The beginning of a new school year has a particular energy—fresh notebooks, sharpened pencils, and a renewed focus on learning the essentials. In the long-term and post-acute care (LTPAC) world, we can take a cue from that “back to school” spirit. No matter how long we have been in the profession, a refresher on the fundamentals is like revisiting the ABCs of nursing. Refreshers keep skills sharp, prevent costly mistakes, and ensure residents get the safest, highest-quality care possible. Clinical staff face increasing demands, from managing high-acuity residents and navigating regulatory changes to coordinating with multiple interdisciplinary providers. In the context of these demands, going “back to basics” is a critical step that refocuses on care delivery.
Reinforcing clinical fundamentals is not about simplifying care; rather, it is about strengthening it from the ground up. Whether a new nurse, an experienced charge nurse, or a director of nursing services (DNS), returning to fundamental practices can sharpen clinical judgement, boost team performance, and most importantly, protect residents.
Why Review the Basics?
Even veteran clinicians can drift from the fundamentals under the pressure of staffing shortages, complex regulations, and higher-acuity residents. Think of revisiting fundamentals like re-reading a classic novel. It may surprise you to see how much you can improve with a little review.
Bypassing foundational steps will lead to big problems, like missed early warning signs, medication errors, preventable wounds, litigation for not following facility policy and procedure, and deficiencies during survey. The “curriculum” for clinical excellence always begins with the basics.
Lesson Plan: Core Clinical Skills Worth Recommitting To
- Vital Signs 101
- Like learning to count before doing algebra, accurate vital signs are the foundation for clinical decision-making. Obtaining vital signs is more than just recording the date and plugging in numbers. It should involve interpreting trends, comparing them to baseline, and knowing when to escalate.
- For example, a slight increase in respiratory rate or a new-onset low-grade fever may indicate an early infection or respiratory distress. Correct positioning is essential for an accurate blood pressure reading. To ensure residents receive appropriate care, begin with accurate information.
- Head-to-Toe Assessment Refresher
- A good assessment is like a thorough essay. You can’t skip sections and still expect a complete picture. Routine assessments can occasionally become rushed or superficial, but taking the time for thorough, focused assessments allows nurses to catch skin changes, gait instability, cognitive shifts, or signs of pain early.
- Combatting “checklist fatigue” means encouraging staff to be intentional and meaningful: they should listen, look, palpate, and think about what they are finding. A proper head-to-toe assessment should provide actionable findings that guide care, not just a series of boxes to check.
- Skin Integrity Checks
- Pressure injuries remain a top concern in LTPAC, often preventable with proactive measures. Think of the Braden Scale as a pop quiz the facility should ace every time. Early detection and intervention are key to avoiding “failing grades” in wound prevention.
- Daily skin checks during care routines, repositioning schedules, moisture management, and the use of pressure-relieving devices are all frontline defenses. Educating CNAs and nurses to speak up when they observe early skin changes can prevent wounds before they worsen.
- Medication Administration: The Seven Rights Exam
- Administering medications goes beyond just giving pills. Medication administration is a complex process that demands vigilance. Following the “seven rights” (right resident, right drug, right dose, right time, right route, right documentation, and right response) is essential. But don’t stop there: understand why the resident is on each medication, be alert for side effects, and question anything that doesn’t make sense. Ensure that, if a medication has parameters, staff take the resident’s blood pressure, pulse, etc. prior to administration. Recognize and act on any deviations from ordered parameters in accordance with clinical protocols.
- This is especially crucial for residents on psychotropics, anticoagulants, or insulin. Nurses should feel confident in pausing when something doesn’t seem right, questioning unusual orders, and advocating for safety.
- Clear and Accurate Documentation: Writing the Best Paper
- Nursing notes are the story of the resident’s day, so don’t turn in a blank page. Documentation should include changes in condition, responses to interventions, and conversations with the provider and family. Ensure nurses are refreshed on the facility’s documentation policy. Brief but meaningful entries matter. Vague phrases like “no change” or “doing okay” do not help the next shift. Instead, share clinical observations, objective data, and timely updates.
Communication: The Group Project
Nursing is a team effort, and like any group project, communication is the key to success. That’s why structured communication tools like Situation-Background-Assessment-Recommendation, or SBAR, should be second nature. Whether handing off a resident, calling a provider, or briefing a colleague, consistent formats prevent details from falling through the cracks.
Equally important is empowering CNAs, dietary staff, and housekeeping to report what they see. Often, those who spend the most time with residents notice subtle changes first.
Leadership: Teaching by Example
Nurse leaders play a pivotal role in promoting clinical excellence. This means more than just reviewing charts or attending meetings. It means leading by example. A DNS or unit manager who assists with a complex dressing change or helps troubleshoot a medication discrepancy sends a strong message that fundamentals matter.
Quick huddles or “skill-of-the-week” refreshers can serve as low-burden ways to highlight core topics like fall prevention, safe transfers, or infection control.
Overcoming the Excuses
“I don’t have time” is the nursing equivalent of “the dog ate my homework.” Skipping the basics often leads to more work down the line, including correcting errors, addressing preventable complications, or explaining incidents to families and surveyors.
Replace a mindset of “that’s not my job” by asking “how can we help each other?” Collaboration between roles does not mean that it’s someone else’s work. It means recognizing how small acts of teamwork protect residents and improve outcomes. For example, a housekeeper might notice that a resident’s call bell cord has slipped out of reach. Instead of walking past, they place it within reach, check that the resident can easily access it, and then notify the CNA of the action they took so staff are aware and can follow up as needed. Another example might be an activities aide who notices that a typically talkative resident seems withdrawn and has trouble holding materials they usually manage with ease. The aide shares their observations with the nurse, who then performs an assessment and identifies early signs of infection. These simple acts of observation play a crucial role in residents’ safety and overall well-being.
Reinforce, Recognize, and Repeat
Sustainable change doesn’t happen overnight. Integrate these fundamentals into new employee orientation, competency checklists, and performance evaluations. Use quality assurance and performance improvement (QAPI) data to show how returning to basics has measurable impact: fewer falls, better wound outcomes, and improved satisfaction scores.
Don’t forget recognition. Celebrate staff members who consistently demonstrate clinical diligence. Even a thank you note or a spotlight at a staff meeting can reinforce expectations and boost morale.
Graduate to Excellence
Revisiting the fundamentals isn’t a remedial class. It is how staff demonstrate a graduate-level commitment to excellence. By focusing on the ABCs of nursing care, staff strengthen resident safety, improve outcomes, and create a work environment that values skill, pride, and teamwork.
So, sharpen the pencils, open the notebooks, and let’s make this the best school year yet—one skill, one resident, one shift at a time.
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