Administrators are caught between a rock and a hard place. Among the rubs are reimbursement rate reductions of up to 15 percent, constant pressure to reduce hospital admissions, new battles to attract and retain core nursing staff in a shallow pool of nurses, and possible further cutbacks in Medicare and Medicaid payments, just to name a few.
Like many since the 2008 economic crash, facility administrators have no choice. They must do more with less.
At risk is care quality, which triggers a domino chain. Less quality equals less satisfaction. Eventually, this means fewer patients; fewer residents; and fewer referrals from hospitals, families, and from happy clients.
At issue is prosperity—a survival of the fittest—in a rapidly changing, super-competitive, viselike

What’s A Provider To Do?

In tough economic times, three administrators—in Alaska, Massachusetts, and Nebraska—took a counterintuitive approach. They spent money on registered nurse (RN) training. They enrolled their nurses in a unique gerontological certification course based at the University of Nebraska Medical Center.
Bill BogdanovichAmong facility operators who became involved in the course—known as Gero Nurse Prep (GNP)—early were Alaska’s Charlie Franz, Massachusetts’ Bill Bogdanovich, and Nebraska’s Roger Biens. What intrigued them? That higher-care quality also fosters lower costs.
GNP was born with one purpose: improve quality in long term and post-acute care centers. It was created by the University of Nebraska Medical Center (UNMC) College of Nursing.
“RN degree programs historically gave little attention to geriatric nursing,” says Catherine Bevil, RN, EdD, director of continuing nursing education at UNMC. “While that’s changing as the biggest generation in U.S. history ages, the fact remains that most RNs today—about two-thirds—have zero geriatric training.”
GNP, she said, is solely focused on current, evidence-based clinical nursing skills for seniors. “The nursing profession has always been about health promotion, disease prevention, and symptom management. We take that to a new level for geriatrics. It’s niche nursing for long term and post-acute care.”
Advanced geriatric knowledge and skills, says Bevil, mean measurably better care. Ten interactive learning modules train RNs to:
■ Manage physical and mental aspects of aging;
■ Quickly recognize symptoms, changes, and problems;
■ Keep physicians, administrators, and the nursing team well informed; and
■ Be attentive and compassionate in talking to residents and their families.

Training Promotes Patient-Centered Care

“Many seniors say they feel invisible,” says Bevil. “This course puts them front and center.”
The learning program emphasizes prevention of adverse events, especially those with potential for lingering, time-intensive, and costly consequences.
For example, falls, medication errors, and pressure ulcers are serious health risks for seniors in long term and post-acute care. “Proper nursing practice cuts risk substantially,” Bevil says. “In geriatric nursing especially, an ounce of prevention is better than a pound of cure—but RNs need sharper awareness and preemptive action steps.”
Catherine Bevil, RN, EdDHigher-quality care yields other benefits, she explains. It means happier residents and families, and that means happier nurses. Not only do RNs feel more competent, confident, and empowered, they also get more positive feedback and recognition, she says.
That in turn feeds staff stability, with lower RN churn, which means fewer temp nurses, less recruiting time and expense, less new staff orientation, and less disruption of nursing care teams, Bevil says.
GNP prepares RNs to pass the certification exam in gerontological nursing administered by the American Nurses Credentialing Center. To date, GNP alums have a 98 percent pass rate.
As with physicians, “board-certified” is the gold standard of quality. “Only 1 percent of RNs are now certified in gerontological nursing, so providers with board-certified nursing staff really set themselves apart,” says Bevil. “That pays dividends in both patient and nurse recruiting and retention.”

Training Earns Respect

Course alums report that having RN-BC on their name badge earns them new respect. “Physicians look at me differently now,” says Maggie Spilker, RN-BC, with Heritage Care Center in Fairbury, Neb.Roger Biens
Roger Biens, administrator at Brookstone Meadows, Elkhorn, Neb., has a unique perspective, first serving as RN and director of nursing. Among the first GNP alums, he was promoted to administrator after becoming certified. Brookstone is part of Vetter Health Services, with more than 30 centers in five states and a systemwide GNP adopter.
His 140-bed skilled nursing center depends on hospital referrals for about half of its occupancy. Referrals hinge on a 30-day rehospitalization rate, Biens notes. “We have to invest in the best RNs. We can’t afford not to.”

Nurses Step Up

For Charlie Franz, administrator at Heritage Place, Soldotna, Alaska, eight of 11 RNs completed the course and were certified on their first try.
Charlie Franz“In our [partner] hospital, there is a lot of emphasis on physician certification,” says Franz, “so we put emphasis on nursing certification. It was voluntary, they stepped up and did it, and I think they walk a little taller and a lot prouder.”
He notes that the course helped his RNs improve resident assessments, interpret lab results, and communicate better with licensed practical nurse and nurse assistant staff. “The feedback I get is how effective the RN staff are at explaining situations, diagnoses, behavioral issues, and complications,” he says.
What’s more, since GNP, Franz has seen use of off-label antipsychotics drop to zero.

Program Attracts, Retains Good RNs

As a teenager, Bill Bogdanovich’s first job was at a nursing home. He rose to become chief executive officer and owner of diversified Broad Reach Healthcare, in Chatham, Mass.—and in 2013 won the American College of Health Care Administrators’ Facility Leadership Award.
He, too, invited his RN staff to enroll in GNP, and all accepted. To date, 13 earned certification on their first try. Two more RNs are slated to be certified in 2013, achieving Bogdanovich’s goal of 100 percent RN staff certification.
“I now hear a different level of critical thinking,” he says. He sees RNs engage the entire nursing team. “I see them asking questions and answering them—together and in depth.”
An unexpected benefit: “Our state surveyors were quite impressed that we supported our RNs in this way, that so many enrolled and did well.”
Bogdanovich’s bottom line? GNP helps retain good RNs. “Less turnover—the right staff longevity—makes it possible to focus on doing things you want to do. Otherwise, you’re constantly hiring and orienting brand-new people.”
Voicing the position of long term and post-acute care operators nationwide, Bogdanovich puts it succinctly: “Despite increasing demands and declining resources, administrators are challenged to do at least as much, if not more, to provide scope and level of service.”
Separated by thousands of miles, Franz and Biens drew the same conclusion, and each used GNP to help meet the challenge.
For AHCA/NCAL Gero Nurse Prep details, go to
Heidi J. Keeler, PhD, RN, is assistant professor, Community Based Health Department, nurse planner, continuing nursing education, University of Nebraska Medical Center College of Nursing, Omaha, Neb. Keeler can be reached at (402) 559-4524 or