term care will be a very important national issue. Right now, though, we have to see what kinds of bridges we can build. I'm sure all kinds of collaboration will take place in the future.

Peck: What are some positions the ANA has already taken related to long-term care?

Dr. Malone: I can be very specific about that. This past June the House of Delegates adopted resolutions to:

* support clear and consistent regulations for quality in long-term care;

* oppose attempts to weaken Federal regulations, including a return of standard-setting authorization to the states and/or adopting deemed status;

* support strong and consistent Federal oversight of standard setting and enforcement of long-term care regulations;

* support Federal legislation and regulation requiring long-term care facilities to have a sufficient number of professional RNs on-site providing direct patient care 24 hours a day;

* support development of regulation that will ensure adequate and appropriate orientation and ongoing education of nurses in long-term care;

* support public access to full information about long-term care facilities, including various regulatory reviews;

* continue support and enhancement of training standards for nursing assistants;

* promote nursing input into development and implementation of Federal financing mechanisms and programs for long-term care;

* support legislation to increase Federal funding for initiatives fostering a greater level of care by professional RNs, to address the changing acuity of residents in long-term care.

I was pleased with the House of Delegates' work and, in terms of overall long-term care policy, I'd say that we're starting to get there.

Peck: It's conceivable that some long-term care directors of nursing may be somewhat put off by the ANA's heavily pro-regulatory stance; OBRA regulation is sometimes seen as a demoralizing paperwork exercise and enforcement as inconsistent and confusing. What would you say to those nurses?

Dr. Malone: The two core values of the ANA positions regarding Federal involvement in the provision of long-term care are that Federal standard setting, oversight and enforcement must be strong and consistent and that the central role of the professional nurse in providing long-term care must be recognized and supported. The ANA has never reflexively supported intensive Federal involvement in any area of care. However, with an ever-growing and vulnerable elder population, Federal intervention is both necessary and appropriate.

Peck: You noted at the NADONA meeting the signs of a growing nursing shortage throughout healthcare and of the aging of the existing nursing supply, with an average age tending toward the mid-40s. What implications do these trends have for long-term care nursing?

Dr. Malone: There's no question that nurses are aging everywhere throughout the system. It's great that people are making commitments to nursing at midlife or are returning to nursing for advanced degrees, but we really do need to reach out to young people. One of the problems is that it is easier to go with motivated middle-agers, but recruiting young people takes more work. We need more education about nursing and its opportunities, and we need more scholarships for deserving young people.

We also need more nurses for geriatrics and for long-term care because, as I mentioned, there is a healthcare revolution on the way. With the exception of a certain core group, though, most nurses do not view long-term care with the same eagerness that they do acute care. There's a need for more education of nursing school students and faculty about the realities of long-term care. There is also a need to look at the pay issue. Salaries have to be competitive but, until recently anyway, nursing home owners and operators didn't act that way. You will not find most nurses turning to work with the elderly simply because they wish to do so. Fortunately, as the demand for long-term care nurses rises, so will salaries.

Peck: Some say long-term care financing and organization will have to improve first. How do you envision the "ideal" long-term care situation?

Dr. Malone: To begin with, I think a lot more nurses must start thinking about owning long-term care facilities themselves. With their knowledge, I think they will prove to be more than competitive with the other folks out there. Baby Boomers will be very demanding of quality, and more than a few providers are going to be left behind; this is a great opportunity for nurses to take hold through ownership.

We also need more nurses involved in political decision-making bodies. We have three nurses in the House of Representatives right now, and we need more in the House, the Senate and in state legislatures. I'm sure the ANA would support any NADONA members who might consider running.

Finally, with some long-term care moving away from institutions and out to the home and community, I think we need more efforts like our Community Nursing Demonstration Project, which was authorized in 1987 to provide a full continuum of Medicare Part B benefits, for a fixed fee, to enrollees in four organizations: Carondelet Health Services in Tucson, Arizona; Carle Clinic Association in Urbana, Illinois; Living at Home Block Nurse Program in St. Paul, Minnesota; and Visiting Nurse Service of New York in Long Island City. All of these are demonstration projects and all are promising models for the future.

In general, I think we nurses have to ask ourselves, Are we going to continue functioning in the same professional model we always have, while others see the new opportunities in healthcare and take advantage of them, or are we going to think about ourselves and what we do in new ways?

For further information, phone ANA headquarters at (202) 651-7000; fax (202) 651-7001; Web site:
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Publication:Nursing Homes
Article Type:Interview
Date:Sep 1, 1998
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