Baccalaureate-educated Registered Nurses in nursing homes: Experiences and opinions of administrators and nursing staff

Ramona Backhaus*, Hilde Verbeek, Erik van Rossum, Elizabeth Capezuti, Jan P. H. Hamers

*Corresponding author for this work

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AimsTo understand how nursing homes employ baccalaureate-educated Registered Nurses (BRNs) and how they view the unique contributions of baccalaureate-educated Registered Nurses to staff and residents in their organizations. BackgroundAlthough providing care for nursing home residents is complex and thus requires a high level of skills, organizations often struggle to recruit and retain BRNs. Some nursing home organizations do not employ baccalaureate-educated Registered Nurses at all. Among those that do, it is unknown how well these organizations make use of baccalaureate-educated Registered Nurses' expertise or if their roles are different from those of other staff. DesignA qualitative study, consisting of 26 individual and three group interviews was conducted in the Netherlands. MethodsInterviews were conducted at the board-, management- and staff-level in six nursing home organizations. Data were collected between January 2016-May 2016. ResultsOrganizations employed baccalaureate-educated Registered Nurses to fulfil an informal leadership role for direct care teams. Organizations that do not employ baccalaureate-educated Registered Nurses were unable to articulate their role in the nursing home setting. Difficulties baccalaureate-educated Registered Nurses experienced during role implementation depended on role clarity, the term used to refer to the baccalaureate-educated Registered Nurse, the extent to which nurses received support, openness from direct care teams and baccalaureate-educated Registered Nurses' own behaviour. The unique contribution of baccalaureate-educated Registered Nurses perceived by respondents differed between and in organizations. ConclusionOur findings suggest that there is no one size fits all approach to employing baccalaureate-educated Registered Nurses in nursing homes. To ensure the satisfaction of both baccalaureate-educated Registered Nurses and the organizations that employ them, careful implementation and evaluation of their role is crucial.
Original languageEnglish
Pages (from-to)75-88
Number of pages14
JournalJournal of Advanced Nursing
Issue number1
Publication statusPublished - 1 Jan 2018


  • elderly care
  • leadership
  • long-term care
  • nursing homes
  • quality of care
  • Registered Nurses
  • role implementation

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