ABSTRACT
A core component of the Green House nursing home model is an altered supervisory relationship between the nurse and direct care workers. Some have expressed concern that the Green House nursing model might weaken professional nursing oversight, threatening the quality of clinical care. Implementation of the nursing role within the Green House model varied both within and across sites. Four nursing model types were identified: Traditional, Visitor, Parallel and Integrated. Government policies have been enacted to support culture change. Beginning in the 1970s, fueled by widespread published accounts of abuse, neglect, and fraud in nursing homes, federal and state governments began raising questions about the quality of care in nursing homes. Culture change innovators often implement modified Certified Nursing Assistant (CNA) roles such as empowered workers, universal worker roles, or “self-managed work teams” designed to promote both resident quality of life and improved quality of work life.
