Medical director presence and time in U.S. nursing homes, 2017-2023.

Background: Federal regulations require all nursing homes to have a medical director, where medical directors oversee resident medical care and develop, implement, and evaluate resident care policies and procedures that reflect current standards of practice.

Methods: This descriptive study examined medical director: (1) presence or absence and the amount of time spent from 2017 to 2023; (2) presence and time by ownership type; (3) variations in presence and time across states; and (4) overall CMS deficiencies for violations of medical director regulations. This study used federal Payroll-Based Journal (PBJ) data on staffing positions for the period of 2017-2023, along with federal nursing home ownership data and deficiencies data for 2023.

Assessment of Nursing Staff Learning Needs Around Person-Centered Risk Management in Nursing Homes.

The purpose of the current study was to describe nursing home (NH) staff's perceived learning and practice competency needs to facilitate effective delivery of person-centered care (PCC) when older adult residents' care preferences involve perceived risks. This needs assessment included a survey of NH staff and leaders ( = 87) and two focus groups (FGs) ( = 14). Results indicated staff were most confident handling preferences related to medication refusal (mean item rating = 4.

Nursing Leadership - Transforming the Work Environment in Nursing Homes.

The work environment is a modifiable construct associated with the quality of nursing home care. This article describes and explains variables known to be associated with the work environment of nurses in nursing homes, including the history and characteristics of nursing homes; the nature of nursing work; the nursing skill mix, and care delivery. Nursing leadership has the potential to transform the nursing home work environment and improve quality of care through education, research, advocacy, and implementation of evidence-based practices.

Nursing surveillance and immediate jeopardy in Veteran Health Administration community living centers unannounced survey program 2018 to 2019.

Background: The VA Community Living Center (CLC) Unannounced Survey Program aims to assess standards of care set by the government to protect residents.

Purpose: To describe patterns of practice failures in nursing surveillance causing or having potential to cause immediate jeopardy, as defined by the Centers for Medicare and Medicaid Services.

Methods: Using CLC survey data consisting of 200 statements of deficiency (SODs) for 2018 to 2019, we collected a SOD sample (n = 20) of immediate jeopardy events.

Appropriate Nurse Staffing Levels for U.S. Nursing Homes.

US nursing homes are required to have sufficient nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident. Minimum nurse staffing levels have been identified in research studies and recommended by experts. Beyond the minimum levels, nursing homes must take into account the resident acuity to assure they have adequate staffing levels to meet the needs of residents.

Using the Observational Teamwork Assessment in Surgery Instrument to Measure RN Teamwork During Cardiac Surgery: Lessons Learned.

Background: Surgical teams aspire to be safe and avoid preventable deaths. A lack of teamwork has been associated with safety failures, including adverse events and errors.

Purpose: The purpose of the pilot study was to: (1) modify the Observational Teamwork Assessment in Surgery (OTAS) and the original data collection method to measure registered nurse (RN) teamwork during the intraoperative phase of 5 open heart surgical procedures and (2) recommend strategies to further test the reliability and validity of the modified OTAS.

Examining the Beliefs of Skilled Nursing Facility Directors of Nursing Regarding BSN Completion and the Impact of Nurse Leader Education on Patient Outcomes.

Research suggests that acute care patients cared for by baccalaureate-educated nurses have better outcomes. Directors of nursing (DONs) in skilled nursing facilities (SNFs) have lower rates of baccalaureate attainment than acute care nurses for unclear reasons. To understand the interest in advancing education, researchers surveyed SNF DONs in Connecticut to examine their beliefs about academic advancement and the impact of DON education on resident outcomes.

Virtual Breakthrough Series, Part 1: Preventing Catheter-Associated Urinary Tract Infection and Hospital-Acquired Pressure Ulcers in the Veterans Health Administration.

Background: In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs).

Methods: During the prework phase, participating facilities assembled a multidisciplinary team, assessed their current system for CAUTI or HAPU prevention, and examined baseline data to set improvement aims. The action phase consisted of educational conference calls, coaching, and monthly team reports.

Recommendations From the International Consortium on Professional Nursing Practice in Long-Term Care Homes.

In response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regarding the current state of professional nursing practice in LTCHs. At its invitational, 2-day inaugural meeting, the Consortium brought together international nurse experts to explore the potential of registered nurses (RNs) who work as supervisors or charge nurses within the LTCHs and the value of their contribution in nursing homes, consider what RN competencies might be needed, discuss effective educational (curriculum and practice) experiences, health care policy, and human resources planning requirements, and to identify what sustainable nurse leadership strategies and models might enhance the effectiveness of RNs in improving resident, family, and staff outcomes. The Consortium made recommendations about the following priority issues for action: (1) define the competencies of RNs required to care for older adults in LTCHs; (2) create an LTCH environment in which the RN role is differentiated from other team members and RNs can practice to their full scope; and (3) prepare RN leaders to operate effectively in person-centered care LTCH environments.

The Relationship Between Registered Nurses and Nursing Home Quality: An Integrative Review (2008-2014).

Nursing home care is expensive; second only to acute hospital care for inpatient Medicare costs. The increased focus on costs of care accrued by Medicare beneficiaries in nursing homes presents a valuable opportunity for registered nurses (RNs) to further demonstrate quantitatively the value they add to the capacity of the nursing home nursing skill mix to provide cost-effective and efficient quality care. Most of the studies included in this review consistently reported that higher RN staffing and higher ratios of RNs in the nursing skill mix are related to better NH quality.

Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices.

Development of the comprehensive care plan (CCP) is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework-the Resident Assessment Instrument (RAI). Consistent compliance with this requirement has been difficult to achieve.

Pressure ulcer prevention in nursing homes: nurse descriptions of individual and organization level factors.

Sustaining pressure ulcer prevention (PUP) in nursing homes has been difficult to achieve. Implementation science researchers suggest that identification of individual staff and organizational factors influencing current practices is essential to the development of an effective and customized plan to implement practice changes in a specific setting. A mixed methods approach was used to describe nurses' perceptions of individual and organization-level factors influencing performance of PUP in two Veterans Health Administration (VHA) nursing homes prior to implementation of a national VHA initiative on Hospital Acquired Pressure Ulcers (HAPUs).

Quality assurance and performance improvement in nursing homes: using evidence-based protocols to observe nursing care processes in real time.

The Quality Assurance and Performance Improvement Initiative, a component of the Affordable Care Act (2010), is a new approach to quality improvement for US nursing homes. The article describes components of the Quality Assurance and Performance Improvement Initiative, the unique contributions of registered nurses to its implementation, and data collection strategies using direct observation and evidence-based measures and protocols in a Quality Assurance and Performance Improvement program.

Observing how RNs use clinical time in a nursing home: a pilot study.

Registered nurses (RNs) working in nursing homes (NHs) are a scarce professional resource. Their responsibilities include direct (e.g.

The pivotal role of the director of nursing in nursing homes.

The impending wave of aging boomers heightens long-standing concerns for the quality and cost of nursing home care. As industry and policy leaders continue efforts to remedy substandard nursing home care delivery practices, development of a well-prepared and adequately supported workforce of directors of nursing (DONs) is essential to ensuring the industry's readiness for the aging wave population. Directors of nursing are in pivotal positions to influence nursing home quality and costs; however, research demonstrating the extent of this influence-actual and potential-is lacking, and industry leaders have collectively failed to address the current or future capacity of this workforce.

Best practices in nursing homes. Clinical supervision, management, and human resource practices.

Human resource practices including supervision and management are associated with organizational performance. Evidence supportive of such an association in nursing homes is found in the results of numerous research studies conducted during the past 17 years. In this article, best practices related to this topic have been culled from descriptive, explanatory, and intervention studies in a range of interdisciplinary research journals published between 1990 and 2007.

Nursing staff descriptions of clinical supervision and management inVeterans Affairs-affiliated nursing homes.

Forty nursing staff from 2 urban VA-affiliated nursing homes participated in separate focus groups for certified nursing assistants, licensed vocational nurses, and registered nurses. Staff described their experiences with nursing supervisory and managerial staff work behaviors related to 5 common clinical practices, including incontinence, mobility, nutrition, pain, and pressure ulcer management. Themes associated with these behaviors were identified using content analysis.

The work of the RN Minimum Data Set coordinator in its organizational context.

The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) is the foundational clinical framework for nursing home care, functioning as both a clinical assessment instrument and an assessment process. An RN is mandated by statute to complete or coordinate the work associated with this framework. Using both focus groups and questionnaires, 24 RN MDS coordinators attending a national conference for MDS coordinators described their work in its organizational context.

Implementation of the resident assessment instrument/minimum data set in the nursing home as organization: implications for quality improvement in RN clinical assessment.

The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) used in nursing homes (NHs) participating in the Federal Medicare and Medicaid programs is a state-of-the-art, computerized clinical assessment instrument. RAI/MDS-derived data are essential, used for NH reimbursement, quality measurement, regulatory quality monitoring activities, and clinical care planning. Completing or coordinating the RAI/MDS, which may be conceived of as implementation, is a federally mandated responsibility of the RN involving clinical assessment, a core professional competency of any RN.

Self-monitoring of a stress reduction technique using wrist-worn counters.

In a study of 59 veterans and healthcare workers, the reliability of a self-monitoring method used to track the frequency of a spiritually oriented stress reduction technique was assessed. During a 5-week program of silently repeating a mantram (a spiritual word or phrase) to lower stress and anger and improve spiritual well-being, portable wrist-worn counters were used to track daily mantram practice sessions. All outcomes significantly improved in the hypothesized direction.

Organizational correlates of the risk-adjusted pressure ulcer prevalence and subsequent survey deficiency citation in California nursing homes.

Organizational correlates of the risk-adjusted pressure ulcer prevalence and subsequent deficiency citation in nursing homes are not known. The purpose of this study was to examine the relationships between these two outcomes and selected organizational variables, including total nurse staffing levels, specialization, centralization, nursing wages, and facility ownership. Secondary data analysis was conducted on a sample of 897 California nursing homes included in the 1996 On-line Survey Certification and Reporting system and the Office of Statewide Health Planning and Development financial disclosure reports of individual California nursing homes.

Using the Resource Utilization Groups (RUG-III) system as a staffing tool in nursing homes.

Nurse managers working in nursing homes are challenged to develop strategies that maintain a balance among quality of care, nurse staffing levels, and workload within the context of federal and state nurse staffing requirements for nursing homes. One strategy to consider is the use of the Resource Utilization Groups (RUG-III) staffing benchmarks that are associated with each of the 44 resident classification groupings that comprise the RUG-III system. The RUG-III system is described.

Interdisciplinary care planning and the written care plan in nursing homes: a critical review.

Purpose: This article is a critical review the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes.

Design And Methods: We reviewed educational and empirical literature.

Results: Interdisciplinary care planning and the written care plan are mandated processes that are imbedded in the regulatory fabric and routines of the American nursing home.