Baccalaureate-educated Registered Nurses in nursing homes: Experiences and opinions of administrators and nursing staff

Abstract

Aims: To understand how nursing homes employ baccalaureate-educated Registered Nurses (BRNs) and how they view the unique contributions of baccalaureate-educated Registered Nurses to staff and residents in their organizations.

Background: Although providing care for nursing home residents is complex and thus requires a high level of skills, organizations often struggle to recruit and retain BRNs. Some nursing home organizations do not employ baccalaureate-educated Registered Nurses at all. Among those that do, it is unknown how well these organizations make use of baccalaureate-educated Registered Nurses' expertise or if their roles are different from those of other staff.

Design: A qualitative study, consisting of 26 individual and three group interviews was conducted in the Netherlands.

Methods: Interviews were conducted at the board-, management- and staff-level in six nursing home organizations. Data were collected between January 2016-May 2016.

Results: Organizations employed baccalaureate-educated Registered Nurses to fulfil an informal leadership role for direct care teams. Organizations that do not employ baccalaureate-educated Registered Nurses were unable to articulate their role in the nursing home setting. Difficulties baccalaureate-educated Registered Nurses experienced during role implementation depended on role clarity, the term used to refer to the baccalaureate-educated Registered Nurse, the extent to which nurses received support, openness from direct care teams and baccalaureate-educated Registered Nurses' own behaviour. The unique contribution of baccalaureate-educated Registered Nurses perceived by respondents differed between and in organizations.

Conclusion: Our findings suggest that there is no "one size fits all" approach to employing baccalaureate-educated Registered Nurses in nursing homes. To ensure the satisfaction of both baccalaureate-educated Registered Nurses and the organizations that employ them, careful implementation and evaluation of their role is crucial.

Keywords: Registered Nurses; elderly care; leadership; long-term care; nursing homes; quality of care; role implementation.