What a delightful surprise to pick up the Journal of Gerontological Nursing and read the editorial. Thank you for recognizing the Partnership activities. It is rewarding to all of us to feel support and acknowledgment. It is hoped that, as we move into our dissemination phase, we can share our many experiences and lessons with our colleagues across the country.
There is one area of confusion for me, however. Are you suggesting that the industry and education prepare another type of nurse in addition to the ADN and BSN - that of a long-term care nurse technician? And if so, could you differentiate this person from the ADN as the project has them evolving, and the American Medical Association's RCT proposal and all its promises? I agree that the industry needs well-prepared nurses, but not in the form of a new type of worker with a new title.
Susan Sherman, MA, RN
Head, Department cf Nursing
Community College of Philadelphia
The Community College
Nursing Home Partnership
Dr Brower Responds:
Editorials state positions and make a case for a need to correct conditions. They frequently arouse emotions in some way. Using that as a gauge, this is the first editorial that I have written that has brought a response. I remind the readers that publishers do not necessarily agree with the positions expressed by guest editors.
I am saddened that Ms dements is leaving nursing; she characterizes the nurse we need to encourage to stay in nursing. It is often nurses who become outraged by conditions who catalyze words into positive actions for change.
The sad truth is that a number of RNs do not recognize the worth, dignity, and contributions that LPNs make in the nursing home. They are the backbone of staffing. Too often they are not given adequate support, supervision, and inservice education. As the first line of defense in patient care, they grapple with the mountains of paperwork, heavy work demands, and a nursing assistant staff that is constantly turning over. Too often they do it alone.
Ms Clements, won't you please reconsider? Your compassion and love for older people and your years of nursing experience can be capitalized on if you obtain your nursing degree. But even more important would be your empathie understanding of the difficult role the LPN faces. As an RN, you would be able to make more of an impact. But I cannot promise you that you will not burn out in that role, either.
Ms Bayer also sounds like a dedicated nurse who was able to create constructive change. However, is she implying that all nursing homes in Maine are as good as the ones she owns? My experience tells me that for every good nursing home there are eight that have problems. Ms Bayer does live up to my experience that nurses and others who work in long-term care are so sensitive to any criticism that they personalize that criticism and react defensively. This is true even more so when there is a proprietary interest. It is indeed the exceptional RN who works to bring constructive change outside of her own institutions. Like many state professional boards whose function is to protect the public, they become short-sighted and self-protective.
To be fair, I need to add a postscript to my editorial. The home to which I referred has a dedicated administrator. She took over from an administrator who had brought the home to the brink of chaos and threat of closure. Ironically, the administrator she replaced was an RN. The current administrator is working diligently to bring positive change; I saw some of it while I was there, and it continued after I left. One of the bravest things she did was terminate several long-term nursing staff who were obvious problems.
To Ms Sherman I realized that it was heresy to suggest that we need yet another type of nurse. Yet, I remind you that there are already operating room and emergency room technicians. The technician who would be educated in long-term care would have much more time to devote to theory and principles of developmental disabilities. There would be no need to cover obstetrics, or maternal and child care. But the emphasis would be on aging, geriatrics, and chronic health problems. The longterm care technician would be prepared to care for persons afflicted with developmental disabilities across the life span and in many types of institutional and non-institutional settings. Gerontological nursing education continues to be devalued by a large number of nurse educators, and the realities are that there really is too little time in the curriculum to teach all that needs teaching. Don't worry, Susan, I don't expect anyone to take me seriously. But you never know.
H. Terri Brower, EdD, RN, FAAN
Auburn University School of Nursing