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Park Y, Min D. Registered Nurses' perspective of systemic factors affecting nursing home care quality decline: A qualitative descriptive study. Nurs Open 2022; 10:1900-1908. [PMID: 36373815 PMCID: PMC9912408 DOI: 10.1002/nop2.1474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
AIM A growing number of older people are living in nursing homes worldwide, but their safety and quality of care are not guaranteed. This study explores registered nurses' (RNs) perspectives on systemic factors affecting the quality of care and safety decline of nursing home. DESIGN Qualitative descriptive study. METHODS In this study, semi-structured interviews were conducted with 10 RNs working in six nursing homes, who were chosen through purposive sampling. Data were collected from 1 August-19 September 2019, and analysed using thematic analysis. RESULTS The following five themes were derived: lack of sufficient number of RNs, poor work conditions, unclear job descriptions for RNs, no official position of nursing director and absence of transition care system. PATIENT OR PUBLIC CONTRIBUTION All reports of RNs affecting resident safety and quality of care decline were related to systemic factors. Therefore, improving quality of care in nursing homes should be supported by changes in systemic factors, such as maintaining an appropriate number of RNs and improving their working conditions.
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Affiliation(s)
- Yunhee Park
- Department of Nursing, College of MedicineWonkwang UniversityIksanKorea
| | - Deulle Min
- Department of Nursing, College of MedicineWonkwang UniversityIksanKorea
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Asante BL, Zúñiga F, Favez L. Quality of care is what we make of it: a qualitative study of managers' perspectives on quality of care in high-performing nursing homes. BMC Health Serv Res 2021; 21:1090. [PMID: 34645441 PMCID: PMC8515763 DOI: 10.1186/s12913-021-07113-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Leadership has a vital role regarding quality of care in nursing homes. However, few studies have explored upper-level managers’ views on how to assure that residents receive high quality of care. Therefore, this study’s aim was to examine how managers of top-quality nursing homes define, develop and maintain high-quality of care. Method We used interpretive description, an inductive, qualitative approach. Our research included 13 semi-structured interviews with 19 managers. We analyzed their input using reflexive thematic analysis, which is an iterative approach. Results Quality development and maintenance are cyclic processes. Managers in high-performing nursing homes lead with high commitment towards a person-centred quality of care, creating appropriate working conditions and continuously co-creating a vision and the realization of quality of care together with employees. Conclusions This study confirms that, in high-performing nursing homes, a person-centered approach—one where both residents and employees are at the center—is essential for quality development and maintenance. The most effective managers exemplify “person centeredness”: they lead by example and promote quality-focused working conditions. Such strategies motivate employees to provide person-centered care. As this means focusing on residents’ needs, it results in high care quality.
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Affiliation(s)
- Brigitte Lalude Asante
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Lauriane Favez
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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Backman A, Lövheim H, Lindkvist M, Sjögren K, Edvardsson D. The significance of nursing home managers' leadership-longitudinal changes, characteristics and qualifications for perceived leadership, person-centredness and climate. J Clin Nurs 2021; 31:1377-1388. [PMID: 34405477 DOI: 10.1111/jocn.15999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim was to explore changes in nursing home managers' leadership, person-centred care and psychosocial climate comparing matched units in a five-year follow-up and to explore the significance of managers' educational qualifications and the ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate in the follow-up data. BACKGROUND Leadership has been described as crucial for person-centred care and psychosocial climate even though longitudinal data are lacking. The significance of managerial leadership, its characteristics, managerial qualifications and ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate also needs further exploration. DESIGN Repeated cross-sectional study. METHODS This study used valid and reliable measures of leadership, person-centred care, psychosocial climate and demographic variables collected from managers and staff n = 3605 in 2014 and n = 2985 in 2019. Descriptive and regression analyses were used. The STROBE checklist was used in reporting this study. RESULTS Leadership was still positively significantly associated to person-centred care in a five-year follow-up, but no changes in strength were seen. Leadership was still positively significantly associated with psychosocial climate, with stronger associations at follow-up. Six leadership characteristics increased over time. It was also shown that a targeted education for nursing home managers was positively associated with person-centred care. CONCLUSIONS Leadership is still pivotal for person-centred care and psychosocial climate. Knowledge of nursing home managers' leadership, characteristics and educational qualifications of significance for person-centred delivery provides important insights when striving to improve such services. RELEVANCE TO CLINICAL PRACTICE The findings can be used for management and clinical practice development initiatives because it was shown that nursing home managers' leadership is vital to person-centred care practices and improves the climate for both staff and residents in these environments.
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Affiliation(s)
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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Williams JA, Vriniotis MG, Gundersen DA, Boden LI, Collins JE, Katz JN, Wagner GR, Sorensen G. How to ask: Surveying nursing directors of nursing homes. Health Sci Rep 2021; 4:e304. [PMID: 34136659 PMCID: PMC8177897 DOI: 10.1002/hsr2.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS Nursing home research may involve eliciting information from managers, yet response rates for Directors of Nursing have not been recently studied. As a part of a more extensive study, we surveyed all nursing homes in three states in 2018 and 2019, updating how to survey these leaders effectively. We focus on response rates as a measure of non-response error and comparison of nursing home's characteristics to their population values as a measure of representation error. METHODS We surveyed Directors of Nursing or their designees in nursing homes serving adult residents with at least 30 beds in California, Massachusetts, and Ohio (N = 2389). We collected contact information for respondents and then emailed survey invitations and links, followed by three email reminders and a paper version. Nursing home associations in two of the states contacted their members on our behalf. We compared the response rates across waves and states. We also compared the characteristics of nursing homes based on whether the response was via email or paper. In a multivariable logit regression, we used characteristics of the survey and the nursing homes to predict whether their DON responded to the survey using adjustments for multiple comparisons. RESULTS The response rate was higher for the first wave than for the second (30% vs 20.5%). The highest response rate was in Massachusetts (31.8%), followed by Ohio (25.8%) and California (19.5%). Nursing home characteristics did not vary by response mode. Additionally, we did not find any statistically significant predictors of whether a nursing home responded. CONCLUSION A single-mode survey may provide a reasonably representative sample at the cost of sample size. With that said, however, switching modes can increase sample size without potentially biasing the sample.
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Affiliation(s)
| | - Mary G. Vriniotis
- Center for Community‐Based ResearchDana‐Farber Cancer InstituteBostonMassachusetts
- Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Daniel A. Gundersen
- Survey and Qualitative Methods CoreDana‐Farber Cancer InstituteBostonMassachusetts
| | - Leslie I. Boden
- Environmental HealthBoston University School of Public HealthBostonMassachusetts
| | - Jamie E. Collins
- Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Jeffrey N. Katz
- Orthopedic SurgeryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
- MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
- EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Gregory R. Wagner
- Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Glorian Sorensen
- Center for Community‐Based ResearchDana‐Farber Cancer InstituteBostonMassachusetts
- Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
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Kolanowski A, Cortes TA, Mueller C, Bowers B, Boltz M, Bakerjian D, Harrington C, Popejoy L, Vogelsmeier A, Wallhagen M, Fick D, Batchelor M, Harris M, Palan-Lopez R, Dellefield M, Mayo A, Woods DL, Horgas A, Cacchione PZ, Carter D, Tabloski P, Gerdner L. A Call to the CMS: Mandate Adequate Professional Nurse Staffing in Nursing Homes. Am J Nurs 2021; 121:24-27. [PMID: 33625007 DOI: 10.1097/01.naj.0000737292.96068.18] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.
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Affiliation(s)
- Ann Kolanowski
- The authors of this article are: Ann Kolanowski, PhD, RN, FAAN; Tara A. Cortes, PhD, RN, FAAN; Christine Mueller, PhD, RN, FGSA, FAAN; Barbara Bowers, PhD, RN, FAAN; Marie Boltz, PhD, GNP-BC, FAAN; Deb Bakerjian, PhD, APRN, FAAN, FAANP, FGSA; Charlene Harrington, PhD, RN, FAAN; Lori Popejoy, PhD, RN, FAAN; Amy Vogelsmeier, PhD, RN, FAAN; Margaret Wallhagen, PhD, GNP-BC, AGSF, FGSA, FAAN; Donna Fick, PhD, RN, FAAN; Melissa Batchelor, PhD, RN-BC, FNP-BC, FGSA, FAAN; Melodee Harris, PhD, RN, FAAN; Ruth Palan-Lopez, PhD, GNP-BC, FAAN; Mary Dellefield, PhD, RN, FAAN, Ann Mayo, DNS, RN, FAAN; Diana Lynn Woods, PhD, APRN-BC, FGSA, FAAN; Ann Horgas, PhD, RN, FAAN; Pamela Z. Cacchione, PhD, CRNP, GNP, BC, FGSA, FAAN; Diane Carter, MSN, RN, CS, FAAN; Patricia Tabloski, PhD, GNP-BC, FAAN; and Linda Gerdner, PhD, RN, FAAN . For author affiliations, please see http://links.lww.com/AJN/A205 . Contact author: Ann Kolanowski, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Siegel EO, Young HM. Assuring Quality in Nursing Homes: The Black Box of Administrative and Clinical Leadership—A Scoping Review. THE GERONTOLOGIST 2020; 61:e147-e162. [DOI: 10.1093/geront/gnaa175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background and Objectives
Licensed nursing home administrators (NHA) and directors of nursing (DON) are responsible for nursing home quality and assuring optimal performance and job satisfaction/retention of their nursing home workforce. NHA/DON-focused studies have generated important foundational knowledge over the last three decades; yet, targeted research is needed to understand and apply the complexities of the black box of this top management team. This scoping review identifies, reviews, synthesizes, and maps the topical areas of research in NHA/DON positions in U.S. nursing homes.
Research Design and Methods
We conducted searches of 5 databases, yielding 3,479 records; screening/review yielded 88 unique records. We used thematic analysis to code the primary foci of the studies and the variables associated with the concepts of interest.
Results
Most papers (n = 40) focused on role characteristics, 23 examined approaches to management and leadership, 24 focused on perceptions about the role, and the remaining 12 examined role structure. The role-related themes linked to outcomes (n = 42), processes (n = 27), and structures (n = 30).
Discussion and Implications
We highlight important gaps for future research and offer a call to action for research, policy, practice, and education collaborations to accelerate the rate of research and translate the findings into best practices for NHA/DON to lead and manage the nursing home workforce and build capacity to ensure person-centered, high-quality care. Based on foundational descriptive studies, it is time to use what is known to design and implement interventions that enhance the capacity of NHA/DON to improve the structures, processes, and outcomes of nursing homes.
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Affiliation(s)
- Elena O Siegel
- Betty Irene Moore School of Nursing, University California, Davis, Sacramento, USA
| | - Heather M Young
- Betty Irene Moore School of Nursing, University California, Davis, Sacramento, USA
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Miller VJ, Hamler T. A value-critical policy analysis of the nursing home reform act: a focus on care of African American and Latino residents. SOCIAL WORK IN HEALTH CARE 2019; 58:471-493. [PMID: 30920360 DOI: 10.1080/00981389.2019.1587660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/25/2019] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
Improving nursing home care has been a central legislative focus since the 1980s; The major response effort to address these reports of poor-quality care was first met with a federal rule in 1987, the Nursing Home Reform Act (NHRA). Since enactment of the NHRA in 1987, and despite an increasing utilization of nursing home care by aging minorities, the standardization of care practice, or quality indicators (e.g., structural, process, and outcome measures), within long-term nursing home care have remained relatively unchanged. This paper reports a value-critical policy analysis of the most recent final action rule, effective on November 28 of 2016 by the Centers for Medicare and Medicaid Services (CMS) with a particular focus on its impact on African-American and Latino older adults. This paper presents results of two policy analyses. Taken together, this merged analysis focuses on an overview of the problem, the groups most affected by the problem, current program goals and objectives, forms of benefits and services, and a current state of the social problem. Following the analysis, we present changes and improvements to be made, as well as proposals for reform and recommendations for policy changes.
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Affiliation(s)
- Vivian J Miller
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
| | - Tyrone Hamler
- b Mandel School of Applied Social Sciences , Case Western Reserve University , Cleveland , Ohio , USA
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Interchangeability of Licensed Nurses in Nursing Homes: Perspectives of Directors of Nursing. Nurs Outlook 2018; 66:560-569. [PMID: 30343964 DOI: 10.1016/j.outlook.2018.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/26/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Licensed nurse (registered nurse [RN] and licensed practical nurse [LPN]) roles in nursing homes are often viewed as interchangeable. Interchangeability occurs when the differences in RN and LPN education and scopes of practice are not recognized or acknowledged, leading to staffing patterns where the roles and clinical contributions of RNs and LPNs are perceived as equivalent. PURPOSE This study describes the perspectives of directors of nursing about interchangeability between RNs and LPNs and factors that contribute to interchangeability. METHOD This is a secondary analysis of data from a larger study in which 44 Directors of Nursing from Nurisng Homes in two different states were interviewed about their perceptions of the roles of RNs and LPNs. FINDINGS Interchangeability of RNs and LPNs was influenced by directors of nursing's knowledge and awareness of the scopes of practice for the two types of licensed nurses, corporate policies, and educational background of RNs. The findings suggest opportunities for better differentiating roles through the use of job descriptions that more clearly delineate the distinctive contributions of both RNs and LPNs in nursing home settings. DISCUSSION While increasing the number of RNs in nursing homes is desirable, there is immediate opportunity to ensure that the few RNs in nursing homes are used effectively to ensure that the professional nursing care needs of residents are met. NOTE: The review process and decision for this article was managed by Barbara S. Smith, PhD, R, FAAN Associate Editor, Nursing Outlook.
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Siegel EO, Bettega K, Bakerjian D, Sikma S. Leadership in Nursing Homes: Directors of Nursing Aligning Practice With Regulations. J Gerontol Nurs 2018; 44:10-14. [PMID: 29596709 DOI: 10.3928/00989134-20180322-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nursing homes use team nursing, with minimal RN presence, leaving the majority of direct care to licensed practical/vocational nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP), including medication aides. The current article describes challenges faced by nursing home directors of nursing (DONs) leading and managing a team nursing approach, including consideration of scope of practice, delegation and supervision regulations, and related policy implications. A secondary data analysis was performed of qualitative data from a study to develop and test DON guidelines for delegation in nursing home practice. A convenience sample (N = 29) of current or previous DONs and other nursing home leaders with knowledge and expertise in the DON role participated in in-depth, guided interviews. The findings highlight a core concern to nursing licensure policy and regulation: knowledge and practice gaps related to scope of practice and delegation and supervision among DONs, RNs, and LPNs/LVNs, as well as administrators, and the role of nursing leaders in supporting appropriate delegation practices. The findings offer directions for research and practice in addressing challenges in aligning team nursing practices with regulatory standards as well as the related gaps in knowledge among DONs, administrators, and nursing staff. [Journal of Gerontological Nursing, 44(6), 10-14.].
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Sherman RO, Touhy T. An Exploratory Descriptive Study to Evaluate Florida Nurse Leader Challenges and Opportunities in Nursing Homes Settings. SAGE Open Nurs 2017. [DOI: 10.1177/2377960817718754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Rose O. Sherman
- Nursing Leadership Institute, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Theris Touhy
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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Hartmann CW, Solomon J, Palmer JA, Lukas CV. Contextual Facilitators of and Barriers to Nursing Home Pressure Ulcer Prevention. Adv Skin Wound Care 2016; 29:226-38; quiz E1. [PMID: 27089151 PMCID: PMC4932901 DOI: 10.1097/01.asw.0000482113.18800.1c] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To present findings of a study of institutional factors related to pressure ulcer (PrU) prevention in Veterans Health Administration nursing homes. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Identify the study's design, process, and purpose.2. List the factors pertaining to sites with improving performance. OBJECTIVES Important gaps exist in the knowledge of how to achieve successful, sustained prevention of pressure ulcers (PrUs) in nursing homes. This study aimed to address those gaps by comparing nursing leadership and indirect care staff members' impressions about the context of PrU prevention in facilities with improving and declining PrU rates. SETTING The study was conducted in a sample of 6 Veterans Health Administration nursing homes (known as community living centers) purposively selected to represent a range of PrU care performance. DESIGN AND PARTICIPANTS One-time 30-minute semistructured interviews with 23 community living center staff were conducted. Qualitative interview data were analyzed using an analytic framework containing (a) a priori analytic constructs based on the study's conceptual framework and (b) sections for emerging constructs. MAIN RESULTS Analysis revealed 6 key concepts differentiating sites with improving and declining PrU care performance. These concepts were (1) structures through which the change effort is initiated; (2) organizational prioritization, alignment, and support; (3) improvement culture; (4) clarity of roles and responsibilities; (5) communication strategies; and (6) staffing and clinical practices. Results also pointed to potential contextual facilitators of and barriers to successful PrU prevention. CONCLUSIONS Leadership's visible prioritization of and support for PrU prevention and the initiation of PrU prevention activities through formal structures were the most striking components represented at sites with improving performance, but not at ones where performance declined. Sites with improving performance were more likely to align frontline staff and leadership goals for PrU prevention.
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Affiliation(s)
- Christine W Hartmann
- Christine W. Hartmann, PhD • Research Health Scientist • Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center • Bedford, Massachusetts • Research Associate Professsor • Health Law, Policy, and Management • Boston University School of Public Health • Boston, Massachusetts Jeffrey Solomon, PhD • Research Health Scientist • Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center • Bedford, Massachusetts Jennifer A. Palmer, PhD • Health Science Specialist • Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center • Bedford, Massachusetts Carol VanDeusen Lukas, EdD • Clinical Associate Professor • Department of Health Law, Policy, and Management • Boston University School of Public Health • Boston, Massachusetts
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12
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Siegel EO, Sikma S. RNs’ Transitions into Director of Nursing Positions in Nursing Homes: Hiring Practices and Role Development. J Gerontol Nurs 2015; 41:32-8. [DOI: 10.3928/00989134-20150309-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 12/18/2014] [Indexed: 11/20/2022]
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13
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Lerner NB, Trinkoff A, Storr CL, Johantgen M, Han K, Gartrell K. Nursing Home Leadership Tenure and Resident Care Outcomes. JOURNAL OF NURSING REGULATION 2014. [DOI: 10.1016/s2155-8256(15)30044-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Siegel EO, Young HM, Zysberg L, Santillan V. Securing and Managing Nursing Home Resources: Director of Nursing Tactics. THE GERONTOLOGIST 2014; 55:748-59. [PMID: 24534608 DOI: 10.1093/geront/gnu003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 01/16/2014] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY Shrinking resources and increasing demands pose managerial challenges to nursing homes. Little is known about how directors of nursing (DON) navigate resource conditions and potential budget-related challenges. This paper describes the demands-resources tensions that DONs face on a day-to-day basis and the tactics they use to secure and manage resources for the nursing department. DESIGN AND METHODS We conducted a secondary analysis of data from a parent study that used a qualitative approach to understand the DON position. A convenience sample of 29 current and previous DONs and administrators from more than 15 states participated in semistructured interviews for the parent study. Data analysis included open coding and thematic analysis. RESULTS DONs address nursing service demands-resources tensions in various ways, including tactics to generate new sources of revenue, increase budget allocations, and enhance cost efficiencies. IMPLICATIONS The findings provide a rare glimpse into the operational tensions that can arise between resource allocations and demands for nursing services and the tactics some DONs employ to address these tensions. This study highlights the DON's critical role, at the daily, tactical level of adjusting and problem-solving within existing resource conditions. How DONs develop these skills and the extent to which these skills may improve nursing home quality and value are important questions for further practice-, education-, and policy-level investigation.
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Affiliation(s)
- Elena O Siegel
- Betty Irene Moore School of Nursing at UC Davis, Sacramento, California.
| | - Heather M Young
- Betty Irene Moore School of Nursing at UC Davis, Sacramento, California
| | - Leehu Zysberg
- Betty Irene Moore School of Nursing at UC Davis, Sacramento, California. Department of Psychology, Tel Hai College, Upper Galilee, Israel
| | - Vanessa Santillan
- Betty Irene Moore School of Nursing at UC Davis, Sacramento, California
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