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In-Service Education Improvements for Regulatory Compliance and Staff Competency

An effective in-service program not only ensures competency and meets regulatory requirements, but also incorporates many learning styles and fosters the enjoyment of learning. Given the resources that a facility must dedicate to its in-service education program, it’s important that nurse leaders review their program regularly. Ask the following questions: Does in-service training offered by the facility meet regulatory requirements? Are staff enthusiastic about in-service training and is it delivered in a way that it meets a variety of learning styles? Can staff apply what they learned during the in-service, putting it into practice? This article will guide nurse leaders through evaluating their education programs and making improvements, as well as inform about the in-services AAPACN offers.

Overview of Regulatory Requirements

Per Appendix PP of the State Operations Manual (SOM), F838, Facility Assessment, requires the facility to identify the competencies that are necessary for the staff to care for the resident population the facility serves. F726, Competent Nursing Staff, requires the facility employ sufficient nursing staff that possess the skills and competencies necessary to assure resident safety and to attain or maintain the highest practicable level of resident well-being. This includes, but is not limited to, licensed nurses who can assess and evaluate the resident and plan and implement care accordingly. F726 also identifies that nurse aides must demonstrate competency in skills and techniques necessary to care for residents. Furthermore, F947, Required In-Service Training for Nurse Aides, requires that each certified nursing assistant (CNA) complete a minimum of 12 hours of in-service training per year, starting on the CNA’s hire date, that is sufficient to ensure continuing competence. Nurse leaders are encouraged to use the Critical Element Pathway, Sufficient and Competent Staff, found in the LTC Survey Pathways folder, to review their education programs and ascertain compliance with regulatory requirements.

Areas of Competency

The SOM does not specify which competencies a facility must have. CMS’s expectation is that the facility, via the facility assessment process, will determine necessary staff competencies based on the needs of the resident population. For example, if the facility cares for residents who receive peritoneal dialysis, competencies associated with this modality should be established. Another facility may offer specialized bariatric services, so competencies associated with this care should be established. While each facility will have a unique list of competencies, the SOM does provide a list of areas all facilities should include. The table below lists those areas, as well as the AAPACN in-service tools and other resources that are available to support the facility’s education program.

Areas of CompetencyAAPACN In-Service Tools and Resources
Resident rightsResidents’ Right to Privacy
The Many Forms of Abuse and Neglect
Person-centered careComing soon Person-Centered Care Planning
CommunicationProviding Excellent Customer Service
Coming soon Communicating with Residents with Dementia
Basic nursing skillsBasics of Care for the Resident Who Has Urinary Incontinence
Combatting Failure to Thrive in Adults
Back Safety
Coming soon Dining Safety
Basic restorative servicesGuide to Restorative Programs
Skin and wound carePressure Injuries: Assessing for Risk Factors and Implementing Interventions
Playing the Defensive Line Against Pressure Injuries
Medication managementComing soon Avoiding Medication Errors
Pain managementSigns of Pain in Residents with Dementia
Death and Dying Education Bundle
Coming soon Pain Control Beyond Drugs
Infection controlAppropriate Use of Personal Protective Equipment
Flu Trivia
Protecting Against C-Diff Infection
Coming soon Nurse-Driven Antibiotic Stewardship
Identification of changes in conditionNurse Assessment: Acute Changes in Condition
Staying Alert for Acute Conditions
Post-Fall Assessments
Cultural competencyRespecting Cultural Diversity

Four Principles of Educating Adults

A facility can meet the basic regulatory requirements for educating staff and ensuring competency, but those that want to foster a true learning environment will go beyond compliance and prioritize education. Education is the facilitation of learning. While this definition may seem straightforward, educating adults requires at least a basic understanding of how to best facilitate learning. Malcom Knowles’ Adult Learning Theory is one of the preeminent guides for educators and businesses when developing education programs that meet the unique needs of adults. Knowles presents four principles that create an environment conducive to learning for adults:

  • Adults are most interested in learning what they see as relevant.
    • To apply this principle in the facility, help staff see the connections between what they are learning, what their job is, and how the topic affects the residents in their care.
  • Adults learn best with task or problem-centered education, rather than content-centered.
    • Explain concepts by focusing on application and problem prevention. For example, when presenting skin care, emphasize how the care provided prevents pressure injuries, not just general concepts of skin care.
  • Adults relate to their experience, including mistakes, to learn.
    • Encourage staff to reflect on their practice. For example, what went well and what didn’t go well when they were involved in managing an adverse event or assessing a resident’s change in condition?
  • Adults need to be involved in planning and evaluating their learning experiences.
    • Ask staff to evaluate the in-service experience and how they would improve it. In addition, ask them what they need to learn and want to gain competency in. Use this information to improve the learning experience and to identify areas the staff need additional assistance with.

Enthusiasm for Education

When education is routinely presented in only one format, it can become monotonous. Moreover, a given mode of education may not be the best way to facilitate learning. To foster enthusiasm for education, it’s important to recognize that individuals learn in different ways, so a combination of approaches is best. The table below names different domains and styles of learning, along with ways to deliver education to complement each learning domain and style. Links to examples of AAPACN in-service tools are also included that correspond to each domain and style of learning.

Domains:Cognitive – knowledgeAffective – attitudes and beliefsBehavioral – practical application
DeliveryLecture and brainstormingLearning circles and consensus seekingRole plays and simulations
AAPACN In-Service ToolsComing soon Ethical Decision MakingDeath and Dying Education Bundle  Post-Fall Assessments
Styles:Visual – seeing and watchingAuditory – listening and speakingKinesthetic – learn by experiences
DeliveryWatching body language of instructor, viewing imagesDiscussion, summarizing what was heardHands-on activities, role plays
AAPACN In-Service Tools Providing Excellent Customer Service  The Many Forms of Abuse and NeglectPlaying the Defensive Line Against Pressure Injuries

Learners can tell when the person presenting the education is passionate about facilitating learning; that passion can be infectious to staff. Staff also become engaged when they learn things that help them grow and feel supported to be successful. The following tips can help to ensure the environment fosters a love of learning:

  • Make in-service training a fun event, when circumstances allow.
  • Provide feedback right away and reinforce how staff have gained new skills that will help the resident.
  • Engage staff in the in-service by using a variety of methods, such as role plays, discussions, visuals, case studies, and question and answer sessions.


By reevaluating the delivery methods, ensuring all necessary competency areas are covered, and fostering an environment where staff enjoy learning, nurse leaders can have a successful in-service program that meets regulatory requirements and successfully trains staff to provide the best care for residents.

AAPACN is here to help each member with his or her educational needs and support excellent care and services. Check the AAPACN Education webpage for more in-service topics, as well as access to workshops, webinars, and educational programs.

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