Facilities structure restorative nursing programs in many ways. In some facilities, restorative programs are separate from routine nursing care, but in most, the two services are integrated in some manner. Without one evidence-based model, facilities are left to their own devices to plan and implement a program that works for them and is accepted by the survey team. Many factors influence the facility’s selection of the type of program to use. Common structures are:
- All restorative care is provided by the certified nursing assistant (CNA) staff members who have been given extra training in restorative nursing beyond their original class. All CNAs provide restorative procedures listed on the care plan for their assigned residents. Providing additional restorative education for all CNAs is ideal, because restorative becomes a central tenet of facility care and is not compartmentalized into a separate service.
- The facility designates and trains a few restorative nursing assistants (RNA) to provide all formal restorative nursing care to residents according to the approaches and restorative procedures listed on the care plan. Facilities with programs of this type typically have five-days-per-week RNA coverage on one or two shifts. (Staffing is usually staggered so at least one RNA is on duty seven days per week.) The number of residents participating is often limited due to limited staff availability.
- Some facilities have a combination of both CNA and RNA restorative programs, with the highest need and most difficult residents being cared for by RNAs, and the maintenance-level residents being given care by CNAs.
In some facilities, therapy is highly involved in directing restorative nursing. In others, there is no therapy involvement. However, this is a nursing program, planned and administered by nurses. Some surveyors accept programs written by therapists without question, but others do not. The premise behind program rejection is that therapists do not write nursing orders. They are consultants to the nursing program. Most survey teams universally require that a nurse is designated to oversee the restorative program regardless of therapy involvement.
To some extent, an interdisciplinary restorative model is the most effective, but restorative care is always a nursing service program, and nursing is responsible for implementation, documentation, coordination of team members, and ongoing monitoring and supervision. Nurses do the assessments and write the orders. There are a few exceptions, such as a speech therapist ordering special swallowing techniques to prevent aspiration, an occupational therapist fashioning a splint or ordering an adaptive device, or a physical therapist specifying the gait to use for ambulation with the walker or cane. Again, the types of programs provided are determined largely by the facility’s philosophy of care and resident needs. The possibilities are limitless.
This is an excerpt from HCPro’s book, The Long-Term Care Restorative Nursing Desk Reference, written by Barbara Acello, MS, RN.