title: Retooling the RN workforce in long-term care: nursing certification as a pathway to quality improvement.
abstract: This article describes a project to improve nursing care quality in long-term care (LTC) by retooling registered nurses' (RN) geriatric clinical competence. A continuing education course was developed to prepare LTC RNs (N = 84) for national board certification and improve technological competence. The certification pass-rate was 98.5%. The study used a mixed methods design with retrospective pretests administered to RN participants. Multivariate analysis examined the impact of RN certification on empowerment, job satisfaction, intent to turnover, and clinical competence. Results showed certification significantly improved empowerment, satisfaction, and competence. A fixed effects analysis showed intent to turnover was a function of changes in empowerment, job dissatisfaction, and competency (F = 79.2; p < 0.001). Changes in empowerment (t = 1.63, p = 0.11) and competency (t = -0.04, p = 0.97) did not affect changes in job satisfaction. Findings suggest RN certification can reduce persistently high RN turnover rates that negatively impact patient safety and LTC quality.
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE 68198, USA. Electronic address: mecramer@unmc.edu.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cramer
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: High
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Culross
authors.affiliation: Nebraska Methodist Hospital, Omaha, NE, USA; Nebraska Methodist College of Nursing, Omaha, NE, USA.
authors.forename: Deborah Marks
authors.initials: DM
authors.lastname: Conley
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Preethy
authors.initials: P
authors.lastname: Nayar
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Anh T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Diptee
authors.initials: D
authors.lastname: Ojha
mesh_terms: D002568:Certification; D002983:Clinical Competence; D004509:Education, Nursing, Continuing; D005851:Geriatric Nursing / Q000592:standards*; D006801:Humans; D007588:Job Satisfaction; D008134:Long-Term Care; D015999:Multivariate Analysis; D009740:Nursing Staff / Q000523:psychology; D011209:Power, Psychological; D058996:Quality Improvement; D014481:United States
keywords: Evaluation; Long-term care; Nursing homes; Nursing studies; Workforce issues