Nurse Residencies: Now Coming to Long Term Care

It’s not surprising that nurse residencies—ten-week to year-long transition to practice programs offering targeted training and mentoring—are increasingly popular among new nurses and their employers.

By better supporting nursing staff, residencies improve the quality of care and increase nurse retention rates. The clear benefits have led the Institute of Medicine to recommend nurse residency programs across all care settings, and the National Council of State Boards of Nursing to consider a residency requirement for licensure.

For nurses working in long term care, residency programs could be transformational. Long term care nurses see residents whose multiple chronic conditions and long list of medications complicate routine care and post-acute rehabilitation. These nurses are often faced with challenging quality-of-life and end-of-life situations. Unlike nurses working in hospital settings, long term care nurses often work in relative isolation, are frequently the only RN on site, and lack access to colleagues with specialty expertise.

Long term care nurse residency programs could address these issues while helping reduce the staff turnover rate, which is higher in nursing homes than in any other health care setting. But the realities of long-term care also make designing and implementing nurse residencies more complex.

Nearly all established nurse residency programs have been developed for hospital settings. These programs generally assume that a group (or cohort) of new nurses will train at the same time, in the same place, with access to experienced mentors or preceptors, and with support from professional development departments. Such hospital-based models don’t work for most nursing homes, which may hire only one nurse at a time, are less likely to have staff with precepting skills or experience, and have fewer resources for professional development.

To be successful, long term care nurse residencies must cover topics as diverse as dementia care, family interactions, management skills, the independence of the long term care nurse, and the regulatory environment. Providing ongoing access to training, accommodating small and/or geographically dispersed groups of new nurses, training or making experienced mentors available, and keeping costs low are also key.

The good news is that nurse residency programs designed for long term care are now becoming available.

Geri-Res is an online program that includes training materials for nurses and their mentors, along with tools to help nursing homes implement nurse residencies in their organizations. Developed by the UW–Madison School of Nursing and Oregon Health and Sciences University (OHSU), the Geri-Res curriculum for new nurses and nurses new to long term care covers promoting resident function, geriatric nutrition, end of life care, and communicating with health care teams and families, among other topics.

Geri-Res is now being pilot tested in several nursing homes, and 900 nurses from a cooperative of Minnesota nursing homes are taking part in the mentor training modules. After analyzing and incorporating feedback, the UW/OHSU team will make Geri-Res widely available in early 2015.

While initially targeted to nursing homes, Geri-Res has broad potential. “Home health, assisted living and hospitals have been following us closely, asking for tracks tailored to their care environments,” Kim Nolet, UW–Madison research program manager, explained. “We’ve also started planning an advanced curriculum for nurses who have worked in long term care for at least six months, but are still developing their geriatric expertise.  There’s no shortage of important topics, such as transitions in care and advanced dementia care.”

This June, a New Jersey coalition will launch a face-to-face long term care nurse residency.  Rutgers University College of Nursing and the New Jersey Action Coalition designed the program in response to the Institute of Medicine’s “Future of Nursing” report.  “More and more health care will be in the community and long term care, so preparing people for this setting is a priority,” Susan Salmond, RN, EdD, ANEF, FAAN, and dean of the Rutgers College of Nursing told

The program’s first two cohorts of 25 nurses will gain experience in a range of settings, including nursing homes, hospitals, home care and hospice, with an emphasis on transitions of care.  Rutgers faculty will provide instruction, in addition to experienced long term care nurses who have been trained as preceptors. Some 20 participating facilities in northern New Jersey have committed to hiring the trainees.

These first two long term care nurse residencies will hopefully inspire and inform other programs.  “Ultimately, a variety of options need to be available for long term care nurses,” said Barbara Bowers, PhD, RN, FAAN, associate dean for esearch and Rodefer Chair at the UW–Madison School of Nursing.  “They have gone so long with such little preparation to become geriatric specialists that it’s exciting to see them finally start receiving the support they need.”

–Diane Farsetta
–photo by John Maniaci