The competencies of Registered Nurses working in care homes: a modified Delphi study

Abstract

BACKGROUND: Registered Nurses (RNs) working in UK care homes receive most of their training in acute hospitals. At present the role of care home nursing is underdeveloped and it is seen as a low status career. We describe here research to define core competencies for RNs working in UK care homes. METHODS:A two-stage process was adopted. A systematic literature review and focus groups with stakeholders provided an initial list of competencies. The competency list was modified over three rounds of a Delphi process with a multi-disciplinary expert panel of 28 members. RESULTS:Twenty-two competencies entered the consensus process, all competencies were amended and six split. Thirty-one competencies were scored in round two, eight were agreed as essential, one competency was split into two. Twenty-four competencies were submitted for scoring in round three. In total, 22 competencies were agreed as essential for RNs working in care homes. A further ten competencies did not reach consensus. CONCLUSION:The output of this study is an expert-consensus list of competencies for RNs working in care homes. This would be a firm basis on which to build a curriculum for this staff group. Key words: care homes, nursing, competencies BACKGROUNDDue to the ageing population there is increased use of residential and nursing homes -collectively referred to as care homes -to support the growing proportion of older people with more complex care needs. In the UK, care homes provide 465,000 beds, compared with 132,000 in acute hospitalsThe Registered Nurses (RNs) who work in care homes have usually received most of their training in acute hospitals [2]. Acute hospital work however, requires different skills and competencies from work in long-term care. There has been a call by many in nursing education to raise students' understanding of gerontological and care home nursing as specialties that represent demanding and rewarding careers [3].The role of nursing in long-term care is underdeveloped and working with older people is viewed by students as a low status career choice with lack of opportunities for professional development [4]. The Care Quality Commission (CQC) stated concerns about the shortage of nurses within nursing homes, many having insufficient staff on duty to ensure residents receive safe and dignified care. They reported 8% vacancy rates for RNs and the highest turnover rate of any job role in social care settings at 32% [1]. There is a concern that RNs are employed to earn a home its nursing home status and are not enabled to make full use of their competencies. It is also apparent that many RNs working in care homes are overseas workers and, due to changes in regulations, there are worries over their language/communication skills, competence and supervision [2].There is a likely relationship between high turnover rates and nurses' perceptions of low competency in core skill areas for long-term care [5]. In one survey, 50% of RNs in care homes rated their knowledge as insufficient in areas such as psychiatric illness, dea...

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