To advance the quality of care and of life for residents and patients in skilled
nursing facilities through strengthening the professional practice of registered
- Individuals in skilled nursing facilities have a high quality of care and life
and are satisfied with this care
- Families are satisfied with the care their family members receive
- Registered nurses are valued for their individual and collective accountability
for resident’s/patient’s quality of care and life
- Skilled nursing facilities are valued by the public and embraced as a desirable
care and living option
To support the knowledge, professional development and leadership growth of
nurses who provide care to older adults in skilled nursing facilities.
The Nursing Home Collaborative (NHC), a precursor to The Center for Nursing
Excellence in Long-Term Care™ (The Center), was created in 2007 with funding from
Atlantic Philanthropies to address the ongoing challenges associated with
providing quality care to patients and residents in skilled nursing facilities
(SNFs). The NHC was initially comprised of representatives from each of the five
original John A. Hartford Centers of Geriatric Nursing Excellence (HCGNE), the
skilled nursing facility industry, long-term care nursing organizations, quality
of care advocacy groups and Quality Improvement Organizations (QIOs). Since the
initial planning year, this collaboration has been expanded to include the
additional four HCGNEs and the Honor Society of Nursing, Sigma Theta Tau International (STTI).
The Atlantic Philanthropies provided an additional grant to help the NHC, in
collaboration with STTI, develop a business plan for sustainability. As a result
of this business planning effort, STTI launched The Center in 2009.
What is the Center for Nursing Excellence
in Long-Term Care™?
The objective of the Center for Nursing Excellence in Long-Term Care™ is to
support the knowledge, professional development and leadership growth of nurses
who provide care to older adults. STTI’s collaborative initiative will result in
the development of several tools and resources that will transform nurses’ roles
and enable them to take a stronger leadership position within their environments
to ensure quality care and life for patients and residents of long-term care
STTI’s Center for Nursing Excellence in Long-Term Care™, in collaboration with
experts from the Harford Centers of Geriatric Nursing Excellence, skilled
nursing facilities, national providers, trade associations and geriatric
consumer groups, is developing a portfolio of products and services to fulfill
its mission to transform the role of the registered nurse in the long term care
A primary opportunity to improve the quality of care and quality of life for
patients/residents in SNFs lies with registered nurses (RNs). Not only are RNs
the supervisors, leaders and coordinators of patient/resident care and of the
paraprofessionals who provide direct care in SNFs, they also provide direct care
to patients/residents. Given the increasingly complex and challenging
environment of SNFs and the central role of the RN within the SNF, well-prepared
and capable RNs are essential to SNF success. Mounting evidence demonstrates
that the quality of care for patients/residents in SNFs is improved when RNs are
well prepared in gerontological nursing, highly skilled in leadership and
management, educated and involved in quality improvement processes, and work
in a SNF that supports and fosters the accountability and professional
development of the RN.
Investment in the SNF workforce is becoming a national priority, potentially
motivating SNF providers to devote more resources to strengthening the
competencies of their RN staff. For example, the 2008 IOM report, “Retooling for
an Aging America,” has elevated quality improvement, workforce development and
improvement in measurable resident outcomes as important priorities in national
politics. In addition, Senate Bill 2641, introduced in 2008 by Senators Chuck
Grassley and Herb Kohl, proposes that SNFs must include wage and benefit
expenditures for nursing staff on cost reports; that turnover, retention and
hours of care provided by each category of nursing be collected electronically;
and that the publicly available information on Nursing Home Compare, which
currently includes the number of RNs, LPNs and CNAs, also includes turnover and
retention rates. This effort indicates the growing pressure on SNFs to invest in
programs that will lead to improved staff recruitment and retention.
SNF providers also face extremely high turnover rates. Replacing clinical staff
can be very costly. The direct costs associated with turnover include
administrative processing, advertising and interviewing for open positions,
training, and orientation. Indirect costs may include lost productivity until a
replacement is trained, reduced service quality, and reduction in care hours
provided. Estimates of the cost of replacing an RN vary widely based on which of
these costs are included in the calculations and range anywhere from upwards of
$5,000 to $35,000.
Several recent reports highlight the relationship between turnover rates, job
satisfaction and quality of care. Job satisfaction, unsurprisingly, is highly
associated with reduced turnover. Both have a positive impact on quality of
care. Moreover, a reciprocal relationship exists between turnover and quality:
Nursing staff prefer to work in facilities that they perceive as high quality.
Importantly, turnover rates of RNs are highly associated with the turnover rates
of direct-care workers within a SNF. This finding suggests that the job
satisfaction of nursing professionals is an important factor in the job
satisfaction of paraprofessionals.
Products and Services
Through a comprehensive literature review of the field of nursing in skilled
nursing facilities that was published as a special issue of Research in
Gerontological Nursing and dialogue with numerous stakeholders, it was concluded
that the best way to support the professional practice of nursing in skilled
nursing facilities and improve the quality of care and quality of life for
patients/residents was to develop a portfolio of needed and currently
unavailable services and products.
This portfolio of products and services will support the knowledge, professional
development and leadership growth of nurses who provide care to older adults in
SNFs. Once implemented, these products and services will strengthen the role of
the RN and lead to the transformational change in RN practice in SNFs.
While SNFs have implemented many programs to improve quality of care and
clinical outcomes, each of them has been developed and implemented in isolation.
In addition, to date, no initiative has focused on providing the RN with the
skills to foster the competencies necessary to lead, deliver quality of care and
improve clinical outcomes. Even though the essential RN competencies and nursing
facilities organizational structures are so interrelated, The Center is the
first and only effort to address them holistically through an integrated suite
of thoroughly researched, evidence-based products and services.
About the Collaborating Partners
Executive Committee and Advisory Group