Friendly nurse talking with older couple
HealthJuly 20, 2020

Boosting care quality in nursing homes to help stop COVID-19

The confirmed number of Covid-19 cases in nursing homes depends on who you ask: according to the latest data from the Centers for Disease Control and Prevention, over 142,000 nursing home residents have been affected by Covid-19, and over 38,000 have died. Compare that with the New York Times, where the most recent data suggests that more than 335,000 people in nursing homes have become infected, representing over 40% of all cases in the United States.

Regardless of the source, it’s clear that Covid-19 disproportionately affects older individuals. There is a myriad of reasons for this: first, elderly people often have several comorbid conditions which may be exacerbated by Covid-19 infection. Second, nursing homes are confined environments, and healthcare workers frequently move from room to room during the course of their duties, increasing the likelihood of accidental disease transmission.

But quality of care also affects Covid-19 rates in such facilities. While each nursing home is required to have infection control procedures in place, some may not have adequate staffing, inspections, and physical and clinical measures for residents to properly prevent the transmission of harmful pathogens. Additionally, high staff turnover, burnout, job dissatisfaction, and the need for staff members to take second or even third jobs to support themselves, means that providing care of the highest quality may be difficult.

However, leaders in nursing homes can take steps to improve the practice environment, increase nurses’ job satisfaction and performance, and improve quality of care for residents. One method, the Pathway to Excellence in Long-Term Care®, lays a framework to guide nursing home workers toward improvement.

The Pathway to Excellence

The American Nurses Credentialing Center (ANCC) first launched the Pathway to Excellence in Long-Term Care® credentialing program in 2010 in an effort to recognize long-term practice environments supporting nursing excellence. This program helps nurse leaders better engage staff, boost care team performance, and promote a work culture of excellence.

Six standards represent the essential elements of supportive practice environments, according to the Pathway:

  1. Leadership
  2. Professional development
  3. Quality
  4. Safety
  5. Shared decision-making
  6. Well-being

Each of these standards is intended to support and increase all others, which, in turn, boosts the quality of care provided to nursing home residents. Higher emphasis is placed on shared decision-making and professional development and training. It’s expected that each organization will allow nurses to share their input and be accountable for and involved in the process of care improvement.

Schyulkill Center: A case study

In Pottsville, Pa., the Genesis Healthcare Schyulkill Center recently began its own journey in the Pathway to Excellence® program. This 190-bed nursing home facility first introduced a shared decision-making model through a series of meetings, facility postings, and educational seminars. Nurse leaders based the model on accountability, partnership, ownership, and equity.

Nursing staff members were eager to participate in the program’s implementation, and they valued the opportunity to come together to find solutions for care quality problems. A volunteer nurse practice council was established, which then began a self-assessment to determine how each Pathway standard should be addressed and what steps they could take to implement those changes.

Nurse managers were tasked with providing education to the entire staff while also promoting the benefits and importance of the program framework. This, in turn, was used to show how both resident care and employee satisfaction could be improved by using the Pathway method.

Thanks to their combined efforts, Schyulkill’s nurses experienced a more positive impact on their sense of autonomy and satisfaction with their jobs. The organization noted several returns on their investment, including:

  • Improved teamwork
  • Increased nursing staff autonomy and well-being
  • Enhanced marketing

Programs like the Pathway to Excellence in Long-Term Care® may be part of the solution for improving care quality in nursing homes and reducing Covid-19 cases among residents. But the Pathway requires a combined effort on the part of all staff members to identify problems and implement change. Any organization interested in using the Pathway to improve care quality must first complete an application and organizational culture self-assessment, which may be accessed through the American Nurses Credentialing Center website.

Lippincott Solutions note: for the latest coverage on Covid-19 by the Lippincott Nursing team, please visit

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