- Email: [email protected]
LVNs
OFFICIAL SECTION OF THE
American Assisted Living Nurses Association Assisted Living Nurse Certification Exam: RNs and LPN/LVNs The certification exam is based, in part, on an AALNA survey conducted in 2005 about the knowledge and skills important to assisted living (AL) nurses. The content is evidence-based, where possible; it draws on current nursing and management theory and knowledge, older adult demographics, facts on aging, age-related syndromes and changes, and common illnesses that affect the older adult. The 100-item exam was vetted and revised, most recently in March 2008. There are four domains of questions: 1. Primary Care Considerations: demographics of the aging population, normal aging changes, attitudes and stereotypes, health promotion, culture and ethnicity, autonomy, pharmacology (i.e., Beers criteria), nursing theory, death and dying (approximately 20% of questions) 2. Major Health Problems/Review of Systems: cardiovascular, gastrointestinal, genitourinary, respiratory, neurology, psychiatric, endocrine, musculoskeletal, medications, pain management, assessment instruments (approximately 50% of questions) 3. Organizational and Health Policy: health care delivery systems, interdisciplinary teams, continuum of care (including hospice), federal regulations (e.g., Omnibus Budget Reconciliation Act, 1987 (OBRA), Patient Self-Determination Act, 1991 (PSDA), Health Insurance Portability and Accountablity Act, 1996 (HIPAA), reimbursement mechanisms (approximately 15% of questions) 4. Professional Practice: scope and standards of practice, leadership and management styles, delegating, conflict management, job descriptions, performance evaluation, research (human subject protection), change theory, ethical and legal issues, negligence and malpractice (approximately 15% of questions) Administration and processing: account creation and exam administration is online; a specific user and password is required. The exam takes about 2 hours to complete; once started, it must
Geriatric Nursing, Volume 30, Number 1
be completed. It can be taken 2 more times in the event of failure to pass. Passing score: 75. Certificate of achievement: on passing the exam, the certificate is mailed in approximately 14 days. This identifier can be placed on the ID badge: C-AL (certified in assisted living). Certification is good for 4 years, after which documentation of continuing education must be presented for recertification. These details are available on the AALNA Web site. Preparing for the exam: there is no point in taking the exam without preparation (studying, reading). The AALNA Web site lists many resources for precisely this purpose. Consider starting with a free, online review course, available at the Hartford Institute for Geriatric Nursing Web site (www.hartfordign.org), which helps nurses prepare for the American Nurses Accrediting Center national gerontological certification exam. Take the test at the end of the exam to get a sense of those areas needing some updating and study. Look for ‘‘Online Gerontological Nursing Certification Review Course.’’ While at the Hartford Institute Web site, there are two other rich sources of clinical practice information (including assessment tools). See www. ConsultGeriRN.org for more than 30 topics including information on geriatric syndromes; each topic includes background, evaluation and care planning information; they are all evidencebased. The Try This assessment series (almost 40 topics) is a user-friendly source of evidencebased assessment tools on a wide variety of geriatric care issues, including a special series on dementia. All these materials can be downloaded.
Assisted Living National Patient Safety Goals Provided by the Joint Commission (www. jointcommission.org) Identify residents correctly (recommendation: name and date of birth) Improve staff communication B Read back phone or verbal orders to the person who gave the order; this is particularly important with regard to medications. (AALNA recommends questioning
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differences or discrepancies between a current order and a previous order—particularly important when resident is returning from a hospitalization.) B List the abbreviations and symbols that are not to be used. (AALNA recommends creating a policy or list of abbreviations and symbols that can be used, as well.) B Create steps and policies for transfer to the next caregiver. (AALNA recommends developing a transfer document that ‘‘works well’’ for sending and receiving caregivers, e.g., hospital, nursing home, home care.) Prevent infection: use CDC hand-cleaning guidelines (www.cdc.gov/cleanhands/). Check resident medicines B Check for potential drug-drug interactions when a new medication is ordered. B Provide the next caregiver (or setting of care) with a full list of the resident’s medications and give the resident/family/ significant other a copy of this as well. B Conduct medication reconciliation at every time of transfer/changed setting of care. - www.ihi.org/IHI/Topics/Medication Systems/Changes/Reconcile+Medica tions+at+ALL+Transitions+Points. htm - www.jointcommission.org/ sentinelevents/SentinelEventAlert/ sea_35.htm Prevent residents from falling. Prevent older adults from contracting the flu and pneumonia. B AALNA recommends that the residence should have an infection control plan that includes staff education regarding signs and symptoms of influenza (given that older adults may present infection differently from younger adults) and steps to take in event of a flu outbreak. B AALNA recommends that all staff members receive flu vaccine annually. Help residents to be involved in their care and express their concerns about safety issues in the residence.
Malpractice Insurance for Assisted Living Nurses The cost of malpractice insurance has increased for many nurses, but not being covered is not worth the risk. Increased costs are due to an increase in the number of filed lawsuits, increased costs of jury awards, and a reduced number of insurers. Claims and risks associated with nursing homes (NHs) and assisted living residences (ALRs) are those regarding resident rights, inadequate staffing (meaning less supervision and increased resident risk), ‘‘negligent care’’ (i.e., lack of care protocols), falls, medication errors, elopement, and assessment. Although ALRs have fewer claims made against them than NHs, the awards are higher with AL claims. Liability coverage by the employer might not cover all instances. The coverage might be an ‘‘occurrence policy’’ that only covers incidents that happened during the policy period, without regard to when the claim was reported. Coverage might be limited as well; individual defense costs might not be covered. Another type of coverage that can be separately purchased is a ‘‘claims made’’ form, which covers the nurse for any suits or incidents reported in the coverage year. Claims made after the policy is ended are not covered. Additional coverage for claims made after the policy has terminated, known as an ‘‘extended reporting endorsement’’ (or ‘‘tail’’), can be purchased. Given that nursing malpractice suits can take years to evolve and settle, it is prudent for nurses to have a policy that covers them even if they no longer work at the institution in which the alleged event occurred. Note: AALNA is exploring provision of malpractice insurance for AALNA members; more info to come. 0197-4572/09/$ - see front matter Ó 2009 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2008.11.007
Geriatric Nursing, Volume 30, Number 1
American Assisted Living Nurses Association Assisted Living Nurse Certification Exam: RNs and LPN/LVNs The certification exam is based, in part, on an AALNA survey conducted in 2005 about the knowledge and skills important to assisted living (AL) nurses. The content is evidence-based, where possible; it draws on current nursing and management theory and knowledge, older adult demographics, facts on aging, age-related syndromes and changes, and common illnesses that affect the older adult. The 100-item exam was vetted and revised, most recently in March 2008. There are four domains of questions: 1. Primary Care Considerations: demographics of the aging population, normal aging changes, attitudes and stereotypes, health promotion, culture and ethnicity, autonomy, pharmacology (i.e., Beers criteria), nursing theory, death and dying (approximately 20% of questions) 2. Major Health Problems/Review of Systems: cardiovascular, gastrointestinal, genitourinary, respiratory, neurology, psychiatric, endocrine, musculoskeletal, medications, pain management, assessment instruments (approximately 50% of questions) 3. Organizational and Health Policy: health care delivery systems, interdisciplinary teams, continuum of care (including hospice), federal regulations (e.g., Omnibus Budget Reconciliation Act, 1987 (OBRA), Patient Self-Determination Act, 1991 (PSDA), Health Insurance Portability and Accountablity Act, 1996 (HIPAA), reimbursement mechanisms (approximately 15% of questions) 4. Professional Practice: scope and standards of practice, leadership and management styles, delegating, conflict management, job descriptions, performance evaluation, research (human subject protection), change theory, ethical and legal issues, negligence and malpractice (approximately 15% of questions) Administration and processing: account creation and exam administration is online; a specific user and password is required. The exam takes about 2 hours to complete; once started, it must
Geriatric Nursing, Volume 30, Number 1
be completed. It can be taken 2 more times in the event of failure to pass. Passing score: 75. Certificate of achievement: on passing the exam, the certificate is mailed in approximately 14 days. This identifier can be placed on the ID badge: C-AL (certified in assisted living). Certification is good for 4 years, after which documentation of continuing education must be presented for recertification. These details are available on the AALNA Web site. Preparing for the exam: there is no point in taking the exam without preparation (studying, reading). The AALNA Web site lists many resources for precisely this purpose. Consider starting with a free, online review course, available at the Hartford Institute for Geriatric Nursing Web site (www.hartfordign.org), which helps nurses prepare for the American Nurses Accrediting Center national gerontological certification exam. Take the test at the end of the exam to get a sense of those areas needing some updating and study. Look for ‘‘Online Gerontological Nursing Certification Review Course.’’ While at the Hartford Institute Web site, there are two other rich sources of clinical practice information (including assessment tools). See www. ConsultGeriRN.org for more than 30 topics including information on geriatric syndromes; each topic includes background, evaluation and care planning information; they are all evidencebased. The Try This assessment series (almost 40 topics) is a user-friendly source of evidencebased assessment tools on a wide variety of geriatric care issues, including a special series on dementia. All these materials can be downloaded.
Assisted Living National Patient Safety Goals Provided by the Joint Commission (www. jointcommission.org) Identify residents correctly (recommendation: name and date of birth) Improve staff communication B Read back phone or verbal orders to the person who gave the order; this is particularly important with regard to medications. (AALNA recommends questioning
75
76
differences or discrepancies between a current order and a previous order—particularly important when resident is returning from a hospitalization.) B List the abbreviations and symbols that are not to be used. (AALNA recommends creating a policy or list of abbreviations and symbols that can be used, as well.) B Create steps and policies for transfer to the next caregiver. (AALNA recommends developing a transfer document that ‘‘works well’’ for sending and receiving caregivers, e.g., hospital, nursing home, home care.) Prevent infection: use CDC hand-cleaning guidelines (www.cdc.gov/cleanhands/). Check resident medicines B Check for potential drug-drug interactions when a new medication is ordered. B Provide the next caregiver (or setting of care) with a full list of the resident’s medications and give the resident/family/ significant other a copy of this as well. B Conduct medication reconciliation at every time of transfer/changed setting of care. - www.ihi.org/IHI/Topics/Medication Systems/Changes/Reconcile+Medica tions+at+ALL+Transitions+Points. htm - www.jointcommission.org/ sentinelevents/SentinelEventAlert/ sea_35.htm Prevent residents from falling. Prevent older adults from contracting the flu and pneumonia. B AALNA recommends that the residence should have an infection control plan that includes staff education regarding signs and symptoms of influenza (given that older adults may present infection differently from younger adults) and steps to take in event of a flu outbreak. B AALNA recommends that all staff members receive flu vaccine annually. Help residents to be involved in their care and express their concerns about safety issues in the residence.
Malpractice Insurance for Assisted Living Nurses The cost of malpractice insurance has increased for many nurses, but not being covered is not worth the risk. Increased costs are due to an increase in the number of filed lawsuits, increased costs of jury awards, and a reduced number of insurers. Claims and risks associated with nursing homes (NHs) and assisted living residences (ALRs) are those regarding resident rights, inadequate staffing (meaning less supervision and increased resident risk), ‘‘negligent care’’ (i.e., lack of care protocols), falls, medication errors, elopement, and assessment. Although ALRs have fewer claims made against them than NHs, the awards are higher with AL claims. Liability coverage by the employer might not cover all instances. The coverage might be an ‘‘occurrence policy’’ that only covers incidents that happened during the policy period, without regard to when the claim was reported. Coverage might be limited as well; individual defense costs might not be covered. Another type of coverage that can be separately purchased is a ‘‘claims made’’ form, which covers the nurse for any suits or incidents reported in the coverage year. Claims made after the policy is ended are not covered. Additional coverage for claims made after the policy has terminated, known as an ‘‘extended reporting endorsement’’ (or ‘‘tail’’), can be purchased. Given that nursing malpractice suits can take years to evolve and settle, it is prudent for nurses to have a policy that covers them even if they no longer work at the institution in which the alleged event occurred. Note: AALNA is exploring provision of malpractice insurance for AALNA members; more info to come. 0197-4572/09/$ - see front matter Ó 2009 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2008.11.007
Geriatric Nursing, Volume 30, Number 1