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Recruiting RNs to long-term care.

Nursing homes are faced with a golden opportunity to substantially upgrade their nursing staffs -- if they know how to take advantage of it. In a startling turnaround, the much-trumpeted nursing shortage of the past few years no longer exists, at least insofar as hospitals are concerned. As their financial margins continue to shrink in these cost-conscious times, they're laying off fully qualified and highly skilled RNs. Getting these professionals to make the leap from acute care to long-term care may take some doing, but Joan Warden, President and Founder of the National Association of Directors of Nursing-Administration/Long Term Care (NADONA/LTC), has some words of advice, which she offered in this interview with Nursing Homes Editor Richard L. Peck.

Peck: What are some basic considerations for an administrator in trying to recruit RNs who have been laid off from their acute care jobs?

Warden: First let me say that NADONA shares the concerns of the American Nursing Association and the state nursing organizations as they relate to large numbers of RNs suffering layoffs in the acute setting. This will impact on the quality of care for the acute patient, without a doubt. All RNs should be concerned about that situation, and it is indeed unfortunate. Given the need for qualified nursing staff in long-term care, however, this may be an opportunity for that sector.

In thinking about recruiting these RNs, one's natural first response might be that the salary disparaties between acute care and long-term care will pose a major problem. However, I think that while salaries are indeed important, they are not the most important factor in most cases. In my view, the assurance that nurses would still be able to practice professional nursing in the long-term care setting without compromising the principles and standards of good nursing is the most important element. This would include, of course, appropriate staffing, appropriate equipment and supplies and, of course, opportunities for professional advancement.

In visiting nursing homes throughout the United States, and based on comments by our members, I've found that the best facilities are those in which a collegial relationship exists among the nursing home administrator, the Director of Nursing and other department heads. This type of relationship is essential and one that will attract the professional RN.

Peck: What about the problem of the negative attitudes some acute-care oriented RNs may have about working in nursing homes?

Warden: You can't force someone to change their attitudes and beliefs, you can do so only by demonstrating the facts of the matter again and again. Opportunities for doing that in nursing homes are growing. More attention is being given to long-term care by way of research studies, educational programs, more training sites for nursing students, etc. Admittedly, a few of these sites have ended up reinforcing some of the negative attitudes, but the quality of most training sites have succeeded in changing student nurses' perspectives.

Peck: Are there educational opportunities that facilities might provide?

Warden: Most definitely. More and more facilities are offering nurses support for extra coursework and even for pursuit of advanced degrees. This is done, of course, with the hope that the nurse will respond by staying with the facility for several years. There's no guarantee involved that these nurses will stay--it's more a matter of honor, but I've heard of very few situations in which that honor was violated. RNs will most definitely be attracted to facilities where educational opportunities are offered. They will expect the same type of offerings they received in the acute setting. Adding this benefit to a facility benefits package is a good investment for the recruitment of RNs.

Peck: But nursing turnover in many facilities remains substantial. Why is that?

Warden: Again, it is important for the RN to be able to continue to practice as a professional nurse without compromising those ideals to which she is committed. If those ideals are maintained, and if the workplace is pleasant and delivers good care, the administrative staff maintains a good working relationship, there is a philosophy of shared governance and, finally, the salary is competitive, turnover should fall to within normal limits. More and more facilities are striving to meet these goals, and I think they will see results in reduced turnover and more cost-effective nursing care.

Another point: Since most RNs are in "management" positions in nursing facilities, administrators should exercise care in selecting those who will be managing the direct care givers. Does their management style mesh with that of the Administrator? With the Director of Nursing? Are they "problem solvers" or "problem creators?" These are important questions to ask prior to appointing an RN to an administrative position.

Peck: What sort of work setting is important to an RN?

Warden: To begin with basics, an RN would probably attempt to locate a work setting close to home, close to a child care agency (unless the facility itself offers such a service), and one that is clean and professionally attractive. An RN would want to work with other RNs who are professional, eager to share knowledge and challenges, and who take pride in their long-term care profession. An RN would want to be in a working environment that is uncluttered, free of unnecessary stress and -- ideally -- involved with student training in connection with a local college or university.

Flex-hours would be an additional inducement. This type of scheduling has been adopted by many long-term care facilities and, while it does present a challenge, has been well-received. It is important to note that the actual scheduling function is not a nursing function and can be delegated to non-nursing personnel.

Peck: Do you think the trend toward sub-acute care in nursing facilities will be an attraction for RNs?

Warden: Yes it will, as will the opportunity to practice in specialty areas in long-term care. I think that we will see an evolution toward specialized nursing facilities caring for specific types of chronic illness -- AIDS, head injuries, pediatric conditions, Alzheimer's disease, etc., and with that evolution we will hopefully see more nurse clinical specialists and more long-term care-oriented research. These will result in a more positive image for long-term care and, thus, attract RNs from other settings. Many RNs with whom I speak are unaware that many of our long-term care facilities manage such a diverse population, and we should get the word out.

Peck: We have been concentrating on RNs here, but isn't there a tendency in some nursing homes to confuse their functions with those of LPNs, and treat them as one and the same? If so, how should the administrator in fact distinguish between RNs and LPNs?

Warden: This confusion does occur, and it ultimately impedes the delivery of good nursing care in the facility. While the LPN provides "technical care," the RN is not only licensed to provide "technical care," but they are also educated to analyze, assess and make in-depth recommendations, as well. LPNs are not educated to apply theory and research to their practices; RNs are educated in this way. In sum, the administrator should view the LPN as the technical person who not only provides important technical services to the resident but provides information as well. The RN can then analyze and assess that information, and apply her findings directly to planning the resident's overall care, in collaboration with the other caregivers.

Nursing leaders are moving toward this classification of "technical LPNs" and "professional RNs," not so much to separate them as to clarify their respective functions. Keeping this in mind will help administrators better understand the functions of each classification.

Peck: Any concluding thoughts on the recruitment realities?

Warden: Only that nursing facilities, no matter how they evolve, should make sure that they have the staffing to provide the level of care that is needed. And, to me, that means the RN must have leeway to provide hands-on care when desireable or necessary. Many RNs express displeasure with "sitting at a desk all day." Even the most mundane of tasks, such as changing an incontinence garment, can provide information for assessing skin care, waste products, level of alertness and other important physical and clinical considerations. This is not to say that RNs/LPNs must change incontinence garments, but at times it may be clinically indicated to do so. Being unable to have that option due to time spent at a desk can prove to be frustrating to an RN and lead to burnout and turnover. Adopting the philosophy that RNs can and do have direct patient contact can be an attractive recruitment incentive. Personally, I am uneasy with the notion of having assistants monitoring body weights, skin turgor, muscle integrity, mental status and the like, and then reporting what they see to the LPN or RN. Unfortunately, though, given the limitations today's nursing facilities confront, this is too often the case.
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Title Annotation:Nursing Care; nurses
Publication:Nursing Homes
Article Type:Interview
Date:Sep 1, 1993
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