Nationally, Oklahoma has one of the highest rates of staff turnover in nursing homes – 68 percent — a statistic that affects the quality of care that residents receive.
To address that problem, the Fran and Earl Ziegler University of Oklahoma College of Nursing is creating the Long-Term Care Leadership Academy, a training program that aims to develop leadership skills through education and mentoring for staff members at nursing homes across Oklahoma. The goal is that a resulting culture change will improve staff retention and the care that residents receive.
The program is funded by a nearly $400,000 grant from the Civil Money Penalties program, administered by the Oklahoma State Department of Health. When nursing homes are fined, that money goes to the Centers for Medicare and Medicaid Services, and part of it returns to the Oklahoma State Department of Health, where it can only be used for quality improvement projects that help residents of nursing homes.
“Improving the nursing home workplace culture by developing staff leadership skills is an important determinant of quality care for nursing home residents,” said Gary Loving, Ph.D., RN, interim dean of the OU College of Nursing.
Recent studies have shown staff turnover to be more important to nursing home outcomes than staffing or skill mix. Nationally, certified nursing assistants have the highest turnover rate at 51.5 percent, followed by registered nurses at 50 percent and licensed professional nurses at 36 percent. With an overall staff turnover of 68 percent, Oklahoma’s nursing homes lose significantly more employees than the national average of 43.9 percent. In addition, Oklahoma’s Medicaid reimbursement for nursing homes is one of the lowest in the nation, which adds to the difficulty of retaining good staff.
“It is extremely difficult to work on improving the quality of life and care of residents without adequate staff,” said Diana Sturdevant, Ph.D., RN, of the OU College of Nursing. “High turnover depletes limited resources and reduces productivity because of the added costs of hiring and training new employees.”
Sturdevant is leading the Long-Term Care Leadership Academy with OU College of Nursing colleague Teri Round, M.S., RN. The curriculum is being developed by incorporating evidence-based practices and the expertise of college faculty and nursing home experts.
The program will be geared toward three levels of nursing home employees. Level one consists of the director and assistant director of nursing and the administrator. Level two includes RNs and LPNs who have direct leadership responsibilities of co-workers. Level three consists of certified nursing assistants and their roles in affecting the quality of life and improved care for residents.
Four face-to-face regional meetings will be provided, with one day for each level’s education. The fourth day will be a half-day period for all three levels to practice the skills they’ve learned. Program topics include communication and teamwork, giving and receiving delegation, generational differences, person-centered care, culture change, co-worker engagement, retention and succession planning.
Leadership skills will be an important focus for nursing home supervisors, Sturdevant said. Nursing homes typically employ RNs as directors and assistant directors of nursing, and LPNs as charge nurses. They usually do not receive leadership training as part of their academic education.
“They often lack skills in conflict resolution, effective communication and inclusiveness,” Sturdevant said. “Many use an authoritative approach with top-down communication that does little to facilitate teamwork.”
Following the Long-Term Care Leadership Academy, staff members will continue to be mentored. They also will undertake projects designed to support culture change and to meet a need specific to each nursing home. Projects will potentially address antibiotic stewardship, infection prevention, antipsychotic medication reform and others.
“The OU College of Nursing faculty and staff have expertise in leadership training, development and implementation of quality improvement processes and systems change,” Round said. “We are excited to work with nursing home staff members across Oklahoma on meaningful ways they can retain staff and create a better culture for both employees and residents.”
