WEBVTT 00:00:05.300 --> 00:00:09.970 position:50% align:middle - [Dr. Weaver] So I'm going to talk to you about our research on the LPN workforce in New Jersey, 00:00:09.970 --> 00:00:17.030 position:50% align:middle and this study was conducted by myself and Dr. Edna Cadmus and Dr. Pam de Cordova. 00:00:17.030 --> 00:00:24.530 position:50% align:middle And we are at the New Jersey Collaborating Center for Nursing, and that's the state nursing workforce center 00:00:24.530 --> 00:00:25.880 position:50% align:middle in New Jersey. 00:00:25.880 --> 00:00:28.710 position:50% align:middle It was established by legislation in 2002. 00:00:28.710 --> 00:00:37.380 position:50% align:middle So grateful for those visionary nurses that got that legislation through. 00:00:37.380 --> 00:00:42.050 position:50% align:middle And we celebrated our 20th anniversary in 2022. 00:00:42.050 --> 00:00:53.580 position:50% align:middle And also grateful to the NCSBN in supporting this research with the 2019 grant. 00:00:53.580 --> 00:00:58.080 position:50% align:middle So, what do we know about the LPN workforce? 00:00:58.080 --> 00:01:09.970 position:50% align:middle We know there are nearly a million LPNs in the country, and they're essential members of the healthcare team. 00:01:09.970 --> 00:01:14.650 position:50% align:middle In the U.S., the majority of LPNs are working where? 00:01:14.650 --> 00:01:19.010 position:50% align:middle In the long-term care setting and in the home care setting. 00:01:19.010 --> 00:01:26.930 position:50% align:middle So in New Jersey, we gathered data on the LPN workforce from the license renewal survey. 00:01:26.930 --> 00:01:37.590 position:50% align:middle In our last survey, we have 23,330 LPNs in New Jersey, and their primary employment setting is long-term 00:01:37.590 --> 00:01:49.230 position:50% align:middle care 42%, home health and hospice 20%, and 6% in ambulatory and 6% in hospital setting. 00:01:49.230 --> 00:01:59.160 position:50% align:middle The New Jersey Nurse Practice Act tells us what LPNs can do, and it states clearly, they can perform tasks, 00:01:59.160 --> 00:02:05.120 position:50% align:middle reinforce teaching, and provide care under the direction of the RN. 00:02:05.120 --> 00:02:13.590 position:50% align:middle The administrative code stipulates that the RNs shall not delegate assessment of the patient. 00:02:13.590 --> 00:02:20.670 position:50% align:middle And at the time we did this study, we didn't have much else information on the LPN 00:02:20.670 --> 00:02:22.300 position:50% align:middle workforce in New Jersey. 00:02:22.300 --> 00:02:31.400 position:50% align:middle And you know, the health care is constantly evolving so we thought it was time to look at the LPN role and job 00:02:31.400 --> 00:02:37.160 position:50% align:middle functions and better understand what the LPNs were doing in New Jersey. 00:02:37.160 --> 00:02:42.370 position:50% align:middle So we conducted this study, and the purpose is outlined here. 00:02:42.370 --> 00:02:43.930 position:50% align:middle It was in two phases. 00:02:43.930 --> 00:02:52.060 position:50% align:middle We started with the qualitative to explore the perceptions of LPNs and employers of LPNs about the LPN 00:02:52.060 --> 00:02:58.010 position:50% align:middle roles and job functions across all settings. 00:02:58.010 --> 00:03:01.440 position:50% align:middle And then in Phase II, it was quantitative. 00:03:01.440 --> 00:03:06.800 position:50% align:middle We did a survey of the nursing activities and job satisfaction of LPNs. 00:03:06.800 --> 00:03:16.680 position:50% align:middle And then, for LPNs working in nursing home, we did the patient safety culture survey for them. 00:03:16.680 --> 00:03:24.519 position:50% align:middle So for our first Phase I, and this was conducted pre-COVID, in the fall of 2019, 00:03:24.519 --> 00:03:33.530 position:50% align:middle we wanted to obtain a comprehensive understanding of LPNs' and LPN employers' perspective of the LPN role. 00:03:33.530 --> 00:03:36.910 position:50% align:middle We did 10 in-person focus groups with LPNs. 00:03:36.910 --> 00:03:41.510 position:50% align:middle We made sure to have the focus groups across the state. 00:03:41.510 --> 00:03:51.380 position:50% align:middle So we did 10 in-person focus groups in 8 counties, in the North, Central, and Southern regions. 00:03:51.380 --> 00:03:57.440 position:50% align:middle And like I said, there were 43 LPN participants, and you see, on this slide, the average age was 46. 00:03:57.440 --> 00:04:01.950 position:50% align:middle They were in their position eight and a half years. 00:04:01.950 --> 00:04:12.560 position:50% align:middle And once again, the majority worked in long-term care and in home health and hospice. 00:04:12.560 --> 00:04:17.600 position:50% align:middle Regarding the interviews with the employers, we did 17 interviews. 00:04:17.600 --> 00:04:20.860 position:50% align:middle Once again, the majority were in long-term and home health. 00:04:20.860 --> 00:04:26.940 position:50% align:middle And we tried hard to have interviews throughout the state. 00:04:26.940 --> 00:04:35.990 position:50% align:middle The employers indicated that they hired LPNs full-time, part-time, and per diem positions, and the employers, 00:04:35.990 --> 00:04:45.880 position:50% align:middle the number of LPNs they employed ranged from 5 LPNs in a Medicare-certified home health agency and 750 in a 00:04:45.880 --> 00:04:49.970 position:50% align:middle private duty home care agency. 00:04:49.970 --> 00:04:51.380 position:50% align:middle And now the themes. 00:04:51.380 --> 00:04:56.340 position:50% align:middle This is what I love best about qualitative, because I get to share what the participants 00:04:56.340 --> 00:04:57.120 position:50% align:middle said to us. 00:04:57.120 --> 00:05:04.650 position:50% align:middle So we had common themes between the LPNs and the employers, and they're listed here. 00:05:04.650 --> 00:05:10.260 position:50% align:middle And according to both LPNs and employers, they felt there was uncertainty about the 00:05:10.260 --> 00:05:12.990 position:50% align:middle future of LPNs. 00:05:12.990 --> 00:05:20.220 position:50% align:middle They recognize there's going to be a continued demand and need for LPNs in home care and long-term care. 00:05:20.220 --> 00:05:26.990 position:50% align:middle And this was reinforced by an LPN who said, "There are so many opportunities in nursing homes and 00:05:26.990 --> 00:05:30.890 position:50% align:middle long-term care facilities and even in home care. 00:05:30.890 --> 00:05:36.310 position:50% align:middle Because you take on such responsibility, they're always hiring." 00:05:36.310 --> 00:05:43.210 position:50% align:middle However, many LPNs worried about their future and whether they will be needed, and one even said, 00:05:43.210 --> 00:05:49.790 position:50% align:middle "We are worried we're going to die out, unfortunately." 00:05:49.790 --> 00:05:57.270 position:50% align:middle And both the LPNs and employers really felt that LPNs needed more hands-on experience for the 00:05:57.270 --> 00:05:59.060 position:50% align:middle LPN new graduates. 00:05:59.060 --> 00:06:04.070 position:50% align:middle They felt there was a lot of learning on the job. 00:06:04.070 --> 00:06:07.070 position:50% align:middle Now, the LPN focus group themes. 00:06:07.070 --> 00:06:16.930 position:50% align:middle The primary theme was the LPNs question what they should do, what they can do, and what they will do, 00:06:16.930 --> 00:06:25.090 position:50% align:middle and that really illustrates the role confusion that LPNs have in just doing what the facility demands. 00:06:25.090 --> 00:06:29.970 position:50% align:middle And an LPN, I think she explained this nicely, and this came because she worked 00:06:29.970 --> 00:06:34.730 position:50% align:middle at different facilities, and she said, "The scope of practice, 00:06:34.730 --> 00:06:41.940 position:50% align:middle it varies in each facility you work, depends on what you can do and what you can't do." 00:06:41.940 --> 00:06:48.100 position:50% align:middle Another LPN said, "If an admission comes in, I can do a complete assessment, 00:06:48.100 --> 00:06:50.070 position:50% align:middle but I need the RN to sign off on that." 00:06:50.070 --> 00:06:53.600 position:50% align:middle You do the assessment, but the RN has to sign off. 00:06:53.600 --> 00:06:58.380 position:50% align:middle What she's supposed to do is go in and do the assessment. 00:06:58.380 --> 00:07:00.450 position:50% align:middle So you see that confusion there. 00:07:00.450 --> 00:07:06.960 position:50% align:middle And another LPN said, "This is the first place that I worked at that the LPN 00:07:06.960 --> 00:07:10.410 position:50% align:middle was allowed to do an admission assessment actually. 00:07:10.410 --> 00:07:15.430 position:50% align:middle The other place I worked, only the RN could do the assessment. 00:07:15.430 --> 00:07:20.930 position:50% align:middle Now, if I did the entire admission, an RN is going to look at the entire packet and sign 00:07:20.930 --> 00:07:21.930 position:50% align:middle off on it." 00:07:21.930 --> 00:07:27.810 position:50% align:middle So I think you see that the quotes really illustrate this confusion on what they should do. 00:07:27.810 --> 00:07:35.340 position:50% align:middle Another theme was the LPNs felt stuck in their role, and it's really a conundrum for LPNs who believe it's 00:07:35.340 --> 00:07:42.220 position:50% align:middle nearly impossible to go back to school, along with being unable to advance in their role. 00:07:42.220 --> 00:07:50.690 position:50% align:middle And lastly, the LPNs prayed that they made it through their shift, and this, particularly, 00:07:50.690 --> 00:07:54.510 position:50% align:middle came from those working in the long-term care setting. 00:07:54.510 --> 00:08:04.520 position:50% align:middle And an LPN describes this after working evening shift, this is what she explained to us, 00:08:04.520 --> 00:08:12.680 position:50% align:middle "I had 34 patients on 3:00 to 11:00 in long-term care, with one over from sub-acute and others that had 00:08:12.680 --> 00:08:16.300 position:50% align:middle dementia that really should have been on a locked unit. 00:08:16.300 --> 00:08:22.220 position:50% align:middle That used to be my full-time job, and I cried on my way to work every single day because 00:08:22.220 --> 00:08:29.000 position:50% align:middle I was so afraid someone was going to die." 00:08:29.000 --> 00:08:35.170 position:50% align:middle And the employer themes, the main theme was RNs and LPNs are pretty 00:08:35.170 --> 00:08:40.470 position:50% align:middle much interchangeable, whether working as a staff nurse in long-term care or 00:08:40.470 --> 00:08:42.020 position:50% align:middle in the patient's home. 00:08:42.020 --> 00:08:49.210 position:50% align:middle An employer said, "The LPNs and RNs are pretty much interchangeable in the field as far as providing 00:08:49.210 --> 00:08:52.510 position:50% align:middle skilled care to our clients." 00:08:52.510 --> 00:08:58.770 position:50% align:middle At one organization, they even said, "The orientation program for RNs and LPNs is 00:08:58.770 --> 00:09:02.650 position:50% align:middle exactly the same." 00:09:02.650 --> 00:09:09.670 position:50% align:middle They have different competency related to wound VAC and PICC line but, otherwise, exactly the same. 00:09:09.670 --> 00:09:15.460 position:50% align:middle An employer recognized, "The way our policies are written is they are able 00:09:15.460 --> 00:09:25.100 position:50% align:middle to do the same activities as the RN, but the RN is always on duty with them." 00:09:25.100 --> 00:09:28.980 position:50% align:middle Another theme was LPNs make economic cents. 00:09:28.980 --> 00:09:38.520 position:50% align:middle And quite frankly, the employers told us that the reimbursement their organization receives makes 00:09:38.520 --> 00:09:46.910 position:50% align:middle financial sense to hire LPNs who are paid at a lower rate. 00:09:46.910 --> 00:09:48.870 position:50% align:middle So those were our qualitative findings. 00:09:48.870 --> 00:09:53.460 position:50% align:middle And then we went on to Phase II, the quantitative survey. 00:09:53.460 --> 00:09:59.150 position:50% align:middle And our qualitative findings help to inform this work. 00:09:59.150 --> 00:10:08.680 position:50% align:middle We had hoped to do it sooner than October of 2020, but you know what happened between the fall of 2019 and 00:10:08.680 --> 00:10:10.720 position:50% align:middle the fall of 2020. 00:10:10.720 --> 00:10:21.040 position:50% align:middle So we had conducted a descriptive, cross-sectional study and did a Qualtrics survey of the 00:10:21.040 --> 00:10:27.670 position:50% align:middle 20,000+ LPNs who had an email listed with the New Jersey Board of Nursing. 00:10:27.670 --> 00:10:34.920 position:50% align:middle We created the nursing activities survey based on our findings from the qualitative study, 00:10:34.920 --> 00:10:40.380 position:50% align:middle what was published in the literature, and then the National Council of State Boards 00:10:40.380 --> 00:10:42.390 position:50% align:middle of Nursing Model Act. 00:10:42.390 --> 00:10:47.010 position:50% align:middle And then that survey ended up with 60 questions. 00:10:47.010 --> 00:10:54.910 position:50% align:middle We had two job satisfaction questions and demographic questions, and then, for LPNs working in nursing homes, 00:10:54.910 --> 00:11:01.470 position:50% align:middle we used the AHRQ Nursing Home Survey on Patient Safety Culture. 00:11:01.470 --> 00:11:12.710 position:50% align:middle So we had 994 LPNs who participated in the survey, and out of those, 804 met the inclusion criteria 00:11:12.710 --> 00:11:17.950 position:50% align:middle of working in New Jersey and having an LPN license in New Jersey. 00:11:17.950 --> 00:11:24.190 position:50% align:middle And you see, on this slide, the average age of the LPN was 49, 00:11:24.190 --> 00:11:28.800 position:50% align:middle and they had 9 years in their current position. 00:11:28.800 --> 00:11:37.430 position:50% align:middle The majority were female and obtained their education in a vo-tech school, worked full-time, 00:11:37.430 --> 00:11:43.840 position:50% align:middle and interestingly, 31% had 2 or more positions. 00:11:43.840 --> 00:11:50.420 position:50% align:middle The settings in which the LPNs practice really varied, but once again, the majority were in the 00:11:50.420 --> 00:11:52.967 position:50% align:middle long-term care, 41%. 00:11:52.967 --> 00:12:00.170 position:50% align:middle And then we did something in both studies in Phase II. 00:12:00.170 --> 00:12:08.800 position:50% align:middle We compared our respondents with the New Jersey license renewal survey respondents. 00:12:08.800 --> 00:12:16.190 position:50% align:middle So we looked at our respondents versus the 2019-2020 license renewal to see if there was a 00:12:16.190 --> 00:12:18.630 position:50% align:middle statistically significant difference. 00:12:18.630 --> 00:12:25.830 position:50% align:middle And there was no statistically significant difference in the demographics of our respondents and those in the 00:12:25.830 --> 00:12:29.550 position:50% align:middle New Jersey license renewal survey, which is what we want to find, right? 00:12:29.550 --> 00:12:31.470 position:50% align:middle That's good. 00:12:31.470 --> 00:12:31.770 position:50% align:middle All right. 00:12:31.770 --> 00:12:34.290 position:50% align:middle So, what were our results? 00:12:34.290 --> 00:12:41.240 position:50% align:middle This slide shows the results of the nursing activities survey, and I just want to let you know that according 00:12:41.240 --> 00:12:48.300 position:50% align:middle to the New Jersey Board of Nursing, LPNs can perform all the activities on the survey 00:12:48.300 --> 00:12:53.990 position:50% align:middle except for independently completing admission assessment, a focused assessment, 00:12:53.990 --> 00:12:56.390 position:50% align:middle and formulating care plans. 00:12:56.390 --> 00:13:02.190 position:50% align:middle And our board is silent on supervising unlicensed assistant personnel. 00:13:02.190 --> 00:13:07.840 position:50% align:middle So you see the top five things that LPNs do, you're not surprised about that, right? 00:13:07.840 --> 00:13:16.320 position:50% align:middle Document patient care, provide basic nursing care, check and monitor vital signs, document observations, 00:13:16.320 --> 00:13:21.750 position:50% align:middle and administer medications, not surprising. 00:13:21.750 --> 00:13:26.400 position:50% align:middle And look at supervised unlicensed assistive personnel. 00:13:26.400 --> 00:13:33.010 position:50% align:middle That is one of the top activities that they are doing too. 00:13:33.010 --> 00:13:41.570 position:50% align:middle And now, regarding assessments, you see, on this slide, the majority of LPNs indicated, 00:13:41.570 --> 00:13:51.500 position:50% align:middle 55% indicated they were independently completing a comprehensive admission assessment and independently 00:13:51.500 --> 00:14:01.180 position:50% align:middle completing a focused assessment 58% and doing that on a daily, weekly, or monthly basis. 00:14:01.180 --> 00:14:12.180 position:50% align:middle And then 39% were formulating care plans on a daily, weekly, or monthly basis. 00:14:12.180 --> 00:14:16.900 position:50% align:middle Regarding job satisfaction, we asked them how satisfied they were with their jobs, 00:14:16.900 --> 00:14:20.210 position:50% align:middle and overall, the LPNs were satisfied with their jobs. 00:14:20.210 --> 00:14:31.320 position:50% align:middle But not surprising, those working in nursing homes were less satisfied than those working in other settings. 00:14:31.320 --> 00:14:36.270 position:50% align:middle Now, this is the demographics we further surveyed from this study. 00:14:36.270 --> 00:14:39.350 position:50% align:middle We looked at LPNs working in nursing homes. 00:14:39.350 --> 00:14:47.370 position:50% align:middle And we had 258 LPNs who indicated they worked in a nursing home, and the majority worked in for-profit 00:14:47.370 --> 00:14:53.360 position:50% align:middle nursing homes, which the majority of nursing homes in New Jersey are for-profit, so that's not surprising. 00:14:53.360 --> 00:14:58.930 position:50% align:middle And LPNs were a mean age of 48 and worked an average of 10 years in their position. 00:14:58.930 --> 00:15:07.170 position:50% align:middle And once again, we looked at the demographics of these respondents and compared it with the New Jersey license 00:15:07.170 --> 00:15:14.460 position:50% align:middle renewal survey of those who worked in nursing homes from 2019 to 2020, and we did find a statistically 00:15:14.460 --> 00:15:17.040 position:50% align:middle significant difference in age. 00:15:17.040 --> 00:15:23.340 position:50% align:middle Our respondents were older, 48, versus the license renewal was 47. 00:15:23.340 --> 00:15:30.740 position:50% align:middle But otherwise, there was no statistically significant difference. 00:15:30.740 --> 00:15:42.620 position:50% align:middle And this is the positive responses received in the AHRQ nursing home survey on patient safety culture. 00:15:42.620 --> 00:15:49.000 position:50% align:middle The lowest positive responses were in the staffing composure, "Staff have to hurry because they have too 00:15:49.000 --> 00:15:56.190 position:50% align:middle much work to do," and the organizational learning composite, "This nursing home lets mistakes happen 00:15:56.190 --> 00:15:58.980 position:50% align:middle over and over again." 00:15:58.980 --> 00:16:03.620 position:50% align:middle On a positive note, the highest positive response, agree and strongly agree, 00:16:03.620 --> 00:16:10.740 position:50% align:middle were the feedback and communication, "Staff tell someone if they see something that might 00:16:10.740 --> 00:16:17.810 position:50% align:middle harm a resident," and "When staff report something that could harm a resident, someone takes care of it." 00:16:17.810 --> 00:16:25.760 position:50% align:middle Then we compared our respondents with the 2019 user database, and you can see, on this slide, 00:16:25.760 --> 00:16:31.610 position:50% align:middle that the blue is our respondents, that all our responses were lower than the 00:16:31.610 --> 00:16:34.406 position:50% align:middle 2019 user database. 00:16:34.406 --> 00:16:44.670 position:50% align:middle But interestingly, the top three positive responses were similar to the user database. 00:16:44.670 --> 00:16:50.640 position:50% align:middle The top three positive composites were feedback and communication about incidents, 00:16:50.640 --> 00:16:56.780 position:50% align:middle overall perception of resident safety, and supervisor expectations and actions. 00:16:56.780 --> 00:17:03.020 position:50% align:middle And the bottom three lowest responses were also similar, communication and openness, 00:17:03.020 --> 00:17:09.980 position:50% align:middle nonpunitive response to mistakes, and staffing. 00:17:09.980 --> 00:17:19.690 position:50% align:middle When asked about the safety in their nursing homes, 33% provided an overall rating on resident safety 00:17:19.690 --> 00:17:27.010 position:50% align:middle as excellent or very good and only 48% indicated they would advise friends that this was a safe nursing home. 00:17:27.010 --> 00:17:36.060 position:50% align:middle And once again, lower than the 2019 user database. 00:17:36.060 --> 00:17:43.720 position:50% align:middle So it's clear from this study that our respondents, some of the LPNs, are functioning beyond their scope 00:17:43.720 --> 00:17:50.920 position:50% align:middle of practice, and this is what the administrative code really clearly says in New Jersey. 00:17:50.920 --> 00:17:59.570 position:50% align:middle Registered nurses shall not delegate physical, psychological, and social assessment of the patient... 00:17:59.570 --> 00:18:11.740 position:50% align:middle shall not delegate the formulation of the plan of care and the evaluation of the effectiveness of the plan. 00:18:11.740 --> 00:18:15.650 position:50% align:middle And so we're continuing to do work on this. 00:18:15.650 --> 00:18:20.580 position:50% align:middle I'll talk about that in a few minutes, what we've done regarding this. 00:18:20.580 --> 00:18:22.930 position:50% align:middle And staffing. 00:18:22.930 --> 00:18:28.590 position:50% align:middle It's clear that the patient safety culture and staffing, particularly 00:18:28.590 --> 00:18:30.380 position:50% align:middle in nursing homes, needs improvement. 00:18:30.380 --> 00:18:37.050 position:50% align:middle And I know many of you saw in the early days of the pandemic, New Jersey nursing homes really made 00:18:37.050 --> 00:18:39.790 position:50% align:middle national news, right? 00:18:39.790 --> 00:18:50.140 position:50% align:middle So based on what was going on in New Jersey nursing homes, our governor at the time had made a 00:18:50.140 --> 00:18:56.570 position:50% align:middle recommendation for a report to look into the issues of what was going on in nursing homes, 00:18:56.570 --> 00:19:06.060 position:50% align:middle and that report really focused on the staffing that was going on in the nursing homes. 00:19:06.060 --> 00:19:12.940 position:50% align:middle And the recommendation was through the Manatt report that came out, recommendations in establishing and 00:19:12.940 --> 00:19:17.900 position:50% align:middle fostering a culture of safety and quality, including staffing. 00:19:17.900 --> 00:19:23.440 position:50% align:middle And then, subsequent to that report, we did have new staffing ratios that came 00:19:23.440 --> 00:19:28.050 position:50% align:middle out for New Jersey nursing homes. 00:19:28.050 --> 00:19:29.630 position:50% align:middle It was the first step. 00:19:29.630 --> 00:19:38.860 position:50% align:middle You know, what it said was 1 CNA for 8 residents on the day shift, and then, for evenings and nights, RN, LPN, 00:19:38.860 --> 00:19:45.360 position:50% align:middle or CNA for every 10 residents on the evening shift and 14 on the night shift. 00:19:45.360 --> 00:19:53.460 position:50% align:middle But it still didn't address what's going on regarding the RNs because the standard in New Jersey was still 00:19:53.460 --> 00:19:58.570 position:50% align:middle one RN on the day shift, and then, on evenings and nights, 00:19:58.570 --> 00:20:03.990 position:50% align:middle one RN to be there present or on-call. 00:20:03.990 --> 00:20:10.510 position:50% align:middle But I guess looking on the good news is that the National Academy of Medicine made a recommendation 00:20:10.510 --> 00:20:18.090 position:50% align:middle in their National Imperative to Improve Nursing Home Quality that we should have RNs on all shifts, 00:20:18.090 --> 00:20:27.860 position:50% align:middle and I'm sure many of you are aware that CMS came out with the rule in September that supported that, 00:20:27.860 --> 00:20:34.010 position:50% align:middle that we should have an RN on-site 24 hours a day in long-term care settings, 00:20:34.010 --> 00:20:36.960 position:50% align:middle excluding the director of nursing. 00:20:36.960 --> 00:20:43.860 position:50% align:middle And so that's good that that came out, but I am sure you're also aware that they left 00:20:43.860 --> 00:20:49.110 position:50% align:middle out...they did not mention LPNs in that new regulation that CMS put out. 00:20:49.110 --> 00:20:54.000 position:50% align:middle So our collaborating center did respond in the open comment period. 00:20:54.000 --> 00:20:59.540 position:50% align:middle So we look forward to seeing what's going to happen with that regulation. 00:20:59.540 --> 00:21:04.630 position:50% align:middle But anyways, the other thing, the next slide just talks about patient safety culture 00:21:04.630 --> 00:21:05.880 position:50% align:middle for nursing homes. 00:21:05.880 --> 00:21:08.640 position:50% align:middle That's something else that needs to be addressed. 00:21:08.640 --> 00:21:16.650 position:50% align:middle Nurse leaders should do some education regarding a just culture and work on improving the work environment 00:21:16.650 --> 00:21:17.970 position:50% align:middle in the nursing home. 00:21:17.970 --> 00:21:20.300 position:50% align:middle And that can be done in many different ways. 00:21:20.300 --> 00:21:26.520 position:50% align:middle The American Association of Critical-Care Nurses has healthy work environment standards that can be looked 00:21:26.520 --> 00:21:33.310 position:50% align:middle at to implement, and also, the ANCC has Pathway to Excellence Program 00:21:33.310 --> 00:21:41.340 position:50% align:middle for nursing homes, and that can be used as a roadmap for improving the patient safety culture 00:21:41.340 --> 00:21:43.860 position:50% align:middle in nursing homes. 00:21:43.860 --> 00:21:51.450 position:50% align:middle So, as Mr. Smiley mentioned, we had published these results in two issues of the 00:21:51.450 --> 00:21:57.380 position:50% align:middle "Journal of Nursing Regulation" and the "Journal of Nursing Home Patient Safety Culture." 00:21:57.380 --> 00:22:02.900 position:50% align:middle And we continue to work on our recommendations from these studies. 00:22:02.900 --> 00:22:10.270 position:50% align:middle We did present our results to the New Jersey Board of Nursing, who is very supportive of this work. 00:22:10.270 --> 00:22:17.130 position:50% align:middle And I also met with our esteemed New Jersey Board of Nursing president, Dr. Barbara Blozen, 00:22:17.130 --> 00:22:19.780 position:50% align:middle to discuss these results. 00:22:19.780 --> 00:22:24.840 position:50% align:middle We published an article in our New Jersey Nurse to share this information with all the nurses 00:22:24.840 --> 00:22:25.720 position:50% align:middle in New Jersey. 00:22:25.720 --> 00:22:32.150 position:50% align:middle We also presented...we're fortunate in New Jersey we have an LPN Forum, which is part of the New Jersey 00:22:32.150 --> 00:22:34.150 position:50% align:middle State Nurses Association. 00:22:34.150 --> 00:22:37.540 position:50% align:middle So we shared our findings with those members. 00:22:37.540 --> 00:22:46.740 position:50% align:middle We also met with the educators who educate the LPNs to share their findings. 00:22:46.740 --> 00:22:52.220 position:50% align:middle And I'm sure you're aware, there's a new movement that LPNs are moving now 00:22:52.220 --> 00:22:53.850 position:50% align:middle into the acute care settings. 00:22:53.850 --> 00:23:01.140 position:50% align:middle So we've been consulting and sharing our findings with those leaders in the acute care settings in New Jersey 00:23:01.140 --> 00:23:06.790 position:50% align:middle who are bringing in LPNs into their setting. 00:23:06.790 --> 00:23:09.590 position:50% align:middle So this has my contact information, and that's all I have. 00:23:09.590 --> 00:23:13.865 position:50% align:middle I try to finish early for you guys so you can get out, but any questions? 00:23:22.090 --> 00:23:26.280 position:50% align:middle - [Woman 1] Thanks so much for your very interesting information. 00:23:26.280 --> 00:23:29.650 position:50% align:middle I'm from Nova Scotia, Canada, I'm a regulator there. 00:23:29.650 --> 00:23:34.880 position:50% align:middle And so the scope of practice of LPNs is much different than the scope of practice you described, 00:23:34.880 --> 00:23:39.640 position:50% align:middle and they work in a much more variety of settings. 00:23:39.640 --> 00:23:44.710 position:50% align:middle So listening to you, I was kind of going back to the presentation that we 00:23:44.710 --> 00:23:48.820 position:50% align:middle heard this morning about defining what the problem really is. 00:23:48.820 --> 00:23:54.380 position:50% align:middle So when you talked about the LPNs who are not really abiding by the code, 00:23:54.380 --> 00:24:00.890 position:50% align:middle so they're doing independent assessments and other things you mentioned, 00:24:00.890 --> 00:24:12.630 position:50% align:middle the care plans that they're not able to do, so I wonder, is the solution to more enforce that 00:24:12.630 --> 00:24:16.830 position:50% align:middle they're not able to do that through education and support of the registered nurses who are working 00:24:16.830 --> 00:24:23.760 position:50% align:middle for them, or is the time right to modernize the code and make changes to enable that with supporting them 00:24:23.760 --> 00:24:24.730 position:50% align:middle up through education? 00:24:24.730 --> 00:24:30.900 position:50% align:middle I don't know what the answer to that is, but I think it'd be really interesting to study and 00:24:30.900 --> 00:24:36.730 position:50% align:middle also to think about what are the patient outcomes for those clients in which they were working beyond their 00:24:36.730 --> 00:24:38.100 position:50% align:middle scope of practice. 00:24:38.100 --> 00:24:44.510 position:50% align:middle So, is there evidence to show that there were worse patient outcomes for those clients that they were doing 00:24:44.510 --> 00:24:46.610 position:50% align:middle independent care plans for and the assessments? 00:24:46.610 --> 00:24:51.290 position:50% align:middle I don't know if you studied that or if you know the answers to that, but it's very interesting. 00:24:51.290 --> 00:24:53.980 position:50% align:middle - No, but you bring up a lot of good points, you know. 00:24:53.980 --> 00:25:01.950 position:50% align:middle And one of our visions was to have listening sessions, bring together leaders of regulation, employers, 00:25:01.950 --> 00:25:07.360 position:50% align:middle and educators, and bring everybody together to discuss the next steps, you know. 00:25:07.360 --> 00:25:15.230 position:50% align:middle - Because it seemed to me that being employed in a home health setting, they would be much more independent and 00:25:15.230 --> 00:25:20.310 position:50% align:middle not be working with a registered nurse, maybe I don't have the right vision, 00:25:20.310 --> 00:25:22.440 position:50% align:middle but it would be less accessible to them. 00:25:22.440 --> 00:25:27.650 position:50% align:middle So moving into the hospital, they would, hopefully, have more support on their teams 00:25:27.650 --> 00:25:28.630 position:50% align:middle with those registered nurses. 00:25:28.630 --> 00:25:30.000 position:50% align:middle Anyway, super, super interesting. 00:25:30.000 --> 00:25:30.480 position:50% align:middle Thank you for sharing. 00:25:30.480 --> 00:25:32.030 position:50% align:middle - Yeah, you're exactly right. 00:25:32.030 --> 00:25:36.410 position:50% align:middle And then when you think of long-term care, the current regulations in New Jersey, there's, 00:25:36.410 --> 00:25:41.880 position:50% align:middle you know, if you have the option of an RN present or on-call, you know, they're going to choose the on-call. 00:25:41.880 --> 00:25:44.360 position:50% align:middle So they're really working there alone. 00:25:44.360 --> 00:25:50.440 position:50% align:middle - We have that same legislation in Nova Scotia through our Homes for Special Care Act where they have to have 00:25:50.440 --> 00:25:52.430 position:50% align:middle a registered nurse. 00:25:52.430 --> 00:25:57.700 position:50% align:middle They define it as available, so a lot of homes are taking that to mean that they're 00:25:57.700 --> 00:25:58.100 position:50% align:middle at home on-call. 00:25:58.100 --> 00:26:02.390 position:50% align:middle And so we've got a lot of LPNs who are working very independently in that setting. 00:26:02.390 --> 00:26:03.720 position:50% align:middle So, yeah, thank you. 00:26:03.720 --> 00:26:08.740 position:50% align:middle - Thank you. 00:26:08.740 --> 00:26:10.270 position:50% align:middle - [Woman 2] Hi. 00:26:10.270 --> 00:26:13.400 position:50% align:middle Great study, a lot of interesting information. 00:26:13.400 --> 00:26:21.410 position:50% align:middle Did the study happen to highlight or explain or talk about the PN scope of practice that calls for them 00:26:21.410 --> 00:26:23.290 position:50% align:middle to collect data? 00:26:23.290 --> 00:26:27.030 position:50% align:middle So they can't, like, perform an assessment, but they can collect data. 00:26:27.030 --> 00:26:32.330 position:50% align:middle I mean, even in terms of the care plan, they can't create a care plan, 00:26:32.330 --> 00:26:36.430 position:50% align:middle but they can participate in the development of a care plan. 00:26:36.430 --> 00:26:43.930 position:50% align:middle So I certainly appreciate a lot of your findings in that sometimes scope of practice expands and collapses 00:26:43.930 --> 00:26:46.570 position:50% align:middle based on facilities, etc. 00:26:46.570 --> 00:26:51.950 position:50% align:middle But I'm wondering, did they understand kind of some of those differences? 00:26:51.950 --> 00:26:52.960 position:50% align:middle Does that make sense? 00:26:52.960 --> 00:26:58.400 position:50% align:middle - I think that's what made the qualitative, in my opinion, good because we could 00:26:58.400 --> 00:26:59.860 position:50% align:middle ask those questions. 00:26:59.860 --> 00:27:09.080 position:50% align:middle And it sounds like they do recognize that they can collect data, but that gets stretched. 00:27:09.080 --> 00:27:16.380 position:50% align:middle And they use the term a lot in the focus groups about doing body checks instead of assessments. 00:27:16.380 --> 00:27:22.560 position:50% align:middle So it's very gray, a lot of that line there. 00:27:22.560 --> 00:27:30.610 position:50% align:middle But you know, we ask those pointed questions in the survey, "Do you independently complete 00:27:30.610 --> 00:27:32.050 position:50% align:middle an admission assessment?" 00:27:32.050 --> 00:27:32.600 position:50% align:middle And they... 00:27:32.600 --> 00:27:34.500 position:50% align:middle - Yeah. 00:27:34.500 --> 00:27:40.660 position:50% align:middle I think kind of the way I see it is that RN and PN practices almost like a Venn diagram. 00:27:40.660 --> 00:27:45.190 position:50% align:middle There are some things that RNs do, some things exclusively PNs do, 00:27:45.190 --> 00:27:50.320 position:50% align:middle and then there's somewhere in the middle that there are things that they both, you know, do simultaneously. 00:27:50.320 --> 00:27:51.420 position:50% align:middle - Agree, yes. 00:27:51.420 --> 00:27:52.250 position:50% align:middle - So, very interesting. 00:27:52.250 --> 00:27:53.740 position:50% align:middle - Yes, I agree very much. 00:27:53.740 --> 00:28:00.500 position:50% align:middle And it's good to have that illustration when they're working when there's an RN there too, right? 00:28:00.500 --> 00:28:01.680 position:50% align:middle I mean, it's very hard. 00:28:01.680 --> 00:28:07.720 position:50% align:middle How do you do that when there's no RN in the building? 00:28:07.720 --> 00:28:10.070 position:50% align:middle So, more to come. 00:28:10.070 --> 00:28:10.920 position:50% align:middle Any other questions? 00:28:10.920 --> 00:28:14.145 position:50% align:middle This is a good discussion. 00:28:17.200 --> 00:28:18.870 position:50% align:middle All right, well, thank you very much. 00:28:18.870 --> 00:28:20.572 position:50% align:middle Have a good afternoon.