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Directors of nursing services (DNSs) and other managers can support and motivate staff in two critical ways: individually and organizationally. Taking the following steps can help staff deal with the anxiety of caring for residents in a pandemic:
Teach staff how to help each other—and themselves
Judy Davidson, DNP, RN, FCCM, FAAN, a nurse scientist at UC San Diego Health and co-chair of the Strength Through Resiliency Task Force at the American Nurses Association, offers the following two stress reduction techniques that DNSs can use themselves and teach staff as well:
* Tap Out and Take a Lap. “If you see someone at work whose anxiety level is rising, you figuratively tap them out and invite them to take a lap of the unit with you. A lap of the unit usually takes about one minute, and that is all it takes to do this stress reduction technique,” says Davidson. “While walking, you coach them through a little breathwork. If they are really panicked, just do four breaths in and four out. Doing that for five cycles will add up to a minute—which is all it takes to break the stress response that the person is under and ground them again so they can get back into the game.”
If the person isn’t totally panicked, “they may be able to tolerate a more complex breathing pattern, four-seven-eight: Breathe in for four, hold for seven, and breathe out for eight. Four to five repetitions of that will give you a minute that you have walked around the unit, and now both you and your colleague are feeling better,” says Davidson. “I recommend anyone to do that for helping out in-the-moment stress.”
One in four nursing assistants and one in five home health aides report that they are actively looking for another job. That’s a lot of unhappy employees.
This turnover comes at a high price for facilities. It costs an estimated $2,200 to replace a nursing assistant or home care worker, according to the Recruitment and Retention Guide For Employers by PHI (formerly the Paraprofessional Healthcare Institute).
Moreover, frustration in the workplace can be contagious; unsatisfied staff members have a negative impact on residents and their peers alike.
There are books and guides devoted to programs for staff retention. Better hiring processes, rewards systems, and staff training can yield positive returns for facilities—but overhauling an entire program can feel daunting for busy nurse managers.
Here are four simple ways to promote staff retention, starting right where you are.
Your facility needed a new director of nursing (DON), so you stepped up to the plate to give it your best shot. You went through the selection process, feel confident in your leadership skills, and are ready to lead a team to success.
But you have a small confession to make: you’re not sure where to start!
Being a new DON can be challenging, so here is some advice to get you going.
In September 2018, Wendy DeCarvalho, RN, DNS-CT, QCP, and her team watched as Hurricane Florence approached their facility, which is located just two hours from the Carolina coast, nestled in a rural area in the flood zone. They banded together to keep their residents, staff, and families safe.
Here’s her advice, based on that firsthand experience, for how to handle emergencies before, during, and after they happen.
Many directors of nursing services (DNSs) have a hands-off approach when it comes to fee-for-service Medicare Part A and the MDS process, says Suzy Harvey, RN-BC, RAC-CT, managing consultant at BKD in Springfield, MO. “DNSs attend morning meetings and sometimes attend Medicare meetings, but they don’t really get involved because they count on their MDS staff to handle those processes.”
That approach works for the RUG-IV case-mix classification system, but when the Skilled Nursing Facility Prospective Payment System (SNF PPS) switches to the Patient-Driven Payment Model (PDPM) on Oct. 1, rehabilitation therapy will no longer drive Part A skilled care, says Harvey. “With PDPM focused on patient characteristics and skilled nursing services instead of therapy volume, nursing will become key to facility success in this new system, and as the supervisor of the nursing staff, the DNS will need to help lead the way.”
It’s important to note that working on PDPM isn’t just another task to add to the DNS’s plate, adds Harvey. “Getting paid appropriately is the focus of PDPM, but it ties back into quality of care. Much of what you will need to work on for PDPM will also benefit you on survey and your quality measures as well.”
Here are seven key steps a DNS can take to get out in front of PDPM:
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