Making the Case for Safer Nursing Homes

May 2013Kate Darby Rauch

When Laura Wagner was growing up in rural Ohio, older people were part of the fabric of her childhood. In addition to being close with her grandmother, Wagner would stop weekly at local nursing homes to visit her great-grandmother and great-aunt.

She enjoyed the visits and was especially moved by how much they cheered her relatives. But she was never particularly comfortable with the care they received.

“They weren’t the nicest places, actually,” Wagner says. “They were your typical nursing home.… I think over the years nursing homes have gotten marginally better, largely due to the increased federal regulations and oversight. But we have a long way to go, and we need to do a better job at providing opportunities in nursing school education for students to see the amazing impact even one nurse can have towards improving care for this frail population.”

Today Wagner, who recently joined the faculty at UCSF School of Nursing, is a specialist in nursing home safety. Her areas of focus include the risks of physical restraints and restrictive side rails on beds, the development of safer alternatives, and reducing falls and injuries in these settings.

A Serendipitous Career

Laura Wagner In addition to growing up among seniors, Wagner credits serendipity with directing her career.

After finishing her undergraduate degree in nursing from Case Western Reserve University, Wagner headed to the University of Pennsylvania (Penn) for her geriatric nurse practitioner master’s degree. Before moving to Philadelphia, she sent letters to Case Western nursing alumnae asking for help in finding a staff nursing position.

One letter did far more.

“I sent out over 80 letters and got one back from Mary Beth Happ [now at Ohio State University], who was completing her nursing PhD at Penn and doing research on physical restraints in intensive care units,” Wagner says. At the time, Penn was a research hub on the life-threatening risks of strapping or tying down elderly patients – once ubiquitous nursing home practice.

Wagner ended up as a research assistant for Happ, who immediately connected her to others breaking major ground in nursing home safety, including Elizabeth Capezuti, who was studying the use of restrictive side rails in homes. Wagner assisted her on clinical trials.

“That was the moment when I saw the impact that nursing research had on improving outcomes in frail elders,” says Wagner, who went on to earn her PhD in 2004 at Emory University’s Neil Hodgson Woodruff School of Nursing, having followed her mentor Capezuti to the school.

A Nurse Practitioner, Policymaker and Teacher

During her career, Wagner has worked as a geriatric nurse practitioner at an Ohio nursing home, putting into practice new safety guidelines she helped research; developed national and provincial guidelines on fall prevention and restraints in Canada; and worked as an assistant professor of geriatric nursing at New York University College of Nursing. In 2012, she moved west to join UCSF.

Wagner’s list of published research includes studies showing a positive association between nursing home accreditation and reported patient safety culture (in the Joint Commission Journal on Quality and Patient Safety), a correlation between the ratio of registered nurses (RNs) hired in nursing homes compared to nursing aides and deficiencies related to physical restraints and side rails (Western Journal of Nursing Research) and a link between lower nurse staffing and deficiencies in infection control (American Journal of Infection Control).

At UCSF she hopes to excite future nurse researchers and practitioners to follow in her footsteps, fully aware that she faces hurdles.

“Unfortunately, many nurses don’t perceive the long-term care setting as sexy or desirable, but it can be deeply satisfying,” Wagner says. “Your level of independence and autonomy is great, and the ability to impact even the smallest change can make such a huge difference in care.”

Her overarching goal is to transform nursing home care across the globe. “It’s ambitious, especially given the challenges facing nursing homes [state reimbursement policies, challenges with quality, low-staff educational levels],” Wagner says. “But I want to inspire students and nursing home staff to join me in this journey.”