Retooling the RN workforce in long-term care: Nursing certification as a pathway to quality improvement

Mary E. Cramer, Robin High, Beth Culross, Deborah Marks Conley, Preethy Nayar, Anh T. Nguyen, Diptee Ojha

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


This article describes a project to improve nursing care quality in long-term care (LTC) by retooling registered nurses' (RN) geriatric clinical competence. A continuing education course was developed to prepare LTC RNs (N = 84) for national board certification and improve technological competence. The certification pass-rate was 98.5%. The study used a mixed methods design with retrospective pretests administered to RN participants. Multivariate analysis examined the impact of RN certification on empowerment, job satisfaction, intent to turnover, and clinical competence. Results showed certification significantly improved empowerment, satisfaction, and competence. A fixed effects analysis showed intent to turnover was a function of changes in empowerment, job dissatisfaction, and competency (F = 79.2; p < 0.001). Changes in empowerment (t = 1.63, p = 0.11) and competency (t = -0.04, p = 0.97) did not affect changes in job satisfaction. Findings suggest RN certification can reduce persistently high RN turnover rates that negatively impact patient safety and LTC quality.

Original languageEnglish (US)
Pages (from-to)182-187
Number of pages6
JournalGeriatric Nursing
Issue number3
StatePublished - May 2014


  • Evaluation
  • Long-term care
  • Nursing homes
  • Nursing studies
  • Workforce issues

ASJC Scopus subject areas

  • Gerontology


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