Registered nurse (RN) staff are in a unique position to affect quality in long term care settings at the bedside and to influence the care delivered by both individual staff members and the team as a whole.
RN staff in long term care settings need to have well-focused clinical assessment and judgment skills, as they are usually the primary assessor of the patient. Medical support is not always immediately accessible, so the nursing staff must analyze clinical situations and have the confidence to make decisions concerning when residents need additional care.
It makes sense that RNs should be prepared as leaders in moving quality initiatives forward. Not unexpectedly, RN staff are expressing a desire to be part of the solution in caring for elders.
Yet, nurses are already juggling many competing demands. How can they prepare themselves? Success is consistently achieved when nurses are empowered, administration is engaged, and partnerships are created and strengthened.

Nurses Empowered

One success story is Christian Health Care Center, a nonprofit organization in Wyckoff, N.J., that offers a complete continuum of care such as senior living, elder care, short-term rehabilitation, and mental health services. Chief Operating Officer Denise Ratcliffe understands that quality of care rests in the investment of nurses as not only clinicians, but as leaders who understand the complexity of the long term care landscape.
“We as an organization continually look for ways that we can improve and recognize not only the clinical competencies of nurses at our facility, but their leadership skills as well. We left the decision of how this would take place in the hands of our nurses,” Ratcliffe says.
The nurses decided to obtain certification from the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association. ANCC certification is a tangible representation of specialized clinical and leadership experience and is recognized as the highest representation of quality.

The facility purchased slots for an accredited online continuing education course to assist the RNs in achieving board certification.

“In our environment that serves residents requiring assisted living, intermediate, skilled, and Alzheimer’s care, knowledge is power. You need to know your stuff!” says Dawnette Bredberg, director of nursing at the Eastern Nebraska Veterans’ Home in Bellevue, Neb. “The course refreshes your knowledge and brings new knowledge to the table. It helps to refine your skills.” Already a clinical expert and nursing leader, Bredberg recently completed an accredited, online course in gerontological nursing, which prepared her to become board-certified and changed her title from RN to RN-BC.

“It was an ego boost for me to achieve board certification. It was validation for me that ‘Yes, I am an expert in this specialty.’ When you have more knowledge, it makes you more confident and engaged. I was able to use the knowledge I learned with my co-workers and patients,” she says.

Kirsten Reile, director of nursing at Elim Rehab and Care Center in Fargo, N.D., agrees. She completed the same online course in gerontological nursing and became board-certified. Her facility serves both skilled and assisted living residents. “The more educated you are, the better the outcomes. Education and knowledge can change practice,” she says, adding that after the course, she updated her facility’s policy on when to check orthostatic blood pressure.

Becoming an RN-BC is beneficial for all RNs, even for those with many years of experience. “You forget how great it is to learn new things when you are out in the field for awhile,” says Bredberg. “Taking an online certification test prep course is a great overall review. It encourages you to try new solutions to old problems. It makes you want to be part of the team.”

Reile echoes that thought. For her, the course was a good refresher. “It caused me to question how things were done and to change policies. It is making us think proactively rather than reactively about patient care,” she says.

Nurses need not only the clinical expertise, but the confidence to continually move the quality bar. Obtaining certification injects a confidence boost in nurses, one of the necessary elements for facilitating quality of care, participants say.

Administration Engagement

An engaged administration views nursing staff as partners, as crucial links between policy and action at the bedside. The simple act of inviting RN staff into this partnership is a powerful indicator of engaged leadership. It also recognizes the resources needed to achieve facility goals.

“We wanted to remove as many of the barriers to obtaining certification as we could at our facility,” Ratcliffe says. “So we sought funding from our local foundation for both the certification prep course and for the examination fee for our nurses. We were overwhelmed at the response our invitation elicited from our nurses.”

In fact, a domino effect occurred.

“I’d thought about certification for a long time,” Bredberg says. “So when my administrator not only found the online training course but offered to pay for both the preparation and certification test, of course I took the opportunity.” Bredberg then continued to engage administration to utilize internal funding to support additional nurses.

Financial support was influential for Reile as well. Scholarship funds for certification preparation and testing were made available for nurses in her facility from a state-level quality grant. She not only took the opportunity herself, but also purchased the course for four of her unit managers. 

Support, Recogniti​​on Vital

But almost as important as financial backing is the act of showing support for education and those who take the challenge.

“Prior to starting the certification prep course, my administrator looked at me and said, ‘I think you should do this. I know you will do well,’” Bredberg says. “When I completed the course and passed the certification exam, my administrator wanted to throw a party. He put it in the newsletter and told our clients about my educational success.”
Recognition of success was part of the plan for Ratcliffe as well. “When our nurses achieved certification, we hosted a really nice dinner for the newly certified nurses. We invited board members, family, and media. Each nurse was given a leadership book and a nice award,” she says. “Two of the nurses gave powerful testimonials about their journey.”
Administrators who show confidence and interest in their nursing staff are an amazing influence on nursing and subsequently quality success. This investment in nurses causes a rebound interest and investment by the nurses in the facility. They become part of the change, participants say.

Partnerships Strengthened

A valuable feature of selecting an online certification course provided by faculty experts in nursing education is the true partnership that is established among the educators, administrators, and nurses. 

These educational partners ensure that gerontological content is updated, that learner progress in the course is tracked, and that support is given to both administration and nurses alike if there are any technological or educational issues.

When thinking about this partnership, Bredberg says, “I was nervous at first—my administrator was going to get emails about my progress. But as you succeed in the course, you gain confidence.”

The partnership with educational experts benefits the RNs who are enrolled as well as the facility administrators. Comprehensive gerontological content is organized and presented systematically in small, easy-to-absorb pieces. All of the continuing education credit needed to take the certification exam is awarded. Also, tips are provided to make sure nurses are prepared to take the certification exam.

“I liked the fact that there is a course that is all online and self-paced. It allows for flexibility, but still requires you to learn the material before moving on. It is set up to keep you on task and focused on the exam,” says Bredberg.

Ratcliffe agrees that the partnerships among facility administration, RN staff, and educational experts providing online gerontogical training are another key to success. “Christian Health Care Center’s nurse leaders decided on the certification initiative, and they worked together to make it happen,” she says. 

“Our certified nurses are now able to speak the quality language and have an understanding of the patient satisfaction pieces and the finances that need to come together to make high-quality outcomes; they are able to ‘connect the dots’ and feel like they are part of the quality initiatives. We are now building on that achievement.”

Charge nurse Sawsan Lahoud, who directly benefited from Christian Health Care Center’s nurse leadership initiative, reflects on the opportunity provided by her facility.

“I am so happy and grateful that my facility recognized my potential and supported me in my effort to become board-certified in gerontological nursing,” she says. “Everyone has potential, if given the opportunity.” 
Heidi Keeler, PhD, RN, is an assistant professor and nurse planner for continuing nursing education at the University of Nebraska Medical Center in Omaha, Neb. She can be reached at (402) 559-4524 or​.