LeadingAge Magazine · January/February 2012 • Volume 02 • Number 01

“Overall, people have a very negative stereotype of nursing homes, so coming into school you want to work in a hospital. That’s where all your skills are used. People only work in nursing homes if they can’t get a job elsewhere.” That was the perception of Bretta Schmidt, a senior at the University of Wisconsin-Madison when she began nursing school.

Baccalaureate-prepared nurses rarely choose long-term care for employment upon graduation. In one study, only three percent of nursing students reported planning to work in long-term care settings after graduation. At UW-Madison, a recent graduate survey found no nurses pursued employment in nursing homes, while a study conducted two years ago found UW-Madison nursing students did not pursue employment in nursing homes largely because they felt unprepared to manage multiple, complex resident conditions and supervise CNAs. They worried about being thrust into the role of charge nurse too soon, without sufficient experience.

A new program created by the UW–Madison and Edgewood College schools of nursing aims to change the way students think about long-term care nursing. The Wisconsin Long-Term Care Clinical Scholars Program was created in part to enhance the appeal of long-term care settings to baccalaureate prepared nurses by giving them a chance to experience it firsthand. Other goals included increasing students’ feeling of preparedness, their complex nursing skills and their leadership abilities to care for older adults in nursing homes. The program combines real work experience with workshops that help nursing students develop knowledge and problem-solving skills related to the care of long-term care residents.

In the three-month internship’s inaugural round, five student nurses were placed in three nursing homes, including Good Samaritan Society–Lodi, Oakwood Village and Oak Park Place. Each nursing home selected a site coordinator and a preceptor nurse to work with the intern. The internship program staff held three meetings with key site staff to ensure they understood the program and the nursing home’s responsibilities and had monthly e-mail communication with the site coordinator during the internship period to help assure the homes were able to successfully balance their operational needs and support the intern. The preceptors received education on their roles; they are expected to help interns think through complex situations, expose them to a breadth of nursing experiences and support their students in their professional development. They also received several support calls or in-person visits over the course of the internship to help address any challenges.

The interns work at least three shifts a week during the summer (for which they are paid by the nursing home) under the guidance of a preceptor nurse. In Wisconsin, the interns can be classified as nurse techs, a status that allows them to perform skills they have successfully completed in nursing school. In addition, interns participate in weekly interactive workshops led by nursing faculty and guest experts on geriatric care, long-term care systems, and person-centered care. Topics covered include:

  • Time management
  • Polypharmacy
  • Quality of life
  • Communicating with team members and families
  • Achieving and maintaining function
  • Managing diabetes
  • Swallowing and nutrition
  • Assessing and managing changes in condition
  • Assessing and managing changes in cognition
  • End-of-life care
  • Resident comfort and pain management
  • Leadership and management
  • RN decision making
  • Safety culture

Schmidt interned at Good Samaritan Society of Lodi. “I’ve had four clinical rotations so far and this has been my favorite one. It surprised me how much I enjoyed it.” Britta’s preceptor was Anna Henn, who she says was key to her positive experience. “I started by shadowing her to see what she does, and by the third day I took one resident. It was a gradual gain of independence. By the end of summer, I had half her responsibilities. She really wanted to help me learn and took advantage of every teaching opportunity.”

 

People often identify nursing homes as depressing settings, but Schmidt found that not to be the case. She enjoyed connecting with residents. Compared to acute care, nurses work with residents continuously and develop a relationship with them. “That’s what I really loved most about the internship,” Schmidt says.

By the end of the internship, Schmidt says her perception of long-term care changed. “People think all long-term care nurses do is pass pills. That is a big part of it, but I was surprised about all the skills I was able to practice,” she says. With coaching from her preceptor, she was able to conduct assessments, provide wound care, administer IV antibiotics, perform post-surgical care, and communicate with doctors and nurse practitioners about her assessments and recommendations.

Schmidt’s fellow interns also say they found a new appreciation for long-term care settings and nurses. Four out of the five say they feel prepared to take a job in long-term care, and all say they would recommend the internship to other nursing students.

The administration from Good Samaritan Society–Lodi felt the program was a worthwhile investment to see the growth in the preceptor nurse’s leadership, teaching and mentoring abilities, which she can use with other staff and to spread the word that nursing homes, and theirs in particular, are a great place for RNs to work.

The internship program was recently awarded the American Association of Colleges of Nursing Award for Innovative Clinical Rotation in a Nursing Home. The UW-Madison School of Nursing is creating replication materials for the program. Nursing homes who might be interested in partnering with their local school of nursing to launch the internship should email Kimberly Nolet or call her at 608-262-8146 for more information.