Developing skills to equip registered nurses to work in care homes for older people: An international exploration of education and workforce development processes
Registered nurses employed in care homes require a unique skill set to manage care that is predominantly provided in the private sector, and at a location where health and social care intersect. The role necessitates balancing care for residents who have increasingly complex needs and more acute needs, yet who require support to enjoy a quality home life. Studies that have investigated the role and activities of the care home nurse have found it is a multifarious role that requires a range of diverse skills and knowledge, including clinical skills, co-morbidity management skills, gerontological skills, and social care skills. Other facets of the role include running the facility, organising resources, and supporting the facility to acquire accreditation for quality care.
Both undergraduate and post-graduate nurse education and training programmes have not always acknowledged or accommodated the specific skills and professional development needs of care home nurses. With regard to post graduate development, further challenges arise as staff shortages, difficulties in obtaining relief staff, and high course costs can limit education and training opportunities. In addition, organisational barriers such as different organisational cultures, and negative attitudes towards role status and partnership working, can make cross organisational support for skills development difficult to facilitate. Also, employment contracts can prohibit teaching/learning and competency assessment between staff working for different organisations.
A review of nurse education processes and care home workforce competency improvements that operate in other countries, for example USA, Germany and Sweden, revealed a variety of approaches that address some of these issues. Visits to education institutions and care home facilities in these three countries were therefore arranged with the following overarching aim:
- To undertake an international exploration of education and workforce development processes that equip registered nurses to work in care homes for older people in order to generate insights that may inform nurse education and care home practices in England.
Information collected during the visits was analysed, and education and workforce development strategies were identified. These strategies were grouped under the thematic headings: undergraduate education, continuing professional development, and collaboration and integration initiatives to support workforce development.
- Undergraduate education: Many of the approaches observed aim to ensure that nurse education/training address the unique needs of the care home population. At all locations visited, this begins at undergraduate level, whereby undergraduate education and practice placements support students to acquire skills and knowledge relevant to care home nursing. These programmes also support students’ understanding of the complexity of the role, and that it is a specialist, unique role that requires expertise and high levels of skill.
- Continuing professional development: With regard to care home nurse continuing professional development, providing relevant education/training is not enough on its own. Nurses need to be able to access education/training in ways that are expedient, and not cost-prohibitive. During the scholarship, a variety of approaches to enable care home staff to conveniently access education and integrate learning into everyday practice were observed, for example via utilising e-learning packages and virtual university modules, formal work-based/experiential learning and competency assessment, and cross-organisational learning. The success of these initiatives, however, depends upon the willingness and ability of stakeholders to collaborate, integrate practices, and create sustainable learning environments.
- Collaboration and integration initiatives: Collaboration and integration practices were also observed in initiatives that bring together education/clinical practice/research within the same location, and within care practices. This integrated approach promotes evidence-based practice, and can foster creative and innovative practice, which leads to care improvements for residents.
Some of the strategies observed during the visits have since informed nurse education and workforce development practices in a region in North East England. For example: the development of undergraduate care home internships, the development of a competency framework for staff working with older people residing in care homes, and development of online educational materials in collaboration with the local Clinical Research Network.