Using RN Continuing Education as a Weapon Against Rising Costs and Threats to Quality

Transcription

1 Using RN Continuing Education as a Weapon Against Rising Costs and Threats to Quality To move long term care forward our industry must: Invest in the personnel who provide care for our residents; collect data to prove the value added and start with what research tells us. Robert Van Dyk, AHCA Chairman, Opening Ceremony remarks on Sept 20, 2011: AHCA/NCAL Annual Convention, Las Vegas, NV Heading Text Heidi Keeler, PhD, RN Nurse Planner, Gero Nurse Prep Faculty, UNMC College of Nursing Continuing Nursing Education Catherine Bevil, EdD, RN Director of Continuing Nursing Education, UNMC College of Nursing Continuing Nursing Education 1

2 Heading Text Kari Gawrych, RN-BC Staff Nurse, Brookstone Village, NE Rosalyn Burke, Adminstrator, Brookstone Village, NE UNMC CON CNE-Committed to Quality University of Nebraska Medical Center College of Nursing Continuing Nursing Education Housed within an academic medical science center Mission education Not for profit National accreditation as a provider by American Nurses Credentialing Center (ANCC) for 32 years Accredited with distinction by ANCC 2

3 Brookstone Village Skilled Nursing Facility providing rehab and long term care, Elkhorn, NE 140-bed rehabilitation and care center Surrounded by a beautiful lake and landscaped courtyards Provides Dignity in Life for each individual Long Term Care: A Perfect Storm Cost ; Reimbursement Quality of Care Demands Staff Turnover Increasing older adult population-demand for service 3

4 Purpose Discuss how the current LTC environment can be improved by an intentional, comprehensive continuing education program for RNs Objectives of Presentation 1. Correlate the attainment of RN board certification with standards of clinical excellence 2. Explore the relationships between comprehensive education, RN retention, and overall quality of care outcomes 3. Provide data supporting the business case for comprehensive RN education and professional development investment 4

5 Objective 1 Correlate the attainment of RN board certification with standards of clinical excellence How can we do this? FACT: There are few rigorous clinical research studies focused on outcomes in LTC Objective 1 We will use data from: 1. Nursing education standards for care of elders 2. Comparison of educational requirement with other professions 3. Existing literature on long term care outcomes 4. Testimonies from nurses 5

6 Nursing Education Facts on Nursing Workforce: 1. Average age of nurse is mid 40s and rising 2. Average nurse s education did not include gerontology 3. < 25% BSN programs and 0% ADN programs contain gerontological preparation Education and Events Normal standard of care, minor tweaks to policy here and there KEY POINT: Higher level of training can be the difference between good and bad outcomes in instances when emergent situations demand complex understanding and immediate evidence-based intervention KEY POINT: More difficult to track these near misses Complex illness with possible rapid decline Return to prior health status Negative outcome ie. Hospital readmission 6

7 What Differentiates Competence vs. Excellence? Specialty Board Certification Clinical experience and education NCLEX Exam for RNS Gerontology Education < 25% BSN programs 0% ADN programs Take a Look at Other Professions 80-85% MDs are board certified LMHPs RNs Board Certification MDs <1% RNs are board certified (Gero) SWs PTs/OTs RTs 7

8 What is Needed for Certification? 1. Hold an active RN license 2. Practiced at least 2 years as an RN 3. Have at least 2,000 hours specifically in gerontological nursing 4. Have 30 contact hours specific to gerontological nursing in the past 3 years. 5. Pass the 175 question ANCC certification exam What Does the Literature Say? Board Certified Specialist Patient mortality odds BC-RN Staff Nurse Generalist Kendall-Gallagher, et al. (2011) 8

9 What Does the Literature Say? Prior to gerontological training Nurses received online gerontological training and tested for certification. Looked at fall rates and work satisfaction pre and post program Number of Falls Decreased After gerontological training Lange, et al. (2009) Explaining the Lack of Hard Outcomes Staffing Ratios Patient Acuity Facility Landscape Leadership Goals Nursing Skill 9

10 Clinical Knowledge Gain Percent % Pre-/Post-test Scores Average Pre-test Score Average Post-test Score Administrator and Learner Testimonies: - I hear our certified nurses talking more in depth with each other about how to address tough clinical problems. There s a different level of critical thinking now. They say wait, let s step back and look at the bigger picture. -B.B., Facility Owner - I have become more patient with my approach, especially towards more "difficult" behaviors. -T.C., RN-BC - We changed practice and policy based on what we learned in the course and in the process of getting certified. K.R., RN-BC 10

11 Education and Events: Transference of Knowledge Since becoming certified, I have used what I have learned with my care team. For example, I now recognize that staff often used baby-talk with residents. This is not best practice, and can result in reduced resident satisfaction and quality of life. I led an inservice on the importance of using professional communication with our residents. I love being able to bring ideas that I have learned back to the staff so that we can provide better care for our residents. Heading Text Comments on Certification Kari Gawrych, RN-BC Staff Nurse, Brookstone Village, NE 11

12 Objective 2 Explore the relationships between comprehensive education, RN retention, and overall quality of care outcomes Quality of Care RN Retention Comprehensive Education Let s Start with Quality of Care: AHCA Quality Initiatives 1. Safely reduce hospital readmissions 2. Increase staff stability 3. Increase customer satisfaction 4. Safely reduce the off-label use of antipsychotics 12

13 Evidence from Research: Summary 1. RN staffing/education/board certification improved outcomes: Adverse events ER use Failure to rescue Mortality 2. Certification increased empowerment, job-related power 3. Certification improved turnover and retention rates Linking Education to Quality of Care States that education and training of staff is an essential element affecting quality resident of care Recommendation: All longterm-care settings should develop appropriate training, education...and training programs for staff IOM, (2001) 13

14 Staff Retention Long Term Care has the highest RN turnover rate From 25-60% Linking Retention to Quality of Care States that job satisfaction and turnover of staff are essential elements affecting quality resident of care Recommendation: Policy should focus on regulation to improve staff satisfaction and turnover rates IOM, (2001) 14

15 Linking Retention with Education Barrier to RN recruitment and retention in LTC: Lack of opportunity and available educational advancement Education=Investment = Opportunity Solution: Offer support for comprehensive educational programs and carer development opportunities Opportunity=More valued =More loyal Offer program with end goal: certification Barriers to Certification Top 5 Barriers to Obtaining Certification: Cost of examination Lack of institutional reward Lack of institutional support Lack of access to preparation courses or materials Discomfort with test taking process Niebuhr, B. & Biel, M. (2007). 15

16 Removing Barriers Top three cited successful incentives offered for certification: Reimbursement for examination fees Listing of certification credential(s) on nametag and/or business card Reimbursement for continuing education Niebuhr, B. & Biel, M. (2007). Objective 3 Provide data supporting the business case for comprehensive RN education and professional development investment 16

17 Business Case Long Term Care has the highest RN turnover rate From 25-60% Barrier to RN recruitment and retention in LTC: Lack of opportunity and available of educational advancement Estimated cost to replace one lost RN: $22-64,000 Bottom Line Investment in Staff Retain Cost of Doing Nothing: Rehire Jones, C., Gates, M., (2007) 17

18 Heading Text Comments on Business Case for Specialty Education Roz Burke, RN Facility Administrator, Brookstone Village Administrator Strategies for RN Success: What We Have Learned Strong administrative leadership Win-win partnership Clear completion time Monitor & reinforce progress Encouragement 18

19 Partnership: The Key to Certification Success RNs Facility Administrator UNMC Partnership: The Key to Certification Success Facility administrator role: Support of the institution Motivation of the participants Strong project leadership Lange, et. al

20 Heading Text How Does Gero Nurse Prep Provide Education Needed to Impact Quality Goals? Course screenshots within 2 presentations Origins of Gero Nurse Prep UNMC College of Nursing & LTC partners One of ten national awards funded by Robert Wood Johnson Foundation Address issues with Quality Work environment Staff retention Course designed for RNs 20

21 Gero Nurse Prep Designed for Certification Success Prepares RNs for ANCC Board Certification in Gerontological Nursing Board Certification: recognition of excellence in nursing specialty Course content mapped to current test outline Contains specialized content relevant for all care settings involving older adults Let s Start with Quality of Care: AHCA Quality Initiatives 1. Safely reduce hospital readmissions 2. Increase staff stability 3. Increase customer satisfaction 4. Safely reduce the off-label use of antipsychotics 21

22 Who Has Been Successful? Course Results Aggregate Data Number of RNs: 100 Time frame: Jan. 1 Sept. 11 Year: 2013 Pass rate: 98% Gero Nurse Prep Support Phone:

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