Page 58 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
widespread, and the current rate of certification in geriatric medicine will not meet current demand.” He concludes:
Finally the nursing home industry must rise to support the proper level of physician professionalism and to achieve the new expectations of regulatory compliance. There must be administrative support for the medical director in terms of salary and resources to maintain levels of quality expected under the new guideline. The medical director must enter this position with the confidence that his/her input will be respected and appreciated. The federal government now formally recognizes the importance of an informed, involved medical director, and it is time for the nursing home industry to do the same.” (Levine, 2006)
A recent study by Rowland, reported in the Journal of the American Directors Association, used a weighting system of F-tag scope and severity on dimensions of quality potentially impacted by the medical director. It concludes that, “The presence of certified medical directors is an independent predictor of quality in US nursing homes.” (Rowland, 2009)
Many providers have experienced physician professionalism with elder care at the highest level, but unfortunately also at levels that leave much room for needed improvement. It is hoped that increased medical director involvement and professionalism can have a positive influence on quality of life and quality of care by impacting both resident care policies and coordination of care.
Nursing Embraces Accountability, Addressing Barriers and Opportunities
We can only speculate what Florence Nightingale might think of how nursing in the care of the elderly has evolved since her day. She is often quoted, “Were there none who were discontented with what they have, the world would never reach anything better.”
Leaders in the nursing profession recently addressed their evolving role in resident-directed care and culture change in a recent issue paper, Nurses Involvement in Nursing Home Culture Change: Overcoming Barriers, Advancing Opportunities. Their recommendations, stated below, could well form the base for consideration of the issue by all professions:
Recommendation 1: Develop and distribute a statement of goals for practicing nurses in culture change homes.
Recommendation 2: Recommendation 3:
Recommendation 4:
Recommendation 5: Recommendation 6:
Develop competencies for nurses practicing in culture change homes.
Conduct a comprehensive review of culture change content in pre-licensure (associate degree and baccalaureate) nursing programs.
Disseminate existing tools/resources on culture change and nursing’s role in culture change to academic nursing programs, including strategies for incorporating this content into the curriculum.
Create new tools/resources based on the competencies for practicing nursing in nursing homes.
Identify research priorities for examining the role of nurses in nursing home culture change. (Burger et al, 2009)
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