The role of nurses in the field of long-term care was the topic for discussion in late September when the IAHSA held a Global Ageing Applied Research Forum in Lyon, France. The forum took place in conjunction with the annual meeting of the European Association of Homes and Services for the Ageing.
Julienne Meyer, IAHSA vice chair and a professor of nursing at City University in London, led the forum. Speakers from Canada, Spain, Switzerland, and the United States shared their research on the important role that nurses can play in guiding and supervising direct care workers in the nursing home and home care environments.
An Expanding Role for Nurses in the Nursing Home
Christine M. Merzeder, clinical coordinator at Paracelsus Recovery in Zurich, Switzerland, recommended redefining the role of the registered nurse (RN) in long-term care by encouraging nurses to “work within their professional boundaries.”
RNs and the organizations that employ them should stop defining the nurse’s role in terms of the physical labor involved in clinical tasks, or the emotional labor involved in keeping residents and family members happy, said Merzeder. Instead, she said, nurses should focus their energies on “intellectual labor.”
“Before you do something hands-on, before you engage emotionally, you have to think about what you are going to do,” said Merzeder. “This is the equivalent of a chief executive officer’s (CEO) work. CEOs need to delegate. They need to plan. They need to distinguish between the operational level and the strategic and visionary level. So does a nurse.”
With the right training, nurses can build a knowledge base that gives them the tools to carry out their intellectual labor, said Merzeder. That labor includes:
Assessing and diagnosing health care needs.
Evaluating the effectiveness of care.
Monitoring residents’ physical condition and behaviors.
Working to help residents maintain their current abilities, prevent functional decline, and regain functionality after a health crisis.
Directing palliative care.
Performing some hands-on tasks that are beyond the skill level of direct care workers.
“The nurse’s role must be knowledge-based and not skill-based,” said Merzeder. “The skills can be taught to others. The skills can be supervised.”
Merzeder acknowledged that the enhanced professional role of nurses might be more acceptable in some countries than others, depending on their regulatory environments and ability to adequately compensate RNs for the additional training and advanced degrees that their expanded role might require. Such a role might be challenging to implement in the United States and the United Kingdom (UK), for instance, where RNs have a limited presence in nursing and aged care homes.
Despite a dearth of RNs in the UK’s aged care homes, Meyer agreed that “we’ve got to get nursing input into every care home, whether it’s a nursing care home or it’s a residential care home, because people are going in later, sicker, and more frail.”
Nurses must become “leaders who nurture the natural leadership in others within these settings,” said Myer.
What is an Effective Nurse Supervisor?
Catherine McGilton, an associate professor of nursing at the University of Toronto, and Montserrat Gea-Sánchez, a professor of nursing and physiotherapy at the University of Lleida in Spain, shared their work to develop and validate a scale that measures how well RNs are carrying out their supervisory roles.
McGilton’s review of the literature led her to conclude that effective supervisors share certain characteristics. They are generally dependable and empathetic, respect others, communicate effectively, and are willing to offer personal support, counseling, and guidance to those they supervise.
Using these characteristics as a guide, McGilton developed a 50-item scale to gauge how direct care workers rate their supervisors. The scale includes such statements as “My supervisor recognizes my ability to deliver high-quality care,” and “My supervisor tries to meet my needs in ways such as informing me of what is expected of me.”
McGilton and Gea-Sánchez worked in their respective countries to validate the scale as an accurate tool for evaluating supportive supervisors. That validation process, which involved conducting focus groups with providers and workers, was an important step in ensuring that the scale can be used in practice settings, said Robyn Stone, senior vice president for research at LeadingAge and a forum speaker.
“Measuring how supportive the supervisor is can tell you whether you have the right person in the job, or whether you risk potentially losing workers because you’ve got a bad supervisor,” she said. “But you must use a scale that is valid and reliable, or else you don’t know what you’re measuring. Bringing researchers and providers together to test the scale is critical.”
The Role of Nurses in Home Care
Having nurses with strong supervisory skills is especially important in the home care setting, said Stone in the final segment of the forum.
“Home care workers work in widely dispersed settings, which makes their job very solitary,” said Stone. “Unlike direct care workers in a nursing home, home care workers lack a community of peers, so they depend even more on their supervisors for support and guidance.”
Stone shared LeadingAge research showing that consistent assignment and the availability of career ladders could have a role to play in reducing worker turnover in home care settings.
LeadingAge is currently seeking funding for a new initiative to study the characteristics of a supportive home care work environment. The initiative, which will involve conducting case studies of highly effective home care programs, is part of a new strategic focus on workforce issues at LeadingAge.
“Workforce development, and the role of nursing in particular, is so central in our sector,” said Stone. “We can’t continue to take it for granted. Instead, we need to focus squarely on training, education, models for delivery, articulation of staff roles, and issues around management, coaching, and nurturing. We have a growing body of quantitative and qualitative research in this area. Our job now is to get that research integrated into practice around the globe.”