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Saturday, June 15, 2024

Craftsman Black Passive House

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NAVIGATING LONG-TERM CARE

A PRACTICAL APPROACH FOR NUSES

Achieving success as a long-term care nurse requires understanding organizational structures, state and federal regulations, and work processes. It can be discouraging when the quality of one’s work is questioned, especially after putting in hard work.

Navigating Long-Term Care: A Practical Approach for Nurses is a comprehensive guide for long-term care nurses to enhance their understanding of organizational structures, state and federal regulations, and work processes. This 15-chapter manual uses the nursing process as a critical thinking framework and covers crucial aspects of resident care, including admissions, discharges, care planning, incident reporting, and more. In addition, the book includes case studies and post-chapter questions to evaluate understanding, making it an excellent resource for facility educators and nurses.

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Orienting and Training Long-Term Care Nurses Must Be Fun, Engaging, and Interactive!

Nurses appreciate engaging, interactive training that fosters their professional growth. Unfortunately, in-person training is becoming rare, and orienting new hires is a nightmare as staff often sit through boring videos and topics.

Great orientations and training programs foster relationship building, and a sense of belonging, improve retention, reduce turnover, and improve quality care delivery. This book “Navigating Long-term Care: A Reflective Workbook for Nurses,” an accompaniment to the new training manual, Navigating Long-term Care: A Practical Approach for Nurses, seeks to bridge training gaps and enhance quality care delivery.

The high turnover rate among nurses in long-term care facilities significantly challenges healthcare quality and access. This issue has been exacerbated by the COVID-19 pandemic, making it essential to address the problem of nurse retention in these settings. This course will explore the critical issue of nurse turnover in long-term care and present a proposed community integration model based on a comprehensive literature review and field study. This model outlines a pathway to cultivate a sense of belonging, improve staff retention, and ultimately enhance the quality of care in long-term care facilities. The seminar provides a comprehensive approach and strategies to reduce nurse turnover and foster a stronger workplace community using various supports, including comprehensive onboarding and orientation, mentoring, and peer support.


  1. Introduction
  • Overview of the high nurse turnover rates in long-term care facilities
    • High nursing staff turnover in nursing homes is associated with higher mortality.
    • Increased number of deficiency citations.
    • Increased likelihood of infection control citation.
    • CNA turnover is associated with higher odds of pressure ulcers, pain, and urinary tract infections in nursing homes.
    • nurse turnover in NHs relates to the use of antipsychotic medications.
    • NH's licensed nurse retention rate is significantly associated with the 30-day rehospitalization rate (est. = -.02, p = .04)
    • High nurse turnover in NHs leads to substantial costs, such as recruitment and training for new nursing staff.
  • Exploration of contributing factors to nurse turnover
    • Affective Sentiments
    • Individual factors
    • Organizational factors
  • Importance of community integration in the workplace
    • To foster a sense of belonging
    • Enhance organizational citizenship.
    • To foster the development of job satisfaction
    • To improve nurse retention
  1. Theoretical Framework- Community Integration Model
  • Definition of Community Integration in the workplace
    • Involves vulnerable populations.
    • Movement or transitioning due to illness, situation, migration, or as part of a rehabilitation or recovery process.
    • Dynamic, continuous, and reciprocal process of integration that occurs over time.
    • Influenced by a number of factors- supports, individual perceptions, participation in and with community.
    • Associated with productivity, independence, job satisfaction, recovery, health, role mastery, well-being, and empowerment.
    • Ultimately developing an affective sentiment of oneness with self and community.
  • Introduction to the model and its components
    • Transition Phase
      • Fear
      • Anxiety
      • Anticipation
      • Excitement
      • Vulnerability
      •  “Transition shock”
    • Adjustment Phase (0-3months)
      • Orienting to the new environment
      • Building trust
      • Becoming self-aware
      • “Transition shock”
      • Forming perceptions
      • Beginning new relationships
    • Adjustment supports.
      • Welcoming and inclusive Environment
      • Effective onboarding and comprehensive Orientation
      • Mentorship and Preceptorship
      • Effective communication
      • Team collaboration and camaraderie
      • Emotionally intelligent leadership (Compassion and empathy)
      • Supportive Supervision
      • Opportunities for emotional support for stressful situations
      • Adequate resources
      • Fair financial remuneration
    • Social Integration Phase (3-6months)
      • Strengthening relationships
      • Increasing participation in the workplace
      • Improved job competence
      • Increasing productivity
    • Social Integration supports.
      • Maintain an Inclusive and safe work environment.
      • Shared governance- e.g. Participation in QAPI
      • Social events (e.g., staff retreat with stress-relieving activities, etc.)
      • Effective leadership
      • Effective Communication
      • Support for Work-Life Balance
      • Recognition and Feedback
      • Maintain efficient systems
      • Maintain adequate resources
      • Cultural competence and diversity training
      • Workload management
      • Staff development (Continuous education and competencies)


    • Community Integration Phase (6-12 months)
      • Independence
      • Role mastery
      • Increased productivity


    • Community integration supports.
      • Career development
      • Recognition and appreciation
      • Celebration of Milestones
      • Continuing education and competency training
      • Foster professional autonomy
      • Maintain a flexible work schedule.
      • Employee perceptions
      • Healthy work environment
      • Access to employee assistance programs
      • Continuing education
      • Review Compensation


    • Barriers to Integration
      • Lack of supports and resources.
      • Poor leadership
      • Workload
      • Financial barriers (Low wages)
      • Environmental barriers (organizational barriers)
      • Marginalization
      • Bullying
      • Incivility
      • Racism
    • A Practical Application of CI Model to a structured orientation program for Long-term care nurses
      •  General onboarding
      • Didactic (7-days)
      • Clinical emersion (5-days)- Patient and Task Layered Approach
        • Day 1 – Preceptor led
        •  10 residents- Assessment and documentation – level 1
        • Day 2- Preceptor led
        • 10 residents – Level 1 task + medication and treatment administration- level 2
        • Day 3- Preceptor led
        • 15 residents- level 1 and 2 tasks + communication and family engagement- level 3
        • Day 4- Preceptor assist
        • 20 residents- level 1,2,3 tasks + safety & quality – level 4
        • Day 5 – new hire led/preceptor assist
        • Full load assignment- level 1,2,3,4 tasks + continuum of care (acute transfer, discharges, admissions)
      • Trained preceptorship
        • Recruit preceptors (offer an incentive to precept)*
        • Role training and expectation
        • Communication and feedback
        • Methods of evaluation (Use of standard evaluation tool)
        • Documentation
        • Provide supportive supervision.
      • Continual Mentorship
        • Weekly one-on-one check-in sessions
        • Weekly goal setting and review
        • Self-care
        • Relationship building
        • Supportive leadership
      • Continual education (Monthly)
        • Include team-building activities.
        • Opportunities for socialization
      • Monthly staff meeting
        • Foster relationship building (Social Integration)
        • Self-care activities
        • Interactive discussions
        • Problem-solving (Team approach)
      •  Maintain a healthy work environment.
        • Continual education
        • (Team building- creating opportunities for engagement and socialization)
        • Cultural/ diversity training
        • Workload management
        • Time management training
        • Effective communication
        • Managing workplace incivility, bullying, and violence
        • Enhance general regulatory compliance.
        • Shared governance
        • Flexible work schedule
        • Communication/suggestion box
      • End of program evaluation
        • Weekly preceptor evaluation
        • Skills competency checklist
        • Comprehensive medication test
        • 3-months new hire survey
        • 3-month end of probation evaluation and feedback
        • 6- months’ recognition and celebration of milestone
        • 12-months employee survey (job satisfaction/retention focus)
        • Annual evaluation and survey