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New Issue Paper Describes the Role of Nurses in Nursing Home “Culture Change”

June 11, 2009

Paper Details the Challenges and Opportunities for Nurses Within the Movement Toward Resident-Centered Care

The Hartford Institute for Geriatric Nursing at NYU College of Nursing, in collaboration with the Coalition for Geriatric Nursing Organizations (CGNO) and the Pioneer Network, has published an issue paper, Nurses’ Involvement in Nursing Home Culture Change: Overcoming Barriers, Advancing Opportunities.  The paper, addressed to nursing homes and professional, registered nurses practicing in nursing homes, discusses the move toward culture change—a movement away from institution-driven models of care toward more consumer-driven models that embrace flexibility and patient self-determination.

“As we move toward more resident-directed care, which has been championed by the Pioneer Network, within the Center for Medicare and Medicaid Services, and by other groups, there is a need for recommendations about the role and competencies of nurses in this changing atmosphere,” says Mathy Mezey, EdD, RN, FAAN, director of the Hartford Institute.   “This document answers the questions: What is the role of nurses in achieving and sustaining this change? What are the challenges to the traditional role of nurses in this new environment?”

The issue paper grew out of a meeting of an interdisciplinary Expert Panel of leaders in culture change and in gerontological nursing, funded by the Commonwealth Fund, held in October 2008. The purpose of the meeting was to foster dialogue, identify facilitators and barriers to nurses’ involvement in culture change, and to identify actions that the culture change movement and the broad nursing community might consider to promote competencies for nurses in a resident-directed care environment in nursing homes.  The Expert Panel included representatives from nursing academic settings, the American Academy of Nursing, the National Gerontological Nursing Association, several long-term nursing associations, the National Citizens Coalition for Nursing Home Reform, and AARP Nursing Institute, as well as social workers, physicians, and pharmacists.

The paper summarizes the Expert Panel discussion and frames the competencies that need to be developed for nurses involved in culture change and resident-directed care.  Recommendations are provided for nursing homes regarding the practicing nurse and for academic programs preparing professional nurses.  For example, the paper recommends that nursing homes develop and distribute a statement of goals for practicing nurses in culture change nursing homes.  Moreover, it is recommended that academic nursing programs conduct comprehensive reviews of culture change content in pre-licensure (diploma, associate degree and baccalaureate) nursing programs.

The paper emphasizes that, “The goals and philosophy of culture change and the goals of nursing are highly compatible.”  Still, culture change poses a number of dilemmas for nurses, challenging their traditional notions of accountability for the clinical care and safety of residents.

“As a growing number of nursing homes become involved in culture change, this movement will have strong implications for nursing clinical practice, administration, education, and research,” says Dr. Mezey.

Some of the themes associated with culture change, including autonomy in personal choices for the residents, consistent staffing, and a less vertical (hierarchical) organizational approach, directly impact nurses and their practice. The paper describes the challenges and opportunities for nurses in environments that are shifting toward greater responsiveness to individual resident preferences and quality of life.

To access the Issue Paper visit the Hartford Institute for Geriatric Nursing Web Site:

For additional information, please contact


The Pioneer Network seeks to transform the culture of aging in America by supporting models where elders live in open, diverse, caring communities. Pioneers are working for deep system change by both evolutionary and revolutionary means, using Pioneer values and principles as the foundations for change.  In-depth change in systems requires change in governmental policy and regulation; change in the individual’s and society’s attitudes toward aging and elders; change in elders’ attitudes towards themselves and their aging; and change in the attitudes and behavior of caregivers toward those for whom they care.

The Coalition of Geriatric Nursing Organizations (CGNO), with eight member organizations, represents over 24,000 geriatric nurses seeking to improve the health care of older adults across care settings and is supported by the John A. Hartford Institute for Geriatric Nursing, located at New York University College of Nursing.  The Coalition organized in October 2001 and chose two major issues for action that would affect older persons: 1) positively affecting the quality of long-term care through improving and implementing the magnet nursing home project, Pioneer Network practices, and other quality programs or practices; and 2) facilitating the measurement of quality in long term care by supporting and advancing the Minimum Data Set, used in nursing homes, and other tools appropriate for the long term care setting, including quality indicators and measures derived from those instruments.

This Press Release is in the following Topics:
College of Nursing, Hartford Institute for Geriatric Nursing

Type: Press Release

Press Contact: Christopher James | (212) 998-6876

New Issue Paper Describes the Role of Nurses in Nursing Home “Culture Change”

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