RNs make measurable contributions to the health and wellness of individuals living in nursing homes. However, most nursing homes do not employ adequate numbers of professional nurses with specialized training in the nursing care of older adults to positively affect resident outcomes. As a result, many people never receive excellent geriatric nursing while living in a long-term care facility. Nurses have introduced various professional practice models into health care institutions as tools for leading nursing practice, improving client outcomes, and achieving organizational goals. Problematically, few professional practice models have been implemented in nursing homes. This article introduces an evidence-based framework for professional nursing practice in long-term care. The Everyday Excellence framework is based on eight guiding principles: Valuing, Envisioning, Peopling, Securing, Learning, Empowering, Leading, and Advancing Excellence. Future research will evaluate the usefulness of this framework for professional nursing practice.

Registered nurses make measurable contributions to the health and wellness of persons living in nursing homes. However, most nursing homes do not employ adequate numbers of professional nurses with specialized training in the nursing care of older adults to positively impact resident outcomes. As a result, many people never receive excellent geriatric nursing while living in a long-term care facility. Nurses have introduced various professional practice models into health care institutions as tools for leading nursing practice, improving client outcomes, and achieving organizational goals. Problematically, few professional practice models have been implemented in nursing homes. This article introduces an evidence-based framework for professional nursing practice in long-term care. The Everyday Excellence framework is based upon eight guiding principles: Valuing, Envisioning, Peopling, Securing, Learning, Empowering, Leading, and Advancing Excellence. Future research will evaluate the usefulness of this framework for professional nursing practice.

Certified nursing assistants (CNAs) are the principal bedside caregivers in nursing homes, yet little is known about their perceptions of the work environment. This population-based, crosssectional study used a mailed questionnaire to a random sample of Iowa CNAs (N = 584), representing 166 nursing homes. Of the respondents, 88.5% (n = 517) were currently employed in long-term care settings; however, 11.5% (n = 67) indicated they had left their jobs. When CNA responses were compared with those of other occupational groups, general workers reported higher scores on involvement, coworker cohesion, work pressure, and supervisor support. Those who left their CNA jobs rated their work environment as characteristic of excessive managerial control and task orientation. Results of this study emphasize the importance of the relationship between CNAs and their supervisors, CNAs' need for greater autonomy and innovation, and the need for the work environment to change dramatically in the area of human resource management.Despite the evolving popularity of home-based and community-based services, nursing homes will always be needed. One of the greatest challenges facing the long-term care (LTC) industry is maintaining an adequate workforce (Fitzpatrick, 2002). Although many have written about the larger problem of a nursing shortage (Janiszewski Goodin, 2003;Rondeau & Wagar, 2006;Seago, Spetz, Chapman, & Dyer, 2006;Selvam, 2001), few have asked certified nursing assistants (CNAs) in LTC settings to evaluate their work environment. Because there is a critical shortfall of direct care workers in Iowa and many other states in which the aging population continues to increase (Fowler, 2003; Iowa Department of Public Health, 2005), we asked both currently employed CNAs and those who had quit their CNA jobs to rate their work environment. We then compared their responses with normative samples from other occupational groups.