Perceptions of Nursing Practice: Capacity for High-Quality Nursing Home Care

Emerging evidence indicates that harmful nursing home resident outcomes occur because of ineffective collaboration between registered nurses (RNs) and licensed practical nurses (LPNs) during assessment, care planning, delegation, and supervision. This observational, factorial vignette survey related video vignettes of RN–LPN collaboration in nursing home care to RN perceptions of: 1) current practice in their home; and 2) preferred practice in their home (N = 444 rated vignettes of nursing practice). Current practice ranged from collaboration with few or poor-quality connections and a lack of differentiation between RN and LPN roles (low-capacity practice) to strong RN–LPN connections and clearly differentiated roles (high-capacity practice); RNs identified high-capacity practice as preferred. Interventions that bring together RNs and LPNs to learn new ways of giving care by differentiating roles while also strengthening connections show promise as levers for changing quality of care in nursing homes.