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Learn MoreThis blog post was written by Holly Harmon, RN, MBA, LNHA, Senior Director of Clinical Services, American Health Care Association and was included in the current issue of PX Alert, HealthStream's quarterly e-newsletter devoted to the wide range of challenges, situations, and issues that have an impact on the patient experience.
Nursing is a profession that offers a great variety of settings to work, including physician office, specialty clinic, school, hospital, home health, skilled nursing and rehabilitation center, retirement community, and many more. This article will focus on nurses transitioning from acute care to post-acute care, specifically skilled nursing and rehabilitation centers. The skilled nursing and rehabilitation aspect of the care continuum serves a vast population that is growing in acuity, including individuals with geriatric complexities and comorbidities. The needs of individuals staying or living in skilled nursing and rehabilitation centers offer the nurse an opportunity to develop or advance unique skills in this specialty practice within post-acute care.
There are four key characteristics representing an assortment of skills and qualities that are important to consider when nurses are transitioning from acute care to post-acute care:
1. Delegation & Empowerment – In skilled nursing and rehabilitation centers, the largest proportion of direct-care staff is typically nursing assistants. Nursing assistants are often referred to as the “eyes and ears” of the nurse. A nurse working in a skilled nursing and rehabilitation center may have two to three times as many residents or patients on his or her assignment than in acute care. Effectively meeting the needs of each resident requires delegation and empowerment between the nurse and nursing assistants. The nurse sets the tone for the working relationship with the nursing assistants, which affects outcomes for the residents or patients. The nurse needs to know the parameters of delegation as determined by the Board of Nursing, licensing and certification standards, and organization policy.
Great care is more likely when nurses demonstrate and acknowledge the true value of the nursing assistants’ work. This occurs when nurses empower nursing assistants and other staff, encouraging them to do what they do best for the benefit of the residents or patients they are serving. Successful empowerment requires mutual respect; being a positive role model; active listening; seeing the possibilities, talents, and skills that exist in each staff member; providing feedback; and developing trust. Nurses who recognize and utilize the invaluable contributions of nursing assistants and other members of the team will find the most success and satisfaction in their practice.
2. Autonomy – Skilled nursing and rehabilitation centers have less on-site resources than acute care. For example, typically there is not 24/7, on-site physician presence in skilled nursing or rehabilitation centers. As a result, nurses transitioning from acute care to post-acute care will experience changes in workflow and decision-making. Autonomy in skilled nursing and rehabilitation centers is viewed by many highly skilled nurses as a benefit to the job. It provides enhanced opportunity to incorporate the nurse’s unique knowledge and expertise into practice through heightened influence and decision-making.
With autonomy also comes great responsibility to effectively practice assessment, monitoring, intervention, evaluation, and critical thinking skills. For example, nurses are key to preventing avoidable hospital readmissions through effective management of acute change in condition, including early identification, assessment, and communication with the physician or other providers. Nurses in this setting must be vigilant in assessing and examining their own skills, updating and refreshing their own competencies, and reflecting on opportunities for improvement.
3. Leadership & Coordination of Services – The nurse is a key player in coordination of care in skilled nursing and rehabilitation centers. Nurses and nursing assistants are typically the only group of staff who work 24/7 in a skilled nursing and rehabilitation center, whereas acute care often has other disciplines working around the clock. A nurse’s leadership skills are important to facilitate communication with families who visit at all hours, ensure continuity of care from shift to shift, and lead direct-care staff in problem-solving when challenges arise. Nurses are often on their own to practice innovative problem-solving and seek solutions to best meet each individual resident’s needs. Nurses often will be confronted with conflict between staff, or between a resident or patient and their family member, thus warranting a need for effective communication, negotiation, and conflict resolution skills.
Skilled nursing and rehabilitation centers are highly regulated, which has shaped a complex healthcare environment where documentation, outcomes, and experiences of residents or their families drive positive or adverse consequences for the center. The nurse’s role is critical to facilitate continuity across the interdisciplinary team through collaboration with each team member, including social services, activities, nutrition, therapy, pharmacy, physician, family, resident, and others. It is important for the nurse to recognize the contributions that each of these interdisciplinary team members brings, and engage them as needed to enhance quality of care and quality of life for individuals.
4. Facilitation of Home Environment, Healthy Relationships, and Quality of Life – Nurses transitioning from acute care to skilled nursing and rehabilitation centers must be conscious of balancing the medical model with the needs of residents who are likely to call this setting “home.” In many cases, this will be a resident’s home for the rest of their life or a temporary home for someone who is in the center for a short term stay of three or four weeks. Creating a meaningful life for a long-stay resident with all the comforts of home will differ from the needs of a short-stay resident who requires short-term rehab and pain management in order to return home. Regardless, the length of stay is typically longer in a skilled nursing and rehabilitation center than in acute care, which raises the importance of a home environment to the resident’s quality of life and quality of care.
Developing healthy relationships between the staff, resident, and family is critical for many reasons. Nurses working in skilled nursing and rehabilitation centers have greater opportunity than in acute care to develop relationships with residents and families. Valuable information can be learned about the resident to better meet his or her needs or preferences. Knowing the person opens endless opportunities for further improving quality of life and quality of care, and also becomes valuable when confronted with a challenging situation, such as an illness that affects the resident’s behavioral expressions. Knowing the resident, their likes and dislikes, and the small and large things that bring meaning and purpose to their life can be the difference in providing effective non-pharmacological interventions that resolve the problem with no adverse effects.
A valuable resource is the Nurse Competencies for Nursing Home Culture Change developed by an interdisciplinary expert panel of leaders in culture change and gerontological nursing. This panel was convened in 2008 by the Hartford Institute for Geriatric Nursing in collaboration with the Coalition of Geriatric Nursing Organizations and Pioneer Network. This tool identifies and supports the 10 competencies that are most critical for nurses to be successful in creating and sustaining person-directed care.
There is great opportunity for nurses to contribute to, and benefit from, working in skilled nursing and rehabilitation centers. The experience of working with a diverse interdisciplinary team, practicing at a heightened level of autonomy, and demonstrating leadership and coordination of services to benefit residents by directly impacting their quality of life and quality of care, is a gift to the profession of nursing. The relationships that develop and learning that is gained from knowing each person as an individual, and understanding the meaning and purpose that shapes each one of us, is impactful in a way that validates why many nurses chose nursing as a profession. This is what inspires the devoted nurses who have chosen skilled nursing and rehabilitation care as their specialty.
About the Author
Holly Harmon, RN, MBA, LNHA, is the senior director of Clinical Services at the American Health Care Association. She has more than 18 years of experience working in healthcare, including post-acute care, long-term care, and assisted-living care.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's provider credentialing, privileging, & enrollment solutions for healthcare organizations.
View All CredentialingExperience standardized and centralized healthcare provider credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
View All Products