Working in long term care has been a very rewarding career. I worked at MGH in Boston prior to joining the long term care industry. I remember being a little bored when I first joined the team. In The 80’s long term care facilities were more like a home away from home for our seniors. They did not receive complex care for that was reserved for the hospital. The most difficult care provided was providing wound care, oxygen therapy, and enteral feeds via a g-tube or ng tube. One Nurse would provide medications to 41 residents and the other nurse on the unit would complete any treatments needed until the med nurse finished the med pass to take over. The other nurse would then go back to the desk and take any doctors orders for new meds as well as write any nursing notes needed. More time was spent with the residents visiting in their rooms or doing other activities like exercise groups for fun and walking programs. You usually had 5 nursing assistants to complete the adl care for the residents. Again care was completed by 10 am with time for fun and mobility activities.

The evening shift comprised of 1 nurse who provided meds and treatments with 5 aides to do evening care. Again residents were walked prior to supper and provided pm care post supper. They usually stayed awake for a while and were in bed by 9pm. Last rounds were at 10pm to ensure everyone had what they needed prior to going to sleep. The nightshift comprised of 1 nurse and 2 aides. Staff did rounds at least every 2 hours to ensure anyone who had a toileting need or any concerns were provided care. Nursing staff that chose long term care as a career choice most likely did due to being able to provide care and make a difference in the everyday moments in the resident’s life.

Today life is very different working in Long term care. Staffing Patterns on Long term care units for the same number of residents have relatively remained the same but the care has changed. Nurses are now required to complete more comprehensive assessments and care for residents with higher acuity. Some residents have surgery and then are in skilled facilities within 1-3 days especially now due to the Medicare Waivers in place. It is not uncommon to work in a facility that accepts complicated wound care, and residents who require aftercare for surgical procedures. You may have a resident that requires IV’s, total parental nutrition and have a tracheotomy. Those residents are usually on a dedicated floor with Nurses that are dedicated and trained to provide the care.

Fast forward 2023. The nursing profession is now challenged with a staffing Shortage.

Click on below to see Fact sheet.

https://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet.pdf

“In March 2022, the American Nurses Foundation and the American Nurses Association released the results of its COVID-19 Impact Assessment Survey, which found that 52% of nurses are considering leaving their current position due primarily to insufficient staffing, work negatively affecting health and well-being, and inability to deliver quality care. In addition, 60% of acute care nurses report feeling burnt out, and 75% report feeling stressed, frustrated, and exhausted.” Cited from https://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet.pdf

Nurses in the Long Term Care industry must think out of the box to meet the current challenges of the nursing shortage. We should recognize that yes there is a shortage but aging nurses retiring is not the only reason for the shortage. Companies are pivoting how care is delivered related to the staffing dilemma and this may or may not sit well with staff. The word transparency comes to mind when I think about the staffing challenge. Companies do need to pivot how care is delivered but the how and why should be transparent. Staff respond to change so much better if they are informed and have a chance to digest the change.

Other Incentives for Staff may be:

The ability to have flex shifts or job share between staff.

Support programs for staff for mental health

Ability to take breaks, and ability to go off site for a break.

Ability to work on the unit that excites them. Not every nurse wants to work on the short term rehab unit. Re-interview staff and identify their strengths

Providing equal pay for experience level. Ensure the new staff hired is not being paid at a higher rate than staff that have worked for the company longer.

Providing education for staff to protect themselves from work place violence.

Provide education on how to care for the younger, homeless residents that are now being admitted to long term care facilities.

Ensuring that staff working on a behavioral unit receive the education needed to deescalate a potential negative outcome.

Ensure that leadership provides 1:1 meetings with staff to identify concerns and gives staff a voice for the solution to perceived concerns.

Most importantly acknowledging staff by name, having eye contact, engaging staff and thanking them for their efforts each day.

The information presented is informative and does not constitute direct legal or regulatory advice

September 2024\Skilled Nursing Support\maria.messina@skillednursingsupport.com

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