By JULIE MINDA
Carroll Manor Nursing & Rehabilitation Center in Washington, D.C., has become the first Catholic nursing home in the country to earn the Pathway to Excellence designation from the American Nurses Credentialing Center. The 252-bed Ascension Health facility is located on the Providence Hospital campus.
The ANCC's Pathway program recognizes acute and long-term care organizations for creating what the ANCC calls "positive practice environments," or settings in which nurses excel. The ANCC says studies show a positive practice environment for nurses helps facilities improve care quality, patient safety, patient satisfaction, nurse satisfaction and nurse retention.
Tina Sandri, vice president and administrator of Carroll Manor, said it can be difficult to recruit registered nurses to nonmanagement roles in long-term care facilities. The Pathway recognition may give the facility an advantage in that regard.
To receive Pathway designation, organizations must meet 12 practice standards — and each standard includes about a dozen subcategories — that indicate that the organization is providing an ideal environment for nurses, licensed practical nurses and certified nurse assistants. There are slightly different standards for acute care and long-term care organizations.
Janice M. Johnson, director of nursing for Carroll Manor, said that unlike the better-known and more rigorous Magnet Recognition Program from the ANCC, the Pathway program does not require two years of outcome data; and it costs less to apply for Pathway designation (Magnet costs and fees range from about $25,000 to more than $68,000, depending on a facility's bed count and other factors; Pathway costs and fees range from about $12,480 to more than $41,520).
Pursuing a Pathway designation requires a substantial commitment on the part of staff and administrators, Johnson said. She filed a 500-page report in support of Carroll Manor's application. There are 401 Magnet-designated organizations and 114 Pathway-designated organizations. Just four of the 114 are long-term care facilities.
Johnson said the cultural transformation that set the stage for the Pathway recognition started in about 2008, when Carroll Manor began to move away from a top-down decision-making model that discouraged staff and residents from veering much from established protocols. There was a set eating schedule, a set menu, a set showering schedule, for example.
Johnson said over the past six years, Carroll Manor has been giving staff more decision-making latitude and encouraging staff to personalize care to suit a resident's preferences for daily routines. All changes are geared toward improving outcomes and quality of life for residents, Johnson said.
"We started a culture change to establish a more homelike environment, and to give residents and family and staff more say-so," said Johnson. "And, we had great outcomes," including decreased unhealthy weight loss, decreased falls and decreased pressure ulcers. Residents can eat what they want, when they want; take a bath rather than shower if they prefer and choose the activities they are interested in.
Staff and leadership at Carroll Manor pursued the Pathways designation to celebrate what they'd achieved and promote continuous improvement, Johnson said.
At the outset, Carroll Manor administrators and employees elected a 15-member executive council and sub-councils charged with completing the Pathway application process. All councils had representation from staff of various departments and various levels of rank and seniority.
The councils measured Carroll Manor's practices in the 12 Pathway categories (see sidebar) against the Pathway standards, and determined where there were gaps.
Johnson said that Carroll Manor met or exceeded many, but not all, of the Pathway criteria. For instance, through its culture change work, nurses already participated in decisions that impacted their work, the facility had an effective approach for incorporating best practices into residents' care, and it had a training and development program geared toward helping its nursing staff advance their skills and achieve a higher credential in nursing.
Johnson said 57 percent of Carroll Manor's residents are age 85 or older; many have outlived family and friends. Staff become a surrogate family for the residents — some staff have cared for the same residents for more than a dozen years. The facility trains nurses in care of the very old, including dementia care; care of the dying; and restorative nursing, or care that maximizes the capability of residents by improving their mobility, continence and eating routines.
The councils identified a need to increase and refine nurses' training to support increased autonomy and leadership development. And they created programs to address these challenges, including introducing a mentoring program.
Besides the improved clinical outcomes that Carroll Manor has documented, Johnson said, the residents are happier. They "are treated as they want to be treated, (and they are) honored and positioned at the center of care planning and decision-
making," Johnson said.
Pathway to Excellence's 12 Practice Standards - Nurses control the practice of nursing
- The environment is safe and healthy
- Resident care and practice concerns are addressed
- Orientation prepares new nurses for the work environment
- The director of nursing is qualified and participates in all levels of the organization
- Professional development is provided and utilized
- Equitable compensation is provided
- Nurses are recognized for achievements
- A balanced lifestyle is encouraged
- Collaborative relationships are valued and supported
- Nurse managers are competent and accountable
- A quality program and evidence-based practice are used
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