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Structuring Student Placements in the Nursing Home
Mathy Mezey, EdD, RN, FAAN, Sarah Greene Burger, RN-C, MPH, FAAN
Ethel Mitty, EdD, RN
Hartford Institute for Geriatric Nursing, New York University College of Nursing
Module 4 of Nursing Homes as Clinical Placement Sites for Nursing Students Series
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Acknowledgments
This is a joint project of
With support from
Grant to the University of Minnesota School of Nursing
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
This project is endorsed by:
Project Steering CommitteeView List of Members
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
About Module 4: Structuring Student Placements in the Nursing Home
Select a nursing home as a clinical placements for nursing students
Design student placements in nursing homes in light of student learning goals
Organize student exposure to resident-directed care and culture change
Analyze resources that can inform student placement in nursing homes:
Resources to enhance clinical teaching in nursing homes generally
Resources specific to clinical teaching of resident-directed care and culture change
General geriatric nursing resources
Objectives/Purpose:
At the end of this module you will be able to:
Please note that Module 4 refers to nursing practice in “typical” nursing homes. For information on nurse practice in nursing homes implementing resident directed care and culture change, see Modules 3 and 5.
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Faculty should preferentially choose nursing homes for clinical
placements that meet nationally recognized standards of high
quality care: Nursing homes with a CMS 5 or 4 Star Quality Rating
These nursing homes will be in the top 10% of nursing homes nationally and represent the highest quality of care
These nursing homes are more likely than others to have higher RN / resident staffing ratios
Nursing homes with Joint Commission accreditation Joint Commission accreditation is voluntary; related to nursing home’s
managed care relationship and healthcare network requirements
Selecting a Nursing Home as a Clinical Placement: General Recommendation 1
Click to view more information on MDS - Module 1: An overview of nursing homes generally and on Nursing Staffing, Module 2: An overview of nursing in nursing homes
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Selecting a Nursing Home as a Clinical Placement: General Recommendation 2
Nursing homes with a CMS 1 Star Rating in all likelihood haveserious deficiencies in quality of care
Avoid homes with one yellow star, indicating chronic poor care,irrespective of student learning objectives
Nursing homes with CMS 2 and 3 Star Ratings are likely to havedeficiencies in important aspects of care and/or staffing
Nursing homes with many and persistent deficiencies should beAvoided
Consider the number and type of deficiencies in relationship to the student learning objectives
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Options for Student Placement When Nursing Homes with High Quality Ratings are Not Geographically Accessible
Seek CMS 3 & 4 star nursing homes interested
in opportunities to improve care
Collaborate with nursing homes: Workshops for
faculty and students
Senior Center
Continuing Care Retirement Community
Naturally Occurring Retirement Community
Assisted Living
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
The Director of Nursing (DON) does not have a minimum of a baccalaureate degree in nursing
RNs are not on site during student placement
There is instability in nurse leadership, and nursing staff (RN; LPN; CNA) turnover is very high
Click here to learn more: Module 2: An overview of nursing in nursing homes
Nursing Faculty Concerns: Nursing Homes as a Clinical Placement
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Select placements other than nursing homes Tailor student assignment to nursing home’s staffing strengths and
students’ level in the program: Use nursing home for task-oriented assignments (e.g., manual
skill acquisition). Assign student to nursing home nursing staff with at least BSN. Assign students to shadow an APN who cares for residents in the
nursing home.
Options for Student Placements When a Nursing Home with Strong RN Presence is Not Available
Click to view more information on MDS: Module 1: An overview of nursing homes generally
Click to view more information on Nursing Staffing: Module 2: An overview of nursing in nursing homes
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Nursing homes engaged in culture change should be preferentially selected as clinical placement sites
Identifying culture change nursing homes Self-identified Member of:
Pioneer Network (http://www.pioneernetwork.net) Eden Alternative (http://www.edenalt.org) Greenhouse (http://www.thegreenhouseproject.org) Wellspring (http://www.wellspringis.org)
Nursing homes can be practicing resident-directed carebut not self-identify as a culture change nursing home.
Resident-Directed Care and Culture Change Nursing HomesResident-Directed Care and Culture Change Nursing Homes
Click here to view content on resident directed care and culture change: Module 3: Content onresident directed care and culture change
Click here to view a case-study on culture change and options for introducing culture change concepts when no culture change facilities are geographically available: Module 5: A case study to help faculty introduce resident-directed care and culture change
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Observe and understand Resident choices and autonomy Issues of resident risk versus safety Licensed nursing role in staff and resident empowerment Leadership style
Meet with a primary CNA to learn about resident preferences, how CNAs prioritize and help the resident make decisions
Senior/APN student activity/assignment: modify and adapt resident’s care plan based on the resident’s perception of risk taking and safety needs
In absence of a culture change nursing home see module 5
Opportunities for Student Learning in Culture Change Nursing Homes
Click here to learn more about Resident directed care and culture change: Module 3: Content onresident directed care and culture change
Click here to view a case-study on culture change: Module 5: A case study to help faculty introduce resident-directed care and culture change
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Types of learning objectives Learning objectives related to type of course
Learning objectives related to specific content or skills 1, 2
Health systems: Nursing Home Quality Resident attributes/assessment Diagnosis and management Leadership, staffing and organizational assessment Interdisciplinary team Resident directed care and culture change Ethical decision making Policy and reimbursement
Nursing Nursing Student Learning Objectives Learning Objectives
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Assign student to evaluate overall quality of the nursing home to which they are assigned by comparing with other nursing homes. See websites: www.medicare.gov/NHCompare www.nhqualitycampaign.org
Assign student to compare state regulatory variations among states: http://www.hpm.umn.edu/nhregsplus/ Intensify the depth of assignment based on student’s level
in the program (i.e. generic juniors, seniors, graduate)
Assign students to look at web site: Nursing Home Compare http://www.medicare.gov/NHCompare http://pioneernetwork.org
Learning Objective Health systems: NH Quality Sample Student Assignments
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Learning Objective Health systems: Nursing Home Quality Sample
Student Assignments (Cont’d)
Create assignments to meet student learning goals, e.g. communication, policy, interdisciplinary
Assign student to participate in family/resident care plan meeting
“Adopt a resident”: interview resident, family, interdisciplinary team members, staff to create a “collage” of the resident: history, etc. [reminiscence-type therapy] After soliciting input from nursing staff, have student prepare and
present an evidence-based in-service program (e.g., culture change, geriatric syndromes, geriatric resources)
Discussion: why did the facility get a “low” star rating? What were the deficiencies? How were they related to nursing care? How can nursing leadership/management change in order to achieve better outcomes?
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Student assignments can consist of the following:
Dementia unit: meet learning objectives related to communication Sub-acute care unit: meet learning objectives related to acquiring
manual/technical skills (ventilators; tracheostomy care) Interdisciplinary team meetings: meet learning objectives related to
understanding team roles Short-stay residents: meet learning objectives for synthesis of
patient care management
Learning ObjectiveResident Attributes/ Assessment
Sample Student Assignments
For a description of resident attributes, special care units etc. see:
Module 2: An overview of nursing in nursing homes
Module 1: An overview of nursing homes generally
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Assign students to compare the job descriptions of the chief nursing officer in the nursing home, the hospital, in assisted living and in home care
Assign students to compare nurse staffing (RN; LPN; CNA) in their nursing home placement with nursing home staffing nationally and in their state (content related to policy) View the Nursing Home Compare Website
Assign students to observe the role of the DON, the nurse manager, the CNA (content related to leadership)
Assign students to assess the program offered in a nursing home rehabilitation unit verses the rehabilitation program in home care or in a hospital rehab unit
Assign student to observe examples of communication within and between different categories/strata of staff (i.e. direction and type of communication)
Learning Objective Leadership, Staffing and Organizational Assessment
Sample Student Assignments
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Nursing homes are ideal clinical placements to expose nursing students
to an inter-disciplinary team. 1,2
Students should have the opportunity to observe the process and
outcomes of an interdisciplinary team meeting.
The Interdisciplinary Team in Nursing Homes
Click here to view the GNEC Module on the interdisciplinary team
For more information, click to view Module 1: An overview of nursing homes generally
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Observe the role of nurses on the interdisciplinary team Present a resident issue at team meetings Speak with and “shadow” key members of the interdisciplinary team Meet with resident/family prior to team meeting to learn their wishes
or concerns Meet with the resident’s CNA to get their view on care needs and/or
solutions to problems
Learning Objective: Interdisciplinary teamsSample Student Assignments
AGS Geriatric Competences for Inter-disciplinary practice
Module 2: An overview of nursing in nursing homes
For more information, click on the following links:
Module 1: An overview of nursing homes generally
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Determine a resident’s capacity to execute an advance directive Evaluate the extent of resident involvement in their “everyday decisions”
(e.g., bathing; eating) Understand how decisions are made to transfer a resident to the hospital Senior level student: In discussion with the resident, evaluate the benefit and
burden of potential treatments/interventions1
Learning Objective: Ethics and Decision Making Sample Student Assignments
For more information click to view Module 2: An overview of nursing in nursing homes
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Speak with social workers regarding criteria for nursing home admission and discharge
Meet with the MDS coordinator to understand how assessment drives reimbursement
Evaluate the quality improvement data collected and distributed to the interdisciplinary team
Read and evaluate the NH current quality improvement plan and/or study APN Student Assignment: Evaluate/describe how advocacy groups like
NCCNHR and Pioneer Network work to change policy to improve care and quality of life
Learning Objective: Policy and ReimbursementSample Student Assignments
Module 2: An overview of nursing in nursing homes
Module 1: An overview of nursing homes generally
For more information click on the following links:
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Faculty should: Learn/understand the mission of the nursing home Seek unit staff ‘buy-in”:
to the goal and purpose of the placement to assure their awareness of students’ level of knowledge and skills
Learn how nursing staff organize their time to provide resident care Identify opportunities for electronic communication Recognize staff and students through established joint “rituals” (e.g.
graduations; awards; end of semester luncheons; nurses week celebrations)
If possible, spend several hours at the nursing home to: Identify professional roles in the nursing home Understand decision-making practices regarding resident care Understand the culture – and routine(s) – of the nursing home, including time and
location of interdisciplinary team conferences Learn the EMR system/ process with which the students will be
interacting/involved
Adapted with permission of CS Aron., Illinois State University, Mennonite College of Nursing
Enhancing Communication with the Nursing Homes to Strengthen the Student Learning Environment
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Related Resources for Clinical Teaching in Nursing Homes
Weekly Reflection Questions UNC Charlotte School of Nursing
http://nursing.uncc.edu
Elder Project Fairfield University School of Nursing
http://www.fairfield.edu/son http://www.fairfield.edu/son
ECLEPs Project College of Nursing, Oregon Health Sciences
Universityhttp://www.ecleps.org
View General Geriatric
Nursing Resources
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Recap: Key Points about Structuring Student Placement in the Nursing Home
All nursing homes are not alike
Use objective criteria as to quality and staffing to help you select a nursing home for student placement
Choose programs within a nursing home to meet specific learning objectives
We present the following key points to consider:
© 2010 The Hartford Institute for Geriatric Nursing, NYU College of Nursing and The American Association of Colleges of Nursing
Please Proceed to the following modules of the SeriesNursing Homes as Clinical Placement Sites
for Nursing Students
Overview of the Project
Module 1: An overview of nursing homes generally
Module 2: An overview of nursing in nursing homes
Module 3: Content on resident directed care and culture change
Module 4: Selecting and structuring clinical placements in nursing homes
Module 5: A case study to help faculty introduce resident directed care and culture change
Module 6: Strategies to help nursing homes position themselves as clinical placement