Leadership in Nursing Homes: Directors of Nursing Aligning Practice With Regulations.

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.].

RNs' Transitions into Director of Nursing Positions in Nursing Homes: Hiring Practices and Role Development.

The current paper discusses RNs' transitions into their first nursing home director of nursing (DON) position, including hiring practice and role development. A convenience sample of 29 current and previous DONs and nursing home administrators completed semistructured interviews for the current qualitative, descriptive study. Using thematic analysis, the finding revealed three primary themes: (a) DON hiring criteria are not necessarily matched to role demands; (b) various pathways to developing DON expertise suggest an undervaluing of the competencies needed to effectively enact this nursing leadership position; and (c) although limited formal training for the DON position was well-acknowledged, concerns or reports of the consequences varied, and there is no consensus as to the optimal route to preparation. Overall, the current study findings highlight gaps across practice, policy, and research, emphasizing the consequences of limited attention to gathering evidence of the breadth and depth of DON role demands and related role qualifications.

Medication management roles in assisted living.

Residents in assisted living (AL) frequently need assistance with medication management. Rooted in a social model, AL serves people facing increasing health management challenges as they "age in place." This study explored roles in AL medication management and satisfaction with unlicensed assistive personnel (UAP) as medication aides, a cost-effective staffing approach that is used frequently. The sample included 112 participants representing all parties involved in medication administration (residents, medication aides, administrators, RNs and licensed practical nurses, pharmacists, and primary care providers) in 15 AL settings in four states. Results include description of medication management roles; empirical validation of existing AL nursing professional standards; and satisfaction with the role of UAP as medication aide from all perspectives. Clinical implications include creating a supportive environment for medication aides (i.e., UAPs); the importance of the RN role as facilitator of AL medication management; and the need for collaboration and interprofessional team development across disparate settings.

Strategies to promote safe medication administration in assisted living settings.

Assisted living (AL) provides lower cost, less institutional environments than skilled nursing facilities, yet less professional oversight, despite the high prevalence of chronic conditions among residents. Unlicensed staff administer large quantities of medications daily, and medication management is one of the three top quality issues in AL, with error rates ranging from 10% to 40%. This qualitative study described AL provider views on medication safety and strategies used to promote safety in medication administration. The sample included 96 participants representing all parties involved in medication administration (i.e., medication aides, administrators, RNs, consulting pharmacists, primary care providers) in 12 AL settings in three states. Core themes were the importance of medication safety, unique contextual factors in AL, and strategies used to promote medication safety. This study has implications for research on interventions to improve medication safety at the individual, facility, and policy levels.

Supporting self-determination of older adults in community health settings: a curriculum development project.

This article describes a curriculum development project to strengthen the geriatric component of an RN-to-BSN program through creation of a multidisciplinary curricular framework that supports the self-determination of older adults and promotes best practices in geriatric community health nursing. The project involved integrating multidisciplinary theories with nursing competencies generated from interviews with geriatric community health nurses that subsequently were cross-validated with baccalaureate competencies for geriatric nursing care. The outcome was a theory and practice-based curricular model for teaching geriatric community health nursing used to strengthen the development of geriatric nursing competence of RN-to-BSN students.

Types, prevalence, and potential clinical significance of medication administration errors in assisted living.

OBJECTIVES: To describe the types and potential clinical significance of medication administration errors in assisted living (AL). DESIGN: Cross-sectional observational study. SETTING: This study was conducted in 12 AL settings in three states (Oregon, Washington, and New Jersey). PARTICIPANTS: Participants included 29 unlicensed assistive personnel and 510 AL residents. MEASUREMENTS: Medication administration observations, chart review, and determination of rates, types, and potential clinical significance of errors using standardized methodology. RESULTS: Of 4,866 observations, 1,373 errors were observed (28.2% error rate). Of these, 70.8% were wrong time, 12.9% wrong dose, 11.1% omitted dose, 3.5% extra dose, 1.5% unauthorized drug, and 0.2% wrong drug. Excluding wrong time, the overall error rate dropped to 8.2%. Of the 1,373 errors, three were rated as having potential clinical significance. CONCLUSION: A high number of daily medications are given in AL. Wrong time accounted for the majority of the errors. The bulk of the medications are low risk and routine; to promote optimal care delivery, clinicians need to focus on high-risk medications and residents with complex health problems.

Linking theory and gerontological nursing practice in senior housing.

This article illustrates the use of 2 theoretical models in planning and implementing health programs in senior housing. The Person-Environment Fit Model, developed by Lawton, and the Transitions Theory, developed by Meleis and colleagues, form the basis for understanding the interaction between people and their environments through transitions common in late life. The models and their application to practice are described, with examples at the individual, group, and community levels. Implications and future directions are identified for the use of such models in gerontological nursing practice.

Staff perceptions of caring: the importance of a supportive environment.

Five themes of caring interventions emerged from the perspective of staff caregivers-valuing personhood and the work, belonging, knowing, acting together, and promoting quality. Three themes of caring organizational conditions identified by participants included communicating, providing resources, and trusting. The research-based Model of Caring in the Organizational Environment can be used to assess and improve the caring environment of nursing homes as well as to develop caring managers and staff. Organizational well-being for nursing homes is everyone's responsibility and requires formal and informal leaders who can create supportive caring organizational conditions, engage in caring interventions with staff, and inspire the synergy of caring.