Nursing Leadership

Being a leader in your facility, although sometimes overwhelming, is a rewarding role that allows you to touch the lives of many people including your residents, their families, and, of course, your staff. Your efforts and attitude impact everything from resident outcomes, to survey results, to workplace culture in your facility. Find resources that explore topics such as leadership styles, strategies for successfully managing staff, and more to support you in your important role.  

  • QIO-Developed Trauma-Informed Care Resources (7/19)

    By MQIO Program - July 15, 2019

    Purpose of these resources This is a comprehensive, but not all inclusive, list of resources that may be helpful for nursing homes as they work to ensure that residents who are trauma survivors receive culturally competent, traumainformed care in accordance with professional standards of practice and accounting for residents’ experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident (per §483.25(m) requirement that will be implemented beginning November 28, 2019).

    Who should use these resources? Nursing home leadership teams may assign responsibility to a person, such as a social worker, to review the resources below, identifying those that might be helpful for a) leadership, staff, and/or resident/family education, or b) behavioral/emotional care policy or program development or revision. 

    Why this is important? The included resources provide information that will help nursing homes to build capacity among interdisciplinary team members to deliver holistic resident care, being sensitive to how a range of experiences over the resident’s life may relate to their current physical, emotional, and behavioral health status. Trauma is common throughout human experience, and we need to respond with empathy and understanding. Providing trauma informed care can help staff to avoid re-victimization of those who have survived trauma and create an environment where the individual feels safe and secure. 

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  • CDC Infection Control Interactive Graphic Novel for Environmental Services (EVS) Personnel (6/19)

    By CDC - June 19, 2019

    EVS personnel play a critical role in preventing the spread of germs and healthcare-associated infections

    EVS and the Battle Against Infection” is an interactive graphic novel illustrating the important role of EVS personnel in the prevention of healthcare-associated infections. The online version of the training tool features real-world infection prevention and control scenarios and allows participants to choose options that affect the outcome of the story. 

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  • When Florence Hit: What to Do Before, During, and After an Emergency

    By Jessica Kunkler, MA - February 26, 2019

    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.

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  • Nurse Leader Reference Sheet

    By AADNS - February 12, 2019
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  • 7 Ways the DNS Can Lead the Charge for PDPM

    By Caralyn Davis, Staff Writer - February 12, 2019

    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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  • F-Tag 760: Avoiding a Citation When Crushing Medication

    By Lynn A. Milligan, MSN/ED, RN, DNS-CT, RAC-CT - February 12, 2019
    Some residents require or request that their medication be crushed for oral administration. But not following CMS guidelines for crushing medications could result in a citation under §483.45(f)(2) F760 (Residents Are Free of Any Significant Medication Error). This citation could also occur in administering crushed medications via feeding tube. Facility leaders and the nurse administering the medications must first be sure that the particular medication can be crushed per manufacturer instructions. The Institute for Safe Medication Practices website can be a helpful resource in determining which medications should not be crushed.
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  • Q&A: What is the best way to ensure that Notices of Transfer and Discharge are delivered appropriately?

    By AADNS Network - February 12, 2019
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  • Emergency Preparedness- Updates to Appendix Z of the State Operations Manual (1/19)

    By CMS - February 05, 2019

    CMS is updating Appendix Z of the SOM to reflect changes to add emerging infectious diseases to the definition of all-hazards approach, new Home Health Agency (HHA) citations, and clarifications under alternate source power and emergency standby systems.


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  • Are You Taking the Right Steps to Build Census?

    By Caralyn Davis, Staff Writer - January 29, 2019

    These days, nursing homes face census pressures on multiple fronts. “Some issues are beyond the control of the director of nursing services (DNS),” says Carol Hill, MSN, RN, RAC-MT, DNS-MT, QCP-MT, CPC, president of Hill Educational Services in Warrior, AL. “For example, when census is low at the hospital and referrals simply aren’t out there or when you have trouble hiring staff because your local labor market is extremely tight, you can’t do much about it.”

     

    However, no matter what outside forces are at play, a DNS still has the opportunity to maximize census, notes Hill. “On the positive side, it’s not a stand-alone endeavor that just adds one more job to the DNS’s task list. Boosting census requires looking at the total picture, so a lot of what you will do to improve census also will benefit your Quality Measures in the different programs, as well as your survey performance.”

     

    The following steps can help providers get on the right track.

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  • PDPM Prep and Skilled Nursing: Secure Skilled Coverage Starting Day One

    By Caralyn Davis, Staff Writer - January 16, 2019

    When the Patient-Driven Payment Model (PDPM) replaces RUG-IV as the case-mix classification system for the Skilled Nursing Facility Prospective Payment System (SNF PPS) effective Oct. 1, 2019, some SNFs may see their Part A length of stay temporarily increase, says Maureen McCarthy, BS, RN, RAC-MT, QCP-MT, DNS-MT, RAC-CTA, president/CEO of Celtic Consulting in Torrington, CT.

     

    “The skilled coverage rules for Medicare won’t change just because we are changing payment systems. However, 95 percent of SNF days are in rehab categories, and many providers have been so focused on obtaining the best rehab RUG score that they have lost sight of what the skilled coverage is,” notes McCarthy. “So length of stay may go up for a period of time as SNFs re-learn how to skill patients for nursing services and become comfortable with understanding when the need for skilled care ends if rehab is not involved.”

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  • AADNS's Pathway to PDPM Readiness Tool

    By AADNS - January 16, 2019
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  • Section GG Data Collection Tool II

    By AANAC - January 01, 2019
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  • Section GG Data Collection Tool

    By American Association of Nurse Assessment Coordination - January 01, 2019
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  • Food Safety and Holiday Treats: 6 Ways to Shore Up Visitor Food Policy Implementation

    By Jessica Kunkler, MA, Staff Writer - December 18, 2018

    During the holidays, SNF staff across the country welcome an increased number of visitors with special treats to share with loved ones. While extra visitors and sweet treats add to the spirit of the facility at holiday times, they can also pose safety risks to residents. (Consider a yummy pumpkin roll with cream cheese frosting, left at room temperature for 48 hours in a resident’s room.) If you haven’t already done so, now is a good time to shore up your facility’s visitor food policy implementation. Here’s how:

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  • Q&A: Our Med A biller has our NACs putting “discharge-return anticipated’ in our MDS system for ALL discharges. Is this correct?

    By AANDS Network - December 17, 2018
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