Many nursing school graduates hope to land their first jobs in hospitals and, in particular, on medical-surgical units—the kind of fast-paced, acute-care environments that have historically been seen as ideal training grounds for new nurses.
But nurse leaders in New Jersey are working to lure new nurses to long-term care facilities, an increasing locus of care as the population ages and as the rate of chronic conditions rises.
To do that, they have created a model nurse residency program at long-term care facilities in the state. The program educates and trains new nurses at these facilities over a 12-month period to help them transition into practice. It also educates staff to serve as preceptors. Its goals are to educate new nurses in geriatrics and gerontology, expose them to careers in elder care, help stabilize the state’s nurse workforce and, ultimately, improve care for residents of long-term care facilities.
The aim is to “recruit and retain new nurses in long-term care facilities,” said Debra Weinschenk, RN, BSN, staff development director at Bristol Glen, a continuing care retirement community in New Jersey that is participating in the program. “The goal of the nurse residency program is to market our learning opportunities in sub-acute and long-term care, which will hopefully enhance retention of staff in this growing arena.”
The 30-month program launched in 2013, when the New Jersey Action Coalition (NJAC) received $1.6 million from the Centers for Medicare & Medicaid Services. The NJAC is part of the Future of Nursing: Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation and AARP that aims to transform nursing to improve health and health care. It is rooted in a 2010 report by the Institute of Medicine that called for more residency programs across all settings to help new nurses transition into practice.
Long-term care residency programs are taking shape in other states, too. In Utah, HealthInsight Utah—co-lead of the Utah Action Coalition for Health, also part of the Campaign—and the University of Utah College of Nursing received a joint grant earlier this year from the Health Resources and Services Administration to implement a long-term care nurse residency program in 21 skilled nursing facilities across the state. The program will begin next February.
In Rhode Island, Stepping Up, a job training program, partnered with the Rhode Island Action Coalition to enroll unemployed and underemployed nurses in a nurse residency program that exposes nurses to a variety of settings, including long-term care facilities.
And faculty at the University of Wisconsin-Madison and Oregon Health and Sciences University created an online program that includes tools to help nursing homes implement nurse residency programs. The curriculum focuses on helping nurses understand the long-term care environment, resident function, geriatric nutrition, end-of-life care, communication, and other topics. Pilot “geri-res” programs are being conducted in Oregon, Minnesota, Wisconsin, and South Dakota.
A ‘Wonderful Opportunity’
Kathleen Simon, RN, a nursing student who is earning her bachelor’s degree and participating in the long-term care residency program at Bristol Glen in New Jersey, calls it a “wonderful opportunity” to learn about geriatrics. “I work with some very experienced nurses and am able to put the critical thinking skills I am learning in school to work in the practice setting.”
As part of the residency program, nurses develop a performance improvement project in which they identify a problem, create a plan to address it, pitch the plan to an interdisciplinary team of providers, and carry out agreed-upon changes.
For her project, Simon is expanding Bristol Glen’s restorative program to prevent functional decline. She fostered more patient independence through interventions that enable them to feed themselves and exercise. And she developed competencies in this program for the facility’s entire nursing staff.
“I’ve seen Kathleen grow and develop leadership skills during the residency,” Weinschenk said. The program also benefited other staff, too, she said. “We are sharing best practices, learning from each other, and networking more.”
The Christian Health Care Center selected two staff nurses and a nurse preceptor to participate in the long-term care residency program. Nancy Mericle, BA, RN, CDON/LTC, director of nursing at this New Jersey facility, said they benefited greatly from the program.
After completing the residency, nurse residents returned to their jobs with improved assessment and critical-thinking skills, a better understanding of quality improvement, Medicare and managed care, and a fuller understanding of all of the factors that influence health and health care, Mericle said. “The nurse preceptor brought back many new and innovative ideas for us to include in our own nurse orientation at CHCC,” she said. “We are very thankful that we had the opportunity to be part of this initiative and hope that this residency program or others like it will be part of educating and exciting nurses to work in long-term care.”
As our country ages and our health care system evolves, highly trained nurses are being called on to provide more support to family caregivers who are taking care of loved ones with chronic conditions, dementia at home.