A UMSON clinical instructor publishes a paper highlighting the work of Bachelor of Science in Nursing students at the Keswick Multi-Care Center.
Photo: Left to right, USMON baccalaureate nursing students participating in a Teaching Nursing Home initiative as part of the Johns Hopkins Geriatric Workforce Enhancement Program: Rivka Grosberg, Michelle Reeves, Joi Scott, Esther Speizer, Taylor Cross, Emma Kondeh, Robin Payne, Madeline Petrusky, and Deborah Anokye
Melissa McClean, MSN, CRNP, ANP-BC, ACHPN, CNE, clinical instructor, recently published an article, “Bolstering the Workforce Through Geriatric Workforce Enhancement Programs,” highlighting the work of BSN students and UMSON partners, in the October 2024 issue of Caring for the Ages, the official newspaper of the Post-Acute and Long-Term Care Medical Association (PALTmed).
The article was also highlighted in the PALTtalk with Caring podcast with Dr. Karl Steinberg, MD, CMD (host), and UMSON’s Elizabeth Galik, PhD, CRNP, FAAN, FAANP, professor and chair of the Department of Organizational Systems and Adult Health (editor-in-chief, Caring for the Ages). McClean had the opportunity to describe students' experiences with a Geriatric Workforce Enhancement Program (GWEP) program and how it aims to increase education in age-friendly care for baccalaureate nursing students.
Caring for the Ages provides news to clinicians working in the post-acute and long-term care setting. McClean’s article focused on a recent clinical experience with UMSON BSN practicum students who participated in a program at Keswick Multi-Care Center in Baltimore that increased their knowledge and skills in caring for older adults. The program, a partnership between UMSON and the Johns Hopkins GWEP, was made possible through funding from the Health Resources Services Administration.
With permission from the publisher, the full text of McClean’s article is below:
Bolstering the Workforce Through Geriatric Workforce Enhancement Programs
I recently received an email from a former baccalaureate nursing student. She expressed interest in employment opportunities at the nursing home where she had attended a clinical experience as part of her final practicum course. I swiftly reached out to my Geriatric Workforce Enhancement Program (GWEP) colleagues to share the good news. Once I confirmed they would be willing to connect the student with the correct contact at the facility, I replied to the student confirming someone would be in touch and wished her well in her career transition.
This student’s interest in nursing home employment provided a sense of hope for myself and my colleagues. It confirmed that our recent efforts to introduce geriatric-focused content in our baccalaureate training program held promise for the post-acute and long-term care field. In my experience as a nurse educator in an urban, state-funded academic institution, recently licensed nurses do not often seek jobs in nursing homes or other PALTC settings. This is often due to a lack of exposure in their training programs and few career paths for new graduates (J Prof Nurs2023;46:A1–A2).
This article is intended for the many clinicians, administrators, academicians, and researchers interested in the current trends related to the PALTC workforce. It will provide an example of an Age-Friendly training program in a baccalaureate nursing program and review recommendations to usher the next generation of nurses into fulfilling careers caring for older adults.
Current Trends
There are 1.2 million Americans seeking care and residential services in nursing homes even though the quality of care provided in these settings has been under intense scrutiny for many years. Poor quality care can often be attributed to a nursing home workforce that is generally underpaid, overworked, and lacking education in geriatrics (HHS Office of Inspector General, “Lessons Learned During the Pandemic Can Help Improve Care in Nursing Homes,” Feb. 2024, https://bit.ly/OIG-lessons).
Workforce statistics confirm that nurses are not drawn to careers in nursing homes and PALTC. The U.S. Department of Health and Human Services’ National Center for Health Workforce Analysis released survey data from 2022 indicating that only 3% of nurses (116,583 nurses) across the United States work in long-term care or nursing homes, a reduction from the 4% (130,063 nurses) who reportedly worked in the same setting in 2018 (“NCHWA Nursing Workforce Dashboard,” Aug. 10, 2024, https://bit.ly/NCHWA-nursing).
The concerns related to workforce viability are coupled with recent changes in nursing home operations. The Centers for Medicare & Medicaid Services recently published a final rule holding U.S. nursing homes accountable for minimum staffing standards. Beginning August 8, 2024, nursing homes will be required to provide 3.48 hours of nursing staff per resident per day, to include 0.55 hours of care provided by a registered nurse and 2.45 hours of direct nurse aid care. Additionally, facilities will need to have a registered nurse available on-site for 24 hours a day, seven days a week, to provide skilled nursing care (“Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule [CMS 3442-F],” Apr. 22, 2024, https://go.cms.gov/3MjutH1).
The rule comes after decades of advocacy calling for minimum staffing standards to ensure the quality of care in nursing homes. To combat long-standing concerns with poor staff recruitment and retainment, CMS will also use $75 million to launch a nursing home staffing campaign to include scholarships and tuition reimbursement for nurses.
GWEPs and Age-Friendly Care
Academicians are called to recognize their role in equipping nurses with the knowledge and skills to provide high-quality care to older adults to aid in the success of CMS’s minimum staffing requirements. One approach to prepare the nursing home workforce is to introduce geriatric-focused content in training programs through GWEPs. GWEPs have many programming options to meet the needs of their community and stakeholders, and GWEPs can facilitate experiential learning opportunities for students and clinicians by connecting local facilities with schools of nursing.
Our GWEP uses a framework of care designed specifically for older adults. The 4Ms of Age-Friendly Care, initiated by the John A. Hartford Foundation in collaboration with the Institute for Healthcare Improvement and other organizations, is a framework that assists providers in offering care in alignment with four resident-centered pillars: (1) what matters, (2) medications, (3) mentation, and (4) mobility. (“Age Friendly Health Systems,” Aug. 11, 2024, https://bit.ly/IHI-afhs).
Beginning in 2022, each semester I have taken 12 final semester baccalaureate nursing students for a two-day experience in a partnering PALTC setting. With the assistance of my GWEP colleagues, I recruited interested students, prepared didactic content, and provided on-site clinical instruction including resident care. To date, we’ve taken nearly 40 students to the nursing home. After every semester, we review student feedback and make changes based on student interests and resident preferences.
In our most recent iteration, the students worked with residents to create a storyboard to inform family, friends, and health care providers what mattered most to them. One student reflected on the project and experience: “Although I was only with my patient for a day, I believe that the impact I had on her would be long lasting and help other health care team members dig deeper into her why.”
Enhancing Quality Care
Whether you are a clinician, administrator, faculty member, or researcher, we all have a role in bolstering the nursing home workforce to improve the quality of care for older adults in nursing homes.
- Clinicians can start by acting as an ambassador of the PALTC field and consider mentoring fellow health care providers who are interested in caring for older adults.
- Administrators and others in PALTC leadership can support GWEPs by fostering a partnership with your facility and local schools of nursing. You can also consider financially incentivizing staff who support the GWEP training program and encourage staff to identify as content experts through Age-Friendly certification.
- Faculty can identify PALTC clinical partners as sites for academic instruction, adopt geriatric-focused competencies in the curriculum, and incorporate geriatric-focused content in training programs (Nurse Educ Today 2024; 133: 106034).
- Researchers can analyze the impact of GWEP programs on workplace culture, prospective employment, and the quality of care. They can also explore nursing students’ attitudes toward the care of older adults, their knowledge of Age-Friendly care concepts, and their level of competence in nursing home care.
This article was originally published in the October 2024 issue of Caring for the Ages, the official newspaper of the Post-Acute and Long-Term Care Medical Association (PALTmed): https://www.caringfortheages.com/article/S1526-4114(24)00356-1/fulltext.
pictured: USMON baccalaureate nursing students participating in a Teaching Nursing Home initiative as part of the Johns Hopkins Geriatric Workforce Enhancement Program; l. to r.: Rivka Grosberg, Michelle Reeves, Joi Scott, Esther Speizer, Taylor Cross, Emma Kondeh, Robin Payne, Madeline Petrusky, and Deborah Anokye