When Is a Nursing Home Complaint Really a Complaint? Making Sense Out of Increased Complaints in U.S. Nursing Homes

Official complaints are one tool for addressing nursing home quality concerns in a timely manner. Similar to trends nationwide, the Ohio Department of Health (ODH) has noticed a trend in increasing nursing home complaints and has partnered with the Scripps Gerontology Center to learn more about facilities that receive complaints. Greater understanding may lead to proactive approaches to addressing and preventing issues. This study relies on two years of statewide Ohio nursing home complaint data. Between 2018 and 2019, the average complaint rate per 100 residents went from 6.59 to 7.06, with more than 70% of complaints unsubstantiated. Complaint information from 629 Ohio nursing homes in 2018 was linked with Centers for Medicare and Medicaid Services Nursing Home Compare data, the Ohio Biennial Survey of Long-Term Care Facilities, and Ohio Nursing Home Resident and Family Satisfaction Surveys. Using ordered logistic regression analyses, we investigated nursing home providers' characteristics using different levels of complaints and substantiated complaints. Findings suggest that providers with higher complaint rates are located in urban areas, had administrator and/or director of nursing (DON) turnover in the previous 3 years, experienced decreased occupancy rates, had reduced nurse aide retention, and received lower family satisfaction scores. Additionally, providers with administrator and/or DON turnover, and low family satisfaction scores are more likely to have substantiated complaints. Because increasing numbers of complaints are accompanied by relatively low substantiation rates, policy interventions targeted to specific types of providers may improve the cost-effectiveness of complaint resolution, as well as the quality of care.

Is Higher Nurse Aide Retention Associated with Fewer Nursing Home Allegations and Complaints?

Consumer voices are often left out from assessments of nursing home (NH) quality. For this reason, consumer allegations and complaints against nursing homes were studied in relation to facility rates of nurse aide retention. Analyses involved means and frequencies, correlations, ANOVAs with Tukey correction to examine the independent and dependent variables (N=690). Four quartiles of retention were created. In the final models, medium, high, and extremely high retention facilities are compared to the low retention facilities. Negative binomial regressions were estimated on total, substantiated, and unsubstantiated counts of allegations and complaints. All regressions controlled for the same characteristics, including nurse aide empowerment, consistent assignment, administrator turnover, director of nursing turnover, average age of residents, and percent female. The correlation between retention and the dependent variables was negative and statistically significant (r=-0.11, p<.01). The ANOVAs showed that high retention NHs (61-72%) received significantly fewer allegations than low (0-48%) and medium (49-60%) retention NHs; they also received fewer unsubstantiated allegations, and fewer complaints, both substantiated and unsubstantiated. After controlling for other variables, each retention group was significantly related to having fewer allegations and complaints compared to the low retention NHs. Notably, high retention NHs received between 29 and 35% fewer allegations and complaints of all types. Unexpectedly, extremely high retention NHs had more allegations, complaints, and unsubstantiated allegations than high retention NHs. Policy and practice have a role to promote nurse aide retention, improve job quality, and ensure adequate support for this critical, in-demand workforce.

Testing interaction effects of intellectual capital and burnout on innovative work behaviour of professional nurses

PurposeThe present study aims to examine the moderating effect of burnout between intellectual capital and innovative work behaviour of professional nurses.Design/methodology/approachMixed-method approach was followed that involves conducting both quantitative surveys and qualitative semi-structured interviews. Quantitative data was collected from 844 staff nurses. Interviews were conducted with a total of 20 participants including director of nursing, chief nursing officer, general manager operation, professor cum principal, doctors, nurse educators, ward in charges and staff nurses working with multi, super speciality private and charitable trust hospitals in Mumbai (India).FindingsIntellectual capital and burnout (intellectual capital*burnout) interaction increased the proportion of innovative work behaviour from 0.09 to 0.15, an increase of 66.67%. The results also reveal a significant and negative (−0.09) moderating effect of burnout between intellectual capital and innovative work behaviour of nurses. Qualitative findings also could confirm and support that human, structural and relational capital help nurses to be innovative. However, whenever nurses feel a loss of energy, enthusiasm, motivation and exhaustion, they tend to become less innovative and continue only with the routine works.Research limitations/implicationsThis study provides a new implication for multi, super speciality private and charitable trust hospitals management to relook at and reduce the level of burnout to mitigate its adverse effect.Originality/valueTo the best of the authors’ knowledge, this is the first study and findings related to professional nurses working in multi, super speciality private and charitable trust hospitals in India.

Implementing a vision of person-centredness across a new university hospital in Denmark

The experience of a collaborative process to build a research and development culture at a new university hospital underlined that the Person-centred Practice Framework (McCance and McCormack, 2017) forms a solid and valuable foundation for ongoing work. The fact that the process has involved researchers, leaders at different levels, clinical nurse specialists and other healthcare professionals makes the framework’s focus on the whole care environment especially relevant. How work towards a nursing research culture developed into a person-centred strategy In 2010, the management at our hospital in Denmark established a director of nursing research position, with a remit to create, develop and support a research culture within the nursing and allied health professions. No guidance was offered on how this should be done and as a consequence the ideas and professional profile of the person hired were highly influential (Hølge-Hazelton, 2019). Having a solid background in action research and studies of vocational and professional education, the new director launched a collaborative process to identify the desired characteristics of the research culture. Those contributing included the networks of clinical development nurses and head nurses, and the executive director of nursing. The proposed vision that emerged was: Our research culture should be constructive, creative, inclusive and visible at all levels of the hospital. This vision was discussed and agreed among all head nurses at the hospital. The idea was that the culture should be everybody’s business and include all levels of nursing, and furthermore that these levels would be interdependent and dynamic. The strategy to achieve this was defined as ‘bottom up, top down and don’t forget the middle’, to signal that research and development are closely related and that they should be participatory, based on a broad understanding of evidence (Rycroft-Malone, 2010), clinically relevant, and supported by the hospital’s leadership. Within the first years of work towards realising the vision, two more nursing researchers were hired in clinical departments at the hospital. They also had a background in personal and organisational learning processes, organisational development and action research. Their task was to support the realisation of the strategy at departmental and unit level.

Emergency in the ER

Like many healthcare providers, Shepherd's Grace Hospital struggles to appropriately staff their Emergency Room. Electing to follow employment trends, the hospital has engaged with a staffing agency for four traveling nurses. The purpose of this case is to explore the challenges of bringing contingent workers into an organization and how these short-term employees are viewed by the others more permanently embedded in the organization and the community. Also of importance is how social and psychological capital develop within an organization and how these roles can conflict when translated into a leadership role. This case follows four days of events for a traveling nurse, a traditional nurse, the Director of Nursing Services, the Director of Human Resources at the fictional Shepherd's Grace Hospital in the real city of Little Rock, AR. Upon conclusion, readers are asked to analyze the actions of these four characters along with the interactions of their circumstances (personal, professional, and geographic) to make decisions for how the hospital should move forward.

PRACTICES OF HOSPITAL NURSES FOR CONTINUITY OF CARE IN PRIMARY CARE: AN EXPLORATORY STUDY

ABSTRACT Objective: to know the practices developed by hospital nurses for continuity of care for Primary Care. Method: this is an exploratory, qualitative research conducted in university hospitals in São Paulo and Curitiba, Brazil. For data collection, a semi-structured interview was conducted with the Director of Nursing and an online questionnaire through open-ended and closed-ended questions, with nurses between August 2018 and July 2019. The analyzes of the interviews were carried out as proposed by Minayo based on in the theoretical framework of continuity of care. Results: the research was conducted at three university hospitals, and one Director of Nursing and 48 nurses participated. From analysis of nurses’ answers, two categories of analysis emerged: identification of post-discharge patients’ care needs and the necessary competencies for continuity of care. Where it was perceived since patients’ admission, nurses’ concern for continuity of post-hospital discharge care, establishing flows together with nurses of the Internal Center for Regulation/Discharge Management Service for the Health Department of the municipality, which forwards to patients’ reference health unit. Conclusion: although nurses are professionals who actively participates in care at various points in the health care network and recognizes the importance of continuing post-discharge care, they remain a fragile point in the care chain, and it is necessary to strengthen this mechanism with Primary Care, optimize home care and avoid hospitalizations.

Identifying the Implementation Conditions Associated With Positive Outcomes in a Successful Nursing Facility Demonstration Project

Background and Objectives To identify the implementation barriers, facilitators, and conditions associated with successful outcomes from a clinical demonstration project to reduce potentially avoidable hospitalizations of long-stay nursing facility residents in 19 Indiana nursing homes. Research Design and Methods Optimizing Patient Transfers, Impacting Medical quality, Improving Symptoms—Transforming Institutional Care (OPTIMISTIC) is a multicomponent intervention that includes enhanced geriatric care, transition support, and palliative care. The configurational analysis was used to analyze descriptive and quantitative data collected during the project. The primary outcome was reductions in hospitalizations per 1,000 eligible resident days. Results Analysis of barriers, facilitators, and conditions for success yielded a model with 2 solution pathways associated with a 10% reduction in potentially avoidable hospitalizations per 1,000 resident days: (a) lower baseline hospitalization rates and investment of senior management; or (b) turnover by the director of nursing during the observation period. Conditions for success were similar for a 20% reduction, with the addition of increased resident acuity. Discussion and Implications Key conditions for successful implementation of the OPTIMISTIC intervention include strong investment by senior leadership and an environment in which baseline hospitalization rates leave ample room for improvement. Turnover in the position of director of nursing also linked to successful implementation; this switch in leadership may represent an opportunity for culture change by bringing in new perspectives and viewpoints. These findings help define the conditions for the successful implementation of the OPTIMISTIC model and have implications for the successful implementation of interventions in the nursing facility more generally.

Barriers and Insights in Participant Recruitment in Assisted Living Facilities

An estimated 1.2 million older adults nationwide currently reside in assisted/supportive living facilities, and research is required to continue to identify best outcomes in for their care. However, challenges exist. The aim of this paper is to address barriers and provide insights related to participant recruitment in assisted and supportive living facilities. Identified barriers included unproductive communication with reception area staff, a perceived lack of interest in research activity, and the inability of Director of Nursing (DON) to provide authorization for research activities. Recruitment insights included productive encounters with gatekeepers, establishing trust with executive administration and healthcare personnel, and research team persistence.

2045. GAIN (Generating Antimicrobial Stewardship Initiatives in Chicago Skilled Nursing Facilities) Collaborative Survey Results: CDC Core Elements of Antimicrobial Stewardship Compliance Assessment in 27 Chicago Skilled Nursing Facilities

Background Antimicrobial Stewardship Programs (ASPs) in long-term care facilities is a Centers for Medicare and Medicaid Services requirement as of 2017. The CDC recommends that ASPs in skilled nursing facilities (SNFs) fulfill 7 Core Elements: leadership commitment, accountability, drug expertise, action, tracking, reporting and education. Methods An electronic survey utilizing REDCap was sent to the 76 Chicago SNFs representatives (Administrator, Director of Nursing, and/or Assistant Director of Nursing). Survey questions were adopted from the CDC Core Elements of Antimicrobial Stewardship for Nursing Homes Checklist. Results Twenty-seven (36%) of Chicago SNFs responded. Bed size ranged from 36 – 307 (median 150). Although 93% of facilities had a written statement of leadership support for antimicrobial stewardship, only 22% cited any budgeted financial support for antimicrobial stewardship activities. While Pharmacist Consultants visited all SNFs (most visiting monthly), only 33% of SNFs had an Infectious Disease Provider that consulted on-site. Dedicated time for antimicrobial stewardship activities was less than 10 hours per week in 78% of facilities, with half of all respondents reporting less than 5 hours per week. Treatment guidelines were in place for 63% of SNFs, 56% had an antibiogram, and only 7% utilized the Loeb criteria to guide appropriate antibiotic prescribing. Many facilities tracked antimicrobial stewardship metrics (93%) and reported out to staff (70%). Annual nursing training on antimicrobial stewardship occurs more frequently (85%) than prescriber education (56%). The top 3 barriers identified in implementing ASPs were financial limitations (33%), lack of clinical expertise (33%), and provider opposition (30%). Facilities’ compliance in all seven core elements varied from partially compliant (65%), majority compliant (19%), and majority non-compliant (16%). Conclusion Data from this baseline survey informed focused antimicrobial stewardship initiatives for the GAIN Collaborative. Targeted areas to incorporate into facility action plans include treatment guideline development, antibiograms, annual staff antimicrobial stewardship education, and adoption of the Loeb minimum criteria for antibiotic prescribing into clinical practice. Disclosures All authors: No reported disclosures.