Is the onboarding experience and orientation program in need of improvement in your nursing home? If so, you’re not alone; and the challenge is not unique to the healthcare industry. Only 12% of employees who completed the Gallup survey in 2017 said their employer did a good job onboarding them. According to surveys conducted by Digitate in 2018, only one in five employees would recommend their new employer to a friend after onboarding, and those who had a negative onboarding experience are twice as likely to look for new opportunities in the near future. With the demand high for a compassionate and competent workforce, and the current staffing crisis in post-acute care, investing in revitalizing the onboarding experience and orientation program in the nursing home could pay big dividends. The first article in the staffing solution series discussed ways to improve the onboarding experience using principles of hospitality. This article will build upon the first and discuss ways to improve the orientation program and encourage retention.

During the DNS’s daily rounds, he overhears two CNAs conversing about how two residents frequently argue. The DNS inquires and learns Ms. Smith and Mrs. Johnson, both residents living in the memory care neighborhood, had an argument over a purse the previous evening. Ms. Smith grabbed the purse out of Mrs. Johnson’s hand, hit her twice with the purse, and walked away. Later the same day, a CNA sees Ms. Smith holding Mrs. Johnson’s arm and warning her to stay away from her purse or she will hit her with it again. Mrs. Johnson shakes her head and asks Ms. Smith to help her find her dog. The CNA re-directs Ms. Smith’s attention and assists her to her room so she can watch her favorite TV show. Two days later, Mrs. Johnson’s husband reports a bruise on his wife’s arm and is demanding to know what happened to her. There is no documentation in the medical record or incident report on file for any of the resident to resident altercations observed by the CNAs, nor the bruise. The following day, a state surveyor enters the facility to investigate a hotline complaint of abuse and requests the medical records for Ms. Smith and Mrs. Johnson.

Ms. Smith and Mrs. Johnson probably remind readers of other residents currently or previously in their care. The scenario described is also likely familiar. However, the perception of and regulatory requirements related to resident to resident altercations have evolved, as has the expectation for each case to be investigated for potential abuse. F600 states “The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart.”

A key problem in many nursing homes is inadequate infection surveillance. The written standards, policies, and procedures for an infection prevention and control program (IPCP) must include “a system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility,” according to §483.80(a)(2)(i) of the Code of Federal Regulations.

"The Centers for Medicare & Medicaid Services (CMS) wants providers to have a more formalized surveillance program, says Deb Patterson Burdsall, PhD, RN-BC, CIC, FAPIC. “You have to understand the epidemiological concepts of incidence and prevalence rates; how to calculate infection rates; and how to feed that information back in a feedback loop to the frontline providers—the people who can actually do something about what is going on with infection data.”

Last month, we provided members with a list of the top ten federal deficiencies since January of 2019. As a reminder, the top ten deficiencies are:

1. F880 - Infection prevention and control

2. F689 - Free of accidents, hazards/supervision/devices

3. F812 - Food procurement/storage

4. F656 - Develop/implement comprehensive care plan

5. F684 - Quality of care

6. F761 - Label/storage of drugs and biologicals

7. F657 - Care plan timing and revision

8. F758 - Free from unnecessary psychotropic med/prn use

9. F677 - ADL care for dependent residents

10. F550 - Resident rights

(The citations above in red reflect the potential to cause substandard quality of care when a facility is cited at a scope and severity of F, H, I, J, K, or L level)

This month, we will take a deeper dive into the number three and four top citations and explore common reasons that facilities are struggling to meet these regulations.