Taking Healthcare by Storm: Industry Insights with Erin Kitt-Lewis & Kim Ratliff

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Erin Kitt-Lewis, PhD, RN, Associate Research Professor and Associate Director of Education at Penn State Ross and Carol Nese College of Nursing and Kim Ratliff, RN, Director of Nursing at Wesley Enhanced Living Main Line.

The Pennsylvania Teaching Nursing Home Collaborative bridges nursing schools and nursing homes to enhance geriatric care using the Age-Friendly Health Systems 4Ms Framework. Guests Erin Kitt-Lewis and Kim Ratliff discuss its impact on nursing education, resident care, and professional development, highlighting challenges, pandemic adaptations, and hopes for future expansion. 

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

Publication number QI-022125-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.
 
Hello, everyone, and welcome to another episode of Taking Healthcare by Storm. I am Dr. Jean Storm, the Medical Director of Quality Insights. And today's episode, we are going to be discussing a groundbreaking initiative that I am so excited about. And this initiative is aimed at transforming nursing education and long term care to essential things in our society.

We're talking about the Pennsylvania Teaching Nursing Home Collaborative. It is a unique program that bridges the gap between nursing schools and nursing homes while enhancing care for older adults. Through the age friendly health systems for Ms. Framework. Joining us today are two key leaders in this initiative.

Aaron Kit Lewis, who is associate research professor at Penn State University and the associate director of education at the Tressa Nice and Helen Discovich Center of Geriatric Nursing Excellence and Kim Ratliff, director of nursing at the At Wesley enhanced living mean line, they're going to be sharing their insights on how this collaborative is shaping the future of nursing education, improving resident care and building stronger partnerships between academic institutions and nursing homes.

And I'm going to say. As a nursing home doctor, and I was raised by a nurse. I consider these two individuals that we have on the episode today, Shiro's, I use that, that term a lot, Shiro, but Shiro's, and they certainly are. Erin and Kim, thank you so very much for joining us today. Thank you for inviting me.

Yes, thanks Jean for inviting us. All right, so we're going to dive in. Um, Aaron and Kim, this question is for both of you. Can you tell us how you both came to do what you do and how you came involved, became involved in the Pennsylvania Nursing Home Collaborative?

Sure. The Penn State Ross and Carol Neiss College of Nursing team, which was led by Marie Bolts and Donna Fick, they joined the collaborative in 2021. Um, in the fall of 2023, I think Donna, And Marie recognized the importance of having a nurse clinician serve as a liaison between our college and the nursing home partner, which was we only had one at the time, which was center care, which is in Bellefonte, Pennsylvania, and they knew that I had over.

I have 30 years experience in long term care, and I have been teaching in the undergraduate nursing program with the college for over 20 years, and I think this experience, so my understanding of long term care as its own specialty, and my experience in nursing care of the older adult, as well as my familiarity with the undergraduate nursing curriculum, I think it made me a good fit to serve as the liaison, and when they asked me to serve in this role, I was very excited to join the team.

Um, first of all, I love Donna and Marie and working with them. Um, but it's also been very rewarding for me to see how first center care, but then other long term care facilities embrace the collaborative, um, and really are encouraging students to be excited about working with older adults in long term care.

I love that. So Kim, can you answer the same question? Sure. Uh, I worked with the Jewish Healthcare Foundation in Penn State during the pandemic on some other projects. Also, our nurse practitioner that comes to Wesley is involved in the, with the university. She teaches at the University of Pennsylvania.

So, uh, when, um, They talked about this project. That's how we, uh, were invited, uh, to participate. And it was something that really, uh, piqued our interest. So we were very excited, uh, to be phase one partners. I bet. So Erin, can you explain how the Pennsylvania Teaching Nursing Home Collaborative has evolved since its pilot phase in 2021?

And what key milestones have you seen over the past three years? Thanks. So we've we really have evolved and I was really excited, especially since I joined. I didn't join as part of the team until 2023, but there were several key milestones that we have achieved. The first one is increasing the number of nursing students.

Um, for a long term care clinical experience, and the types of experiences and exposure to long term care is really essential to build a workforce to not only support the care of older adults, but those living in nursing homes. And while Penn State already had Um, some long term care clinical experiences built into our curriculum.

This collaborative really helped us to create and really focus on the age friendly care health systems and, um, with the 4M framework. And then through this, we were able to create clinical assignments that we could, um, take You know, help students, um, and give them opportunities to reflect on their experience and create excitement about working with older adults in long term care.

Other schools of nursing did not have these same clinical opportunities in place, but through this collaboration, now they do have, um, you know, more opportunities and are partnering with Kim, um, and more students across the state. All the Commonwealth are afforded these clinical experiences, which I just think is, you know, wonderful.

Another milestone I wanted to talk about is supporting the growing number of nursing homes who have achieved level one or level two status for the Institute of Healthcare Improvement Age Friendly Care Health Systems. And not only are we educating our students and faculty about age friendly care health systems, but the nursing staff working.

In the front lines, um, working directly with the residents on a day to day basis are being educated on age friendly care. And then the last one I think I want to mention is just the number of schools or colleges of nursing and nursing homes who have joined the collaborative. And while the ultimate goal is to have each and every school of nursing Or and nursing homes join the collaborative.

That's the goal. We haven't reached quite yet, but we have made great progress toward that. And when the collaborative started in 2021, there were only three colleges in the collaborative. It was the University of Pittsburgh, University of Pennsylvania, and then the Penn State Ross and Caronese College of Nursing.

And at last count, which was, I think, mid December, there were We have 20 schools or colleges of nursing involved and 40 long term care facilities that joined the collaborative. So if you think about that, just how many people were, that are now serving older adults and have been touched by this project, um, it really is a pretty great thing and it makes me really hopeful.

Yeah, it makes me hopeful as well, especially post pandemic, right? We're still recovering. So Kim, you're the Director of Nursing at Wesleyan Hands Living Mainline. How have you seen the Teaching Nursing Home Collaborative positively impact both staff and residents at your facilities? And can you share any specific success stories?

Oh, absolutely. Um, I could probably go on for an hour alone about this topic. I'll be short. Um, first, the residents, um, residents love having the students, um, here. Um, they have been involved in different projects, uh, with our residents. Um, they, Uh, through, um, our regular meetings, uh, with, with the teaching nursing home project, we, we hear different ideas and, and, um, one of the ideas was all about me.

And so the, um, nursing students went around and met with the residents, uh, and ask them things about themselves, what movies they like, what's their favorite color, what's important to them. Um, and then My medical records person received that information and she came up with a brilliant idea to make a poster for each resident with this information on it.

So when you go in into the, uh, visit a resident, anybody, whether it's activity, social worker, volunteer, can see that poster and, and make comments. And it's a conversation starter. For the, for you and the resident, um, you know, you might say, Oh, I see you liked, I, I dream of Jeannie. I thought that show was fun.

And, you know, I remember that. And, and you can have a conversation just around that, or they like cats or they like dogs or, or anything. It's, uh, it's, It's been a great addition and the residents. I know I went to see one resident. She says, how did they know all of that about me? Um, she was just so tickled to have a poster that just spoke to her and her interests.

Um, so that is one project, um, that we've had. And for the students that gives them, um, an opportunity to just sit and talk to people and engage in conversation. Um, which, you know, is, is not in maybe in the nursing curriculum, but it sure is part of nursing. And, uh, we have to be able to have casual conversations with our residents.

So that gave them an opportunity to learn that, uh, soft skill as well. Um, the staff, I will, uh, say we had LPN students and CNA students, um, in our, in our facility, uh, prior to this engagement, and my CNAs were at first a little intimidated having RN students. They didn't think that it was their place. Um, to be involved in their education, uh, and, you know, I had to, I had to sit down and meet with them and, and remind them how important and pivotal their role is, um, with the residents.

And as an RN, these nurses, nurses to be needed to know also how important, um, their role is. And it really, um, empowered them. to feel more confident in their own work and more confident to be able to teach those, you know, that they thought were better than them or were achieving more than them. So, I think it, it helped them immensely.

The nurses also feel, it's a different learning experience teaching RN students than LPN and CNA students. So I think it really has rounded out, Really rounded out what we offer very nicely to our residents. I will say I love it because I mean, I was practicing actively practicing as a medical director and is attending physician and nursing homes during, um, you know, the height of the pandemic.

And I think. There needs to be a healing time. And this sounds like that's what's going on through this program. So it really is. Um, it's just wonderful to hear Aaron, the collaborative aims to strengthen academic practice partnerships. So what are some of the biggest challenges you've encountered in building these relationships between nursing schools and nursing homes.

I would say the biggest challenge, which isn't new to this project, is probably time. Um, every nursing home staff, nursing faculty, and the students, we're all very busy. And we have these competing demands upon competing demands, um, whether it's the objectives, what the student needs to learn in that particular clinical day, or, you know, just, Taking time away from the nursing home staff so they can assist the students.

But, you know, to add one more thing to someone's to-do list can, um, be met with resistance sometimes. One of our priorities is to approach the collaborative so that it is mutually beneficial for everyone, not just our college or our students or, or the, just the nursing facility, but for all, including our older adults.

That live in the nursing home and one of the approaches that I've tried to take, um, and my team is that if we're asking you to participate in the teaching nursing, nursing home collaborative, how can this collaborative help you and what are your needs? What are our needs and how can we merge them to find synergy in the process?

Um, and while initially it is a very slow process to get things up and running, what we have learned from seeing, um, some positive outcomes, for instance, um, the nursing home staff has reported seeing a reduction in grievances from residents, um, residents are more mobile and moving more. We've had more referrals to restorative nursing mobility programs or physical therapy.

And thanks to the support from our providers, the medical director and a nurse practitioner who are employed by, um, the nursing facility, um, we're able to see a reduction in the number of medications individual residents are taking. And specifically in one case, they reduced, I think they, um, cut 15 medications on one resident.

And while these are all things that improve the residents quality of life, which is ultimately our goal, these improvements also save staff time. This is time they may not have to consider, you know, to investigate or resolve grievances. And, you know, that can be very time consuming, having residents that are more independent.

can save them time and administering fewer medications. Um, so it's, it's a win win for everyone. And again, getting back to my original sentiment about, um, thinking of the key to these challenges is finding a solution that can be beneficial for all and work within our regular day to day operations. Yeah, I would agree.

So, so Kim, how is the partnership with Penn State's nursing program benefit the professional development of your nursing staff and help them deliver better care to residents? Um, well, I think I spoke to the CNAs, how they, um, feel more empowered and more involved and, and more, um, important in the process.

Uh, and, uh, they feel a little, Um, elevated being able to work with our end students. Um, also, Penn State has offered us, um, uh, educational opportunities has offered us resources that we've been able to utilize here, um, in educating our residents. I think them being here. Engages the conversation about age friendly, uh, because the nursing students are talking about it.

We're talking about it. We're talking with each other about it. Um, and I think that has, um, enhanced, um, uh, the age friendly part of the project for the residents. Um, and I think, you know, it also the nurses teaching our end students. It's a different, it's a different level of learning. And so it has up their game as well.

Um, to be working with the RN students who have, uh, Very different questions and and, uh, um, interest than than maybe the questions proposed by the LPN and CNA students. So I think it's, uh, it's helped everyone low and learn and grow. And I just want to say. You know, again, being involved in the project.

It's not just what happens in the facility. It's what happens in our, um, weekly or monthly calls by weekly. I think they are now calls, um, where you collaborate with. nursing, other nursing homes, other schools of nursing. And together we, um, share ideas amongst ourselves and, and then put it into action. So the University of Pittsburgh might have a great idea that the University of Pennsylvania comes and implements here at Wesley.

Um, or we might have a great idea and another facility picks that up. Uh, so it really is sharing and and collaboration and and don't, isn't that what we all need? Um, we are all trying to, we're all trying to do the same thing with the same obstacles, the same struggles. Um, and isn't it nice to have a collaboration?

of people that where you can come up with the best ideas, um, to provide care for these residents. Yeah, I would agree. So Erin, in your experience, how have nursing students responded to the opportunity to engage in clinical rotations and long term care settings? I, I, you know, I always, I wonder about this because it's sometimes difficult to find nurses to work in long term care and how has this impacted their education and career choices?

So I would say overall it's been a very positive experience for students. Um, we've had clinical rotations in the nursing home for, um, I think since the inception of our program. That's always been a place that we've gone. But what I will say, um, I, I teach a first year course to our students. And if you ask most nursing students on their first day of nursing school, what do you want to do?

What specialty do you want to go into? Most would say pediatrics, obstetrics, or critical care, and many want to become nurse anesthetist. That's probably the most common thing I hear. And it's rare that a. I want to work with older adults occasionally over my 20 years. I do have students say that and that's really exciting to me, but I have yet to have a student say, I want to work in long term care.

And so I guess, um, the reality is, oh, that's That unless you know you're working in peds or OB, you're going to be working with older adults as a nurse. Um, even if you're working in critical care, you will be taking care of older people and, and many of them will maybe be living in a nursing home, um, and be discharged to that nursing home.

So students really need to understand all the healthcare settings and value them. Um, and I think the more, the more exposure that they have to different health care settings, especially opportunities to work with older adults in the nursing home, the more they will realize that nursing home care is a complex specialty and it can be just as interesting and as rewarding as other specialties and probably like Kim and myself who love this area.

You know, I was also a critical care nurse, but I'm just as excited or even more excited about long term care. And I'm hoping that students, um, get a little taste of that. And maybe it's not their first job, but maybe it's their second job. Um, and so each exposure is an opportunity to kind of broaden that student perspective.

And I also think that once students experience clinical in a nursing home setting, they're Where the philosophy is to deliver health care in a home setting. This is where residents live, eat, they socialize there. And I think students are able to step back and really a look at them being a human first, um, and taking that approach to nursing care.

Because in an acute care setting, things happen so fast. The goal is to diagnose, to treat, discharge. It's fast paced and, you know, students have a lot A lot to juggle when they're in those clinical experiences and not that they don't when they're in the nursing home But the nursing home setting allows students that opportunity to figure out how to provide that person centered care You know Kim mentioned all about me boards And they're doing it in this person's home and they're putting the residents Preferences at the top of their list and this can be very humanizing.

It makes the patient feel You know, it humanizes them for the students, which is, I think, one of the most important things we can teach students beyond, you know, what their education is or their career choice, but to really recognize that they're people first, um, and that, you know, If they meet that one person that kind of solidifies that form, I think that's really important.

Um, it also helps them to kind of face and maybe change some preconceived notions or stereotypes they have about older adults. When I ask students about what they expect when they care for these residents before they have their first clinical experience, um, some make assumptions That they'll need total care, that maybe they're not happy about living there, and that they really don't want to engage with the students.

But as Kim mentioned, the residents are really excited to be working with the students. They really like that extra time and attention. And so the students then recognize that these assumptions weren't true. And when the students realize this, I think, you know, it really, um, helps them get more excited about going to clinical each week and seeing the same residents over and over again and developing that report, which they don't get to do in acute care settings.

And, you know, then they recognize that they hold the same kind of values or, um, Ideas that I have, you know, they, they value family, they value friendships, they value these relationships, they want to optimize their function and health. And so I think students are really surprised at all of this. Um, you know, and as Kim mentioned earlier, they really do like to see the students coming and working with them.

And the residents are really interested in them as people too. And so whenever I overhear conversations, you'll hear residents asking them, about like questions about where are you from? What are you learning this week? How did your test go? Um, you know, do you have a special someone? That's always a prime question.

So, you know, really just, you know, this collaborative really enhances that, as Kim mentioned, the soft skills and the experiences, um, for these students. And in that part, to me, if you can change a student on that personal level, to kind of think about it that way, that's what we want. That's like the gold nugget.

Yeah, the nurse's heart, definitely. Kim, the collaborative allows nursing homes flexibility in how they engage with nursing students. Has your facility customized or adapted the model to best fit your needs and your residents? Um, we have and and we, um, had to take a, uh, we had to go back to the drawing board a couple times.

Um, but it has been, um, really, um, uh, the last, I think, 2 years. Year and a half. It's been a pretty, um, pretty solid and, and we've made no changes, but they come in. And again, we're, we're trying to change the students perspective. And most times when I asked the students when I meet with them, if, if it was what they expected, they all say no.

Um, that they expected something way different than what they found. Um, so we do, uh, meet with them. They, they first, uh, work with the CNAs and the nurses and give care in the morning. Um, and then we, they are here on the day we have care conference. Uh, so some of them get to experience care conference with, uh, difficult families and challenging conversations, uh, difficult situations, um, and, uh, and are.

Efforts to try to meet what the resident wants, uh, which can be sometimes very, very difficult. Um, so they get to witness those kinds of conversations and then they meet, uh, we, we go in and, uh, present to them. Uh, the, uh, RNAC does, uh, the executive director sometimes, I do, uh, but during the course of the day, they meet the entire interdisciplinary team.

Um, we have found. some people that that were considering working in long term care, which is fantastic. Um, and there's some again, uh, that, um, may consider it later in their career, which is also which is also great because long term care does provide different flexibilities than the hospital. Um, than the hospital does.

Um, so, and, and there's not jobs for every nurse in peds. Um, and you know, they might get there and realize it's not all it's cracked up to be. Um, so, um, we do, uh, And we do, if we have something, um, specifically interesting going on. I know we had, um, a resident come in with a pretty severe, uh, gangrene situation, I made sure everyone got to see what that looked like.

Um, so we do try to offer them every opportunity we can while they're here. Yeah, that's great. That's wonderful. And talking about education, Aaron, given the collaborative, it's focused on improving quality of care through the age friendly health systems forums framework. How do you ensure that nursing students are not only learning, but are implementing these principles during their clinical placements?

So, yes, we do a lot of, um, kind of standing up, you know, getting them ready for the Age Friendly Care Health Systems 4M framework, and they do some modules, online modules that were created, um, but how we ensure that they actually are implementing it are a couple of different ways. So, we created two clinical assignments.

Um, one is for our third year students who have had, already had pharmacology and had a med surg course. And they complete this 4Ms, um, framework worksheet with their assigned resident for that day. And so they can kind of see, you know, go, they go through the whole, the whole, all of the, they complete the worksheet and then they work with the care team to see what changes can be made.

In regards to the worksheet. So based on what the resident respond, how they responded and then our second year students who haven't had pharmacology and have not had a med surge class yet. We do a modified version of this and they are really focusing on mobility. And the what matters. And so they work with an assigned resident and then We do small, for each of these clinicals, small rounding groups with, you know, incorporating their CNA, the LPN, the supervisor, the RN supervisor, or the charge nurse, anybody else that could be involved, and they'll round using either the worksheet or the modified worksheet.

And then the other thing we do is our, the center cares. Medical director and the nurse practitioner have now created age friendly care progress notes, and so they use the forums worksheet and complete that before they do their quarterly reviews on each resident. And so that shapes their rounding and they bring a whole team as well and so the students get to experience that and the students can also provide some insight during these rounding opportunities.

So, I guess really just showing them this interdisciplinary team using the 4Ms worksheet in some fashion to kind of. Show them what can be done. And that's how we were able to reduce those grievances. I mentioned, get people moving more and also reduce medications. Yeah, that's fantastic. I love that. So Kim.

Talking a little bit about the pandemic, something I know is very familiar to you. Um, but nursing homes face significant staffing challenges and I'm sure still are. How did your involvement in the Teaching Homes Collaborative help support your team? And what strategies did you implement to maintain high quality care under those difficult conditions?

Uh, well, of course, the teaching nursing home if, um, was a was a good place, uh, a therapeutic environment, shall I say, um, for us to discuss challenges we were facing and broadly, I think they've helped the industry, um, bring attention, um, and, and, uh, work on some higher level, uh, things to, to help, um, Um, with the staffing challenges, um, that long term care facilities face, um, and again, having the students in the facility, um, provides a level of, of relief and extra assistance, um, when, when they're in the facility, um, I want to say that the whole experience has I, our facility here, uh, does not struggle with staffing as much as Um, and I think a lot of that is because of the environment, um, we're creating here, um, to meet the needs of the residents and focus on what's important to them, even during the pandemic, which We focused on what was important to them as much as we could, um, by not sending a lot of people to the hospital, um, by having, you know, moving furniture so they could be near the window so they could see their families when they were outside the window visiting them.

Um, so, I think that environment has, you has um, also fostered a family with our staff. Uh, so we have, our turnover is much less and our, well, currently we don't have any open positions. So, um, we're lucky, but I also think that, um, it has helped us regulatory wise. I mean, I know Aaron talked about the grievances.

We have. very few of them. Um, we have, um, when the state now they just left, uh, for so for two years in a row, um, we've been essentially deficiency free. Last year we got some technical things because we had a power outage and we had power cords around and such. But technically, this time we were deficiency free.

Um, Because when they, when the state comes in and meets with the residents and the staff and talks to everyone, everyone's happy, um, because we're, we're meeting them where they are and we're, we're addressing what matters to them. So their lives are, are, are improved. Um, so our surveys go off with. With out of hitch.

And I think that speaks a lot to our involvement in the teaching nursing home and age friendly health systems. That's a dream. No open positions and citation free survey. I know, I know. I'm very humble about it because, uh, anything, as you know, in a nursing home, anything can go wrong any minute, um, and, and can lead to, um, negative repercussions.

So yeah. Yes. So Aaron again talking about the pandemic had a profound impact on long term care facilities. We know how did the collaborative adapt during the pandemic and what lessons were were learned that continue to inform the model today? So I would say, um, one of the things that we consider, you know, and I don't know if it's an adaptation or it's just what we knew knew to be true is, um, and I think it was not only during the pandemic, but it's still true today and will always be true.

But we always need to be prepared and planned, but. Given that we also need to be ready to pivot. And I think the one good thing as you know, Kim kind of mentioned, it is a collaborative. So we're always learning from not just, you know, my college and my one nursing home. And right now we're working, I think, with five different nursing homes, but not just that collaboration, but the whole collective.

And, you know, what You know, Kim is doing, you know, maybe she can share something with us what we're doing. We can share something with her. And so the collaborative, you know, we have to be constantly assessing what can we do to make the lives of people living in long term care better. So for me, it was, You know, every week I'm checking in with the facility lead and asking, you know, how, how are things going?

What did, what did we do well this week? Um, what did we implement that really worked? Um, what's one thing we can do today? What's something we shouldn't keep doing? Um, what's the best use of our time? And so essentially, I think just taking each clinical day, um, and taking time to ask those questions and, you know, making sure that we're really impacting the residents, ultimately, um, improving staff, you know, that, as Kim said, you know, when she's walking through the facility and, you know, Residents and staff are happy and it makes for a, you know, a really nice work living environment.

Um, and so I think that's really important is that idea of, you know, constantly being ready to be flexible and pivoting and, you know, being as Kim mentioned, you know, she's humble, but, you know, You, you want to make sure that just because you had the idea, it might not work. And so you have to be ready to punt, um, and try something else.

Um, and then the other lesson I think we already knew is that, um, you know, oftentimes change that's real and sustainable and it, That's good. Um, it really does take time and we need to keep reminding ourselves and others that while yes, we, we didn't accomplish everything maybe we wanted to do, or it didn't happen exactly how we wanted it to, that we can look back and say, okay, this is what we did accomplish and this is what worked best.

And so how can we build on that? I think those are probably the big lessons. Yeah, so just wrapping up, um, you know, I wanted to ask both of you about your future, your hopes about the future expansion of the collaborative. So, Kim, what are your hopes for the future expansion of, um, the collaborative and what additional support or resources would you like to see for both students and staff and the partnership?

I would like, uh, to see every nursing home, um, become involved, um, and really see the benefits. this project, um, and age friendly health systems in their communities. Um, so many people I talk to say, Oh yeah, we're doing, we're already doing that. And I'm sure they believe they are, and I'm sure they're doing some of it.

Um, but I'm not sure they understand, um, the extent to which the, the I don't, I'm not sure they can understand the direction they can, they can really go in and, and what they can accomplish if they really embrace, um, and take the time, which is difficult. I know everyone is very busy and, you know, have, Um, and I know that people deal ends have to work of shift on the cart.

Um, but it is so worth your time and your engagement and the engagement of all of the staff to become involved and and join the collaborative and learn from each other. lives of your residents, your success as a facility. Um, you were, you know, in, in. The results of your inspection, everything can improve.

Um, if you become more involved and really embrace this project and we can help, uh, recruit more, more nurses, um, to this environment, uh, which we need desperately. Um, we need young nurses. Um, to become involved, uh, in long term care, um, because we're not going to be around forever and we need good people, uh, to replace us.

Um, so it's, it's, I'm hoping that more and more facilities and universities, colleges, schools of nursing get involved. Yeah. I love it. Aaron, same question. What are your hopes for future expansion of the collaborative? So I think I'm going to maybe repeat a lot of what Kim said, but, um, and I also think this is the vision of the Teaching Nursing Home Collaborative is that not only does every long term care facility join this collaborative, but also every school or college of nursing that are training nurses in Pennsylvania join the collaborative.

And I'll even take it one step further, you know, it would be really great to see this happen. Um, and I know there's some other states interested because it has been successful. And so I get it, I get that's really aggressive. But once, as Kim kind of mentioned, that nursing, um, homes see the benefits and nursing programs see the benefits, um, it's a really easy decision to join despite the challenges of not having enough time.

And, um, another thing that I'm. I think really interested in seeing is, um, when I was in nursing school, my first nursing job, I worked as a nursing assistant in long term care. If you would have asked me, you know, the week before I started that job, what would I be doing? I would have not said long term care, but I instantly fell in love with it.

And so my personal hope is that every student, whether that's their career path or not, that they at least have the opportunity to experience Um, the joy and the gratitude that you get from working in long term care. And so if every student can have one positive experience, um, or interact with that one special older adult that makes them excited, as Kim mentioned, it's going to help grow that workforce who we, who we need.

And by we, me, you, Kim, we'll need these people. Um, and then my other personal hope I think I have, um, that we just discussed at our last Penn State, um, team meeting was that, um, we find a way to make the practices that we're implementing sustainable. I hope this funding lasts Indefinitely. But as we know, that's not always the case.

And so I hope that what we're doing now, um, whether it's the nursing homes, the schools of nursing continue that collaboration, um, into the future so that, you know, as things change, you know, Hopefully we never have another pandemic like this, but as, you know, situations arise or whether, you know, it's staffing shortages, um, something new happens that we're able to, you know, get together, collaborate and make that sustained difference.

Um, and then, you know, even in our curriculum, our nursing curriculum really emphasize the importance of care of older adult and focus it as that specialty that it is. Um, and so. Yeah, I think that, um, is, is my hope and I'm really building those age friendly care health systems and, you know, just getting that spread throughout every long term care facility as well.

I agree across the country. So if anyone wants to, uh, find out more, I think the website is patnhc. org and so that is patnhc. org. We will link that in the podcast, um, on the podcast page and Aaron and Kim, thank you so very much for joining us today. I really enjoyed this, uh, conversation and, um, I, I wish you both well.

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