COLUMBIA, Mo.— In today’s nursing homes and other long-term care facilities, registered nurses are often called upon to serve not just as clinicians but as leaders and managers as well—roles that the typical nursing school curriculum does not prepare them for.

The University of Missouri Sinclair School of Nursing helps fill that gap through its Enhanced Leadership Development Academy (ELDA), a nine-month program that combines monthly in-person classes with interactive television sessions, online instruction and mentoring by nursing faculty.

“In long-term care, most nurses are graduates of two-year programs where they learn how to give good nursing care,” said Shirley Farrah, assistant dean for outreach at the Sinclair School of Nursing. Though essential, clinical training alone can leave RNs feeling ill-equipped for positions in long-term care in which they are expected to lead other nurses and staff, identify and solve problems, effect change, and ensure compliance with numerous state and federal regulations.

“There are tremendous opportunities for RNs in leadership positions, but we lose a lot of very talented people because they don’t have the skills to deal with the things they are facing every day,” said Lynne Ott, ELDA co-faculty and vice president for patient services at Fitzgibbon Hospital in Marshall, Mo.

Adding to the challenge are the changes in long-term care over the last couple decades, said Amy Vogelsmeier, MU assistant professor of nursing, who helped develop the ELDA curriculum.

Nursing homes today typically employ fewer RNs than in the past and rely more on licensed practical nurses (LPNs) who have less education than RNs. At the same time, nursing home care is far more complicated. Care that once took place in hospitals—such as extended recovery from an operation, illness or injury—now often takes place in nursing homes. So for a growing number of residents the nursing home is not a permanent destination but a temporary stop between the hospital and their own home, Vogelsmeier said.

Effective leadership in such an environment requires clinical expertise coupled with good communication skills, Farrah said.

“According to the Missouri State Board of Nursing Home Administrators, when someone gets in trouble, it’s usually because of a breakdown in communications,” she said. “You can’t just post a memo or develop new forms. You have to start at the grass-roots level.”

“An important part of the program is helping participants understand the influence they have over the work environment,” said Vogelsmeier. “Staff look to them as leaders, and how they interact with staff is critical.”

The program also helps participants learn to communicate with administrators through classes on such topics as how to make the fiscal case for change. ELDA also encourages institutions to enroll nursing home administrators with their RNs for all or part of the program.

Farrah says having administrators participate enriches the experience for everyone. “When you have a good administrator and a good director of nursing, they’re an unstoppable force.”

By spreading ELDA over the better part of a year, participants can share their experiences trying to apply what they learned, and talk about what did and did not work—something usually not available either in full-time graduate programs or in one- or two-day workshops, noted Alexis Roam, lead faculty and project manager for ELDA and a clinical instructor in the MU School of Nursing.

“They’ll come back and say, ‘This change stuff sounds great, but how do I sustain that and get people on board? How do I deal with people disrupting meetings? How do I delegate and trust people to do the job I expect? How do I make explanations clear?’ These are the type of issues we explore in the ELDA,” Roam said.

Brenda Cobb had been an RN for 22 years when she enrolled in the 2011-12 ELDA, but she was new in her job as director of nursing at a St. Louis nursing home. ELDA helped her with what could have been a daunting transition. “I felt very unsure of what I was doing and how to do it,” she said. “This course allowed me to fine-tune my strengths. I have a clear vision of what I want to accomplish and how to implement it.”

Over the last five years, more than 140 people from about 130 Missouri nursing homes and other long-term care facilities have participated in the program.

The Academy has been proven to increase leadership skills and improve participants’ confidence in their ability to perform as leaders, Farrah said. “Our graduates stay in place longer than average.” Those who have changed jobs were more likely to remain in the field of long-term care. Reduced turnover among leaders is linked to reduced turnover among other staff, which usually translates to better quality of care.

“Resident care improves when a cohesive team is in place, from RN and administrator down to bedside caregivers,” Farrah said.

A grant from the U.S. Department of Health and Human Services and scholarships from the Missouri Department of Health and Senior Services have allowed the program to keep tuition relatively low. With that grant coming to end in 2012-13, the School of Nursing is looking for corporate or foundation funding to keep ELDA going, and perhaps even expand it to other states.

For more information about the MU Enhanced Leadership Development Academy, go to

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