Nurses Working Together to Improve Care and Increase and Expand Our Workforce
Article Outline
- What Can Nurses Do to Help Overcome These Issues?
- The Many Ways to Teach
- Informal Educational Opportunities via Inservice Education
- Ongoing Monitoring
- Additional Formal Education Opportunities
- Copyright
Dr. Barbara Resnick
Regardless of your opinion (or mine) about how bad the nursing shortage is now or how bad it will be in the near future, the nation is currently short 116,000 nurses, and this is predicted to worsen to 500,000 by 2025. Today 3 million registered nurses play a central role in U.S. health care, affecting lives with regard to disease prevention and management, improving clinical outcomes, and facilitating comfort care at the end of life.
More than 2.6 million workers, including nurses, nurse's aids, home health aids, and other health care workers, provided long-term health care in 2007, up 21% since 2002. The need for additional long-term care workers is expected to rise by another 27% percent by 2016. The demand for long-term care workers is anticipated to grow as the 78 million baby boomers age. According to the AARP Public Policy Institute, approximately 69% of people aged 65 or older today will require some sort of long-term care, with an average duration of 3 years over their lifetime. It is clear, therefore, that there is an increased need for nurses at all levels. The consumer demands and expectations of these providers also continue to expand. This can be extremely challenging for nurses who went to nursing school more than 10 years ago. They are expected to remain current with regard to medical management, pharmacotherapy, and nursing interventions and may not have the opportunities to access new information in a timely fashion. Moreover, the issues around health care policy, scope of practice, and what can be done in different types of health care settings changes and evolves. Thus we have a workforce issue as well as challenges to maintain and grow a workforce that has exemplary clinical skills and knowledge to provide care for an increasingly well-educated older population—us, the aging baby boomers!
What Can Nurses Do to Help Overcome These Issues?
I believe the nursing shortage provides us with a terrific opportunity to improve nursing care provided to older adults, and optimize or improve outcomes across all clinical settings. I propose we teach each other. I am not referring to traditional nursing education, which is focused on increasing workforce through the development of new nurses. Rather, I am referring to sharing nursing knowledge across and between levels of nursing. Doctoral and master's prepared nurses are working in leadership positions or as advanced practice nurses, baccalaureate prepared nurses work in a variety of clinical settings, and degree nurses (registered nurses and licensed practical nurses) make up the majority of the long-term care workforce. Direct care workers are critical to all health care settings, although the majority continue also to work in long-term care sites. We have opportunities to teach and learn from each other in these environments and thereby increase knowledge, skills, and quality of care, as well as improve job satisfaction for all of us.
The Many Ways to Teach
I say lets start capturing the moment and utilize one-on-one teaching between nurses and direct care workers at the bedside with regard to assessment skills, understanding of behavioral symptoms, and ways to manage those symptoms. Nurse practitioners working in the long-term care arena should take a moment with each order written to explain the rationale and importance of the intervention and request the support of the staff to make sure it happens. Likewise, we need to follow up with nurses and direct-care workers to monitor the impact of an intervention and discuss why it may or may not have been effective. When we see care that something may not be optimal, we need to step in and model the ideal. Maybe this involves interactions during bathing or at meal times or motivational interventions to engage the resident in physical activity or adhering to a pharmacologic intervention. Does this type of teaching and role modeling work? I believe it does. Such modeling takes persistence and a coordinated effort on the part of all nurses, but it is a terrific first step toward increasing awareness and knowledge and ultimately changing behavior.
Informal Educational Opportunities via Inservice Education
In addition to a bedside one-on-one approach, there is an opportunity to take advantage of informal small-group educational experiences. Traditionally in educational endeavors, it is assumed that the learner knows nothing and needs to learn and know everything. Consequently, the teacher starts at the beginning and delivers everything known to be important on the topic. In teaching adults, this is never a good option. Moreover, health care is an art as well as a science, and thus accrued knowledge is variable among individuals and cannot be ignored. In teaching adults, it is important to start by asking what they know and believe about a topic. Ask open-ended questions such as “Tell me what you already know and/or believe about ….” Encourage the adult learner to express his or her ideas about the solution to the problem and then take the opportunity to share and demonstrate your own understanding of the topic and treatment. You may find that while you teach some information, you also learn some important new thoughts that are based on real-world clinical interactions.
When teaching specific psychomotor skills such as completing orthostatic blood pressures or using a bladder scanner, allowing the learner to practice in a safe environment is critical. A safe environment includes one in which there is room for error without judgment or punitive responses. Always try and remember the first time you may have done the procedure and share what helped you through that experience.
Another useful technique when teaching each other is to ask lots of questions to engage the learner and expand your own learning. Consider the “what ifs”? For example, if you are teaching bladder scan techniques, what if you get a result of 0? What if you are unable to find the bladder? Together you can figure out the next steps to take in the scenario.
Ongoing Monitoring
Education is the first step to improving care and clinical outcomes, but education in and of itself does not change behavior. Ongoing monitoring and oversight is needed to ensure that learning is put into practice. This oversight should not be of the punitive type. Rather, it is should take the form of community responsibility for optimal patient care and safety. For example, if teaching about methicillin-resistant Staphylococcus aureus infections and ways in which to prevent the spread in an assisted-living setting, it is critical that nurses monitor and help each other adhere to strict handwashing recommendations, limit sharing of equipment across residents, and aggressively clean the environment. Simply reminding a colleague to take the time to wash his or her hands before moving on to the next resident may be helpful in continuing the learning process.
Additional Formal Education Opportunities
In addition to one-on-one or informal small-group educational opportunities at the worksite, there is a tremendous need for nurses, at all levels, to participate in national meetings. In so doing, they have the opportunity to learn new clinical, management, and policy information, as well as network with others doing similar work. Also, we need to consider relevant and innovative ways that support attendance to nursing conferences. An example may include developing a scholarship fund within a facility to send a nurse or direct-care worker to conferences such as the Assisted Living Nurses Association annual meeting, the National Gerontological Nurses Meeting, or the Gerontological Advanced Practice Nurses Association meeting. Raising money to send a deserving staff member to the meeting, covering a shift for a colleague to attend, or approving time off are also ways that nurses can support each other in education and quality of care.
I challenge us all to use every opportunity to teach each other during clinical encounters and everyday activities. In addition, share information about the nursing meetings listed here with colleagues who would benefit from participation. By working among ourselves in nursing and reaching out to our interdisciplinary colleagues as appropriate to further our education, I believe we can optimize care and increase our numbers of nursing staff. Well-educated, confident, and comfortable workers in the current health care environment will result in a happy workforce. Given our current economic environment, this is particularly important because we all may be working in nursing indefinitely!
Please share the following information about meetings with your colleagues:
PII: S0197-4572(09)00218-3
doi:10.1016/j.gerinurse.2009.06.001
© 2009 Mosby, Inc. All rights reserved.
