The field of long-term care is rapidly changing. From the CMS’s updated Conditions of Participation to the implementation of new survey processes, the last several years have created a new professional landscape for long-term care staff. Payers are increasingly focusing on shorter lengths of stay, and facility staff must find a way to balance this with providing the best care possible.
Suffice it to say, this is rocky terrain, and without a map and the proper tools, it can be challenging to maintain one’s footing and stay on course.
“We really need to have staff and leaders who understand that changing dynamic. And it's not something that you easily learn on the job. Our nurse leaders and the frontline staff need to have the skill set and the knowledge to be able to effectively navigate these changes,” says Beth Florczak, MS, RN, WCC, RAC-CT.
That’s why continuing education and professional development are imperative to continued success for long-term care facilities.
“When we focus on providing our staff with high-quality education, learning, and opportunities to grow, we're going to have better outcomes,” says Florczak.
Don’t let professional development fall by the wayside in 2019. Here are some tips on how to make the case for continuing education, both for your nurse leaders and your frontline staff.
1. Make an argument for the long term
“Professional development is all well and good in theory,” you may be thinking, “but there’s simply no room in the budget for that.”
That’s an understandable concern. It’s no great secret that most long-term care facilities operate on a shoestring budget.
A 2017 report published by CliftonLarsonAllen noted that the median operating margin for skilled nursing facilities nationwide was 0.5% in 2016—a drop from the already low 1.2% a year before.
With razor-thin margins like those, budgeting for professional development often gets pushed to the bottom of the list—especially when there are so many urgent priorities and continuing education is often viewed as a “nice-to-have” rather than a “must-have.”
“There's an expectation from the finance department that education is something that can be done internally, so there's no need to send individuals or teams to outside training. And labor is, of course, the biggest cost that's associated with running any kind of facility. So if it comes down to money for professional development funds versus another nurse on the night shift, I think you’re going to see those funds get shifted in another direction,” says Florczak.
In the short term, it might make sense from a financial perspective to allocate money to what are perceived as immediate needs. But in the long term, says Florczak, investing in professional development could pay substantial dividends.
Without opportunities to learn about regulatory changes and continue developing professional skills, nurse leaders and frontline staff alike frequently become overwhelmed and burned out.
All too often, they ultimately make the decision to leave their facility—or even the long-term care field altogether.
Turnover is one of the biggest problems faced by long-term care facilities across the country—and it has been for decades. Since the ’70s, average turnover rates of LVNs and CNAs have ranged from 55% to 75%, and for CNAs in particular, this rate has often exceeded 100%.
And this frequent turnover costs long-term care facilities billions annually.
Remember this when preparing your case for professional development—and make sure to remind the budget makers. Investing in continuing education could save the facility hundreds of thousands of dollars or more in the long term, and that’s something that the finance department will certainly be interested in.
2. Investing in the facility’s staff = investing in the facility
Many nurse leaders in the post-acute setting were promoted into their nurse leadership roles because they proved themselves with excellent clinical skills. But being a strong clinician doesn’t always translate into being a strong leader. These nurse leaders may not necessarily have the training or the background to lead and motivate staff, to delegate, or to mediate.
“Investing on the front end to develop leaders who have that knowledge to orient staff initially, to train them well, to continue training them, and to engage them in the work environment will have a significant impact,” says Florczak.
As for the frontline staff, a basic understanding of reimbursement and the regulatory process is fundamental, but it often gets missed. Equally important are customer service skills, which go a long way in improving the residents’ experience.
And in today’s social media–savvy environment, a Yelp review can have a real impact.
“One bad interaction with one person can result in a very negative review for an organization. And people look to those reviews very frequently. Although CMS may post the five-star ratings, word of mouth and social media make a significant difference in people’s perceptions. So we want to give a great experience. And that starts with the frontline staff,” says Florczak.
3. Be prepared with the particulars
When preparing your case for professional development funds, make sure to go in with a specific plan of action and solid reasoning to back it up. Otherwise, “professional development” becomes an abstract concept, and it’ll inevitably end up in the heap with all the other nice-to-haves.
To avoid that outcome, be ready to go in and say which courses or trainings you’d like, whom you’ll be sending, and why that training is important. For example: “I would like to send these two nurses to the Nurse Assessment Coordinator training on this date and get them certified. We've had this error come up on our MDSs. By getting these nurses certified, we can improve our coding to ensure X amount of money in reimbursement.”
When you go in with a plan, your request is much more likely to get approved.
4. Go in armed with numbers
Be prepared to speak with the finance department members in their language: numbers and figures.
“Nurse leaders have to be able to speak articulately about why these funds are important and to be able to make that case in dollars and cents,” says Florczak. “They need to understand the budget fundamentally and they have to know their numbers.”
Take the facility’s turnover rates, for example. You should be able to go into the budget meeting and say, “This is my turnover. This is what it costs every time I lose someone—to pay other staff members overtime, to find and hire a replacement, to train and orient a new staff member. Here’s what it would cost to develop our leadership and train our staff to change the culture and help reduce turnover. And here is what we will ultimately save.”
“Healthcare is a data-driven industry. Our nurse leaders need to be able to take in that data, analyze it, and use it to make changes and improvements,” says Florczak. “We do that with quality improvement all the time. We do that with patient outcomes. We need to do the same thing with our own growth and development, as well as the growth and development of those we lead.”
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