Quality Improvement in Nursing Facilities: A NURSING LEADERSHIP PERSPECTIVE

Abstract

The purposes of this study were to characterize the state of quality improvement (QI) in nursing facilities and to identify barriers to improvement from nursing leaders' perspectives. The study employed a non-experimental descriptive design, using closed- and open-ended survey questions in a sample of 51 nursing facilities in a midwestern state. Only two of these facilities had active QI programs. Furthermore, turnover and limited training among these nursing leaders represented major barriers to rapid implementation of such programs. This study is consistent with earlier findings that QI programs are limited in nursing homes.

Outcomes related to effective nurse supervision in long-term care homes: an integrative review

“…Consequently, higher NA turnover rates disrupt continuity of care, which has been associated with poor resident health outcomes such as increased rates of responsive behaviours, infection and pressure sores (Burgio et al . , Castle & Engberg ), and undermines efforts for quality improvement in LTC as the facility must dedicate the resources to hire and train new employees (Adams‐Wendling ). Effective nurse supervisor performance thereby mitigates this process and indirectly improves resident care by reducing NA turnover.…”

The Pivotal Role of the Director of Nursing in Nursing Homes

“…However, there is evidence that the experience and tenure of DONs are associated with better resident outcomes 22 and high turnover of DONs impacts staff's perceptions of positive communication and teamwork. 8 Barriers to DONs attaining advanced education and professional development for this nursing leadership and management position are complex and likely stem from a combination of academic, policy, organizational, and professional nursing factors. 8 Barriers to DONs attaining advanced education and professional development for this nursing leadership and management position are complex and likely stem from a combination of academic, policy, organizational, and professional nursing factors.…”

“…3 An earlier IOM report raised concern about the lack of appropriate educational preparation for DONs, given the complex nature of nursing home organizations and the required skill set and judgment needed to lead and manage nursing services. [5][6][7][8][9][10][11][12][13][14][15][16][17] Unfortunately, regulatory bodies, nursing academia, gerontological nurse experts, and nursing home corporate and local administrations have collectively failed to formally recognize-or respond to-the link between nursing home quality and the DON position. [5][6][7][8][9][10][11][12][13][14][15][16][17] Unfortunately, regulatory bodies, nursing academia, gerontological nurse experts, and nursing home corporate and local administrations have collectively failed to formally recognize-or respond to-the link between nursing home quality and the DON position.…”

Chronicling resident and staff outcomes throughout the implementation of a professional nursing practice model in one Midwest continuing care retirement community

“…give them the support and resources to be successful (Adams-Wendling & Lee 2005, Anderson, Issel, & McDaniel 2003, & Dahlen 2002Toles & Anderson, 2011;Dellefield et al, 2013;Siegel, Mueller, Anderson, & Dellefield, 2010). There is a growing body of research supporting the role of the DON and how they contribute to creating a culture of excellence or quality.…”

“…There is also an insufficient understanding of how to sustain quality improvement in nursing homes (Adams-Wendling & Lee, 2005;Dellefield, Kelly, & Schnelle, 2013). The main focus being placed on medication administration with a lack of accountability and leadership (Brownlee, 2006;Arling, Kaen, Mueller, Bershadsy, & Degenholtz, 2007;Zinn, Mor & Feng, 2007;Scherb, Specht, Loes, & Reed, 2011).…”