- As per the estimations from the U.S. Census Bureau, the elderly population is projected to grow from forty million to up to seventy-two million between the timeline of 2010 and 2030.
- A majority of elderly people living in aged care homes are classified as requiring “high care”.
- A number of research studies have shown that the higher nurse-to-resident ratio would improve elderly patient outcomes.
The primary role of nursing home nurses is to provide care for elderly or disabled patients. On a fundamental level, these nurses would work to ensure that the patients are maintaining the acceptable levels when it comes to personal hygiene and proper nutrition. The roles and duties of these nurses could get to more advanced levels like monitoring vital signs, setting up IVs, giving medications, and drawing blood samples. So, what’s the need for these nursing home nurses in the present day? The answer is here.
Increasing Elderly Population
As per the estimations from the U.S. Census Bureau, the elderly population is projected to grow from forty million to up to seventy-two million between the timeline of 2010 and 2030. And, as per the estimations from the U.S. Bureau of Labor Statistics, the increasing elderly population would result in employment growth for a range of occupations associated with older people care. In this line, it has been said that the employment growth is inevitable in nursing homes and same is the case of nursing home nurses too.
Increasing Need for Nursing Home Nurses
A majority of elderly people living in aged care homes are classified as requiring “high care”. Most of the people are found to have the conditions like:
The handling of these complex health conditions and/or the combination of health conditions is increasing the need for nursing home nurses. All over the country, there is an increasing demand for the experienced registered nurses in the nursing homes. But, some nursing home providers are looking to reduce the costs by hiring less-skilled personal care assistants who are not sufficiently trained for this job.
Skills and Training Required for Nursing Home Nurses
Nurses who are working in nursing homes would require a different skill set when compared to the nurses in hospitals or clinic. Only these special skills would help them focus their care towards the needs of the residents. The primary factors that set these nursing home nurses apart from the other nurses are the following:
- Case management
Thus, the registered nurses in the nursing homes have to be trained to evaluate, monitor, as well as manage complex health conditions. It’s to be noted here that these skills are not required for the personal care attendants.
Requirements of Nurse-Resident Ratios in Nursing Homes
A number of research studies have shown that the higher nurse-to-resident ratio would improve elderly patient outcomes. Moreover, if these are the registered nurses rather than licensed practical nurses, the quality of care improves further. But, unlike the other health care centers like hospitals and childcare centers, there is no requirement for the use of registered RNs in the nursing home facilities. At present, the regulatory administration of nursing homes is primarily based on the act called “Nursing Home Reform Act (NHRA)”. This act was part of the OBRA Act of 1987. It’s to be noted that this legislation was spurred by the horrific tragedies in the nursing home facilities all over the country.
Within the OBRA act, it’s mandatory for each and every nursing home to have enough nursing staff to provide nursing and other related services in order to attain and/or maintain the highest level of well-being of all the nursing home residents, may it be the physical, mental, or psychosocial ones. As such, there are no regulations in place that tells the minimum ratios of nurse-resident with an exception. According to OBRA, a skilled nursing home should have an RN for eight consecutive hours a day, seven days a week, and that there should be a registered nurse designated as “Director of Nursing” on a full-time basis.
Here, an important thing to be noted is that this minimal requirement holds true for both the small, as well as large facilities, irrespective of the number of residents. This requirement is the same irrespective of whether the clinical acuteness is less or more. Also, there are some nursing home facilities that are applying for a waiver from the “Centers for Medicare and Medicaid Services”. If granted, these facilities will be exempted from meeting these requirements.
Barriers to Nurse Employment in Nursing Homes
It’s pretty from the above-mentioned point that the nursing homes don’t even have to employ nurses. People who are using nursing homes could immediately figure out there is no enough supply of nursing staff. Several nursing homes are not having any RNs, especially during the evenings and nights. Here, a point that has to be remembered is that unlike the hospitals and other health care facilities, there will no duty doctors all the 24 hours in a day in these nursing homes. In other words, it can be said that the registered nurse is the only medical professional on staff.
Apart from these inadequate regulations, there are some more barriers to the recruitment of registered nurses to the nursing homes. An important one is the reimbursement rates for the care offered, which is very low. The administrator of the facility will be very much aware that the pay for an RN is much higher when compared to that of LPN and CNA. Furthermore, the turnover rates of nurses are very high right from the historical times. On an average, almost fifty percent of nurses are found to be leaving their organizations every year.
Information about Other Staff in Nursing Homes
Among the new standards that are established by the OBRA, the important one is the training for CNAs. According to this standard, the nursing assistants have to complete a 75-hour program and must pass the licensing exam. Here, it’s to be noted that there is no regulation within OBRA that dictates who would administer the medications to the residents of nursing homes. Therefore, the majority of the nursing homes are found to be having the LPNs as the licensed nurses on board. Their salaries are almost one-third than those of the registered nurses.
But, the LPNs can’t be considered as equal to the registered nurses as they are often called as “profession’s technicians”. In the line of licensure aspects, the RNs are the only professionals who are credentialed and qualified to evaluate resident’s conditions and to determine their required and LPNs are not.
What Can be Done to Fill the Gap?
The health care professionals can advocate legislators to make necessary alterations in the staffing needs so as to be in line with the evidence from the research studies. It’s widely accepted that more RNs would mean better patient care and in turn, better outcomes and hence, the legislators should be made aware of this. They must be informed that nursing homes are the facilities offering more complex care than several other health care facilities and that the old staffing trends won’t be suitable for them today. Also, proper reimbursements should be demanded to the nursing home nurses as comparable to the other facilities. Finally, the continuous support to the new nursing graduates has to be provided remembering the fact that they are the nursing homes’ future.