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Recruitment and Retention of Nurses and Nurse Aides Is a Growing Concern

November 6th, 2009 by admin | Filed under nurse


RNs and licensed practical nurses (LPN) are responsible for a large portion of the health care provided in this country. RNs make up the largest group of health care providers, and, historically, have worked predominantly in hospitals; a smaller number of RNs work in other settings such as ambulatory care, home health care, and nursing homes. (See table 1.) Their responsibilities may include providing direct patient care in a hospital or a home health care setting, managing and directing complex nursing care in an intensive care unit, or supervising the provision of long-term care in a nursing home. LPNs make up the secondlargest group of licensed health caregivers and primarily provide direct patient care under the direction of a physician or RN. Nurse aides augment the care nurses provide by performing routine duties of caring for hospital patients or long-term care residents under the direction of an RN or LPN.1 Most nurse aides work in nursing homes, where they provide assistance with activities of daily living such as dressing, feeding, and bathing.

Both RNs and LPNs are subject to state licensing requirements. Individuals usually select one of three ways to become an RN—through a 2-year associate degree, 3-year diploma, or 4-year baccalaureate degree program. LPN programs are 12 to 18 months in length and generally focus on basic nursing skills such as monitoring patient or resident condition and administering treatments and medications. Federal law requires states to certify nurse aides who provide care in nursing homes and for home health care agencies that receive Medicare and Medicaid reimbursement.2 This certification can be obtained through either a nurse aide training program and a competency evaluation—a written or oral test and skills demonstration—or competency evaluation alone. A state-approved nurse aide training program must require a minimum of 75 hours of training, including at least 16 hours of supervised practical training under the direct supervision of an RN or LPN. Approximately half of the states require the nursing aide training programs to go beyond the 75-hour minimum, with several requiring over 120 hours.3 Federal law also requires states to maintain a registry of nurse aides working in nursing homes who have passed their competency evaluations; no such requirement exists for aides working in home health care.4 For nurse aides working in hospitals, there are no federal requirements related to certification, training, competency evaluations, or a registry.

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