Dedication to robust restorative nursing programming will bring countless benefits to your residents, as well as improved  facility outcomes. Designed to achieve and maintain optimal physical, mental, and psychosocial functioning, restorative nursing programs are central to health-related quality of life. Unfortunately, restorative nursing is often underutilized due to obstacles providers face in staffing and effectively managing programs. Consider these factors and strategies to re-energize or sustain success in your restorative nursing program…

5 Steps to overcome restorative obstacles:

  1. Administrative buy-in. Maintaining restorative programming as a top priority in resident care is essential. Not only are there multiple benefits as noted in the above table, sustaining a robust restorative program also positively impacts health inspection survey outcomes. There are a multitude of survey deficiencies related to quality of care and to functional decline that can potentially be mitigated through effective restorative nursing care.
  2. Identify a restorative champion. A nurse leader who has appropriate restorative training and is scheduled ample time to manage the program will drive success.
  3. Review restorative staffing model. Staffing gaps are the most common barrier to a successful program. If your current staffing model is structured with designated restorative nurse aides, consider a shift to shared responsibility among direct care staff. With this shift, comes the need to ensure all direct caregivers are trained in restorative techniques; however, integrating restorative nursing programs into the routine daily workflow is achievable. Also, remember that groups of 4 are permissible. Consider grouping residents who are cognitively able to participate, and with a similar program/goals.
  4. Caseload management. As a best practice, the restorative nurse manager should conduct a routine meeting (weekly or monthly based on the size of your program) with the primary restorative nurse aides. This will assist in identifying resident goal achievements and those who may be able to transition away from the restorative program to maintain their overall function through another means—e.g., independent exercise routine, integrated activities group, or other means. Routine meetings also assist in collaborative discussion of potential residents who would benefit from participating in restorative groups, or problem solving for those residents who require a change to their program or have been refusing to participate.
  5. Effective documentation. Missing or deficient documentation is a common obstacle. The restorative nurse manager must ensure all documents are in place to validate the delivery of the program. This includes ensuring that treatment flowsheets, the care plan addressing key program elements, a periodic evaluation, and documentation to validate staff training are available, in addition to any additional state documentation requirements.

When weighing the pros and cons of development Restorative Nursing Programming in your facility, consider the overall impact on resident’s well-being, facility quality measures (QMs), SNF Five-Star Rating System, and the organization’s bottom line in your assessment.

Ready to jumpstart Restorative in your facility? Join Proactive for 6-part webinar series (1 hour each session) beginning June 22, 2023 and running weekly on Thursdays through July 27, 2023. Participants will review RNP guidelines, discuss practical implementation solutions, and receive care plan templates and other resources including a competency checklist to guide your facility in revitalizing or sustaining restorative nursing program success.

Learn more and register: Restorative Nursing – Proactive LTC Consulting (



Written By: Stacy Baker, OTR/L, CHC, RAC-CT
Director of Audit Services

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