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.  

  • Why Some Bad Results Haunt NHC QMs/Five Star—and What to Do

    By Caralyn Davis - November 05, 2018

    The MDS-based CASPER Quality Measures (QMs) that are posted on Nursing Home Compare, some of which drive the QM domain in the Five-Star Quality Rating System, are a frequent source of headaches for directors of nursing services (DNSs). “Everyone wants Five-Stars in the overall composite rating to attract clients, but adverse events often linger on the CASPER QMs much longer than many DNSs and administrators think they will,” says Carol Maher, RN-BC, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.


    DNSs should have a basic idea of how long adverse events will impact the CASPER QMs, but that shouldn’t be the primary concern, suggests Maher. “The QMs will impact the overall Five-Star rating, but they have a lesser impact than the survey/health inspection and staffing domains. You must have Five-Stars in your QM domain to be able to add a star to your overall rating, and even Five-Stars in the QMs won’t help if your health inspection rating is one star and you’ve already added a star via the staffing domain. In addition, you have to have only one star in the QM domain to negatively affect your overall rating.” Note: For more information, see the “Overall Nursing Home Rating (Composite Measure)” section of the Nursing Home Compare Five-Star Quality Rating System Technical Users’ Guide.


    So the CASPER QMs are most important as a tool that DNSs can use to identify opportunities for improvement, stresses Maher. “If you focus on providing person-centered care and improving care, you will get to five stars.”

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  • Boost Staff Retention with Appreciation

    By AADNS - November 05, 2018

    In a recent McKnight’s article about Fortune magazine’s “Best Workplaces for Aging Services” and how skilled nursing reached the top of the list, the president and CEO of Van Dyk Healthcare of Hawthorne, NJ, Robert Van Dyk, is quoted with a message about how you have to make sure you care for those who work so hard taking care of your residents if you want to be a best workplace. How do you take care them? Show them appreciation – all the time.

    Aspiring to create a great place for employees to work should always be on the minds of leadership personnel. However, if you are struggling with staff retention, it might be time to take a good look at your culture and how you are appreciating your team.

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  • Influenza: How to Prevent or Minimize Outbreaks

    By Caralyn Davis, Staff Writer - October 25, 2018

    Through Oct. 13, influenza activity remained low across the United States. However, the Centers for Disease Control and Prevention (CDC) expects flu outbreaks to increase in the coming months. Avoiding and minimizing flu outbreaks not only protects residents and staff, it protects the facility as well given the laser focus on infection prevention and control that state surveyors have had during the first year of the Long-term Care Survey Process (LTCSP).

    Directors of nursing services (DNSs) can work with the interdisciplinary team, residents, and families to reduce the risk of influenza transmission and minimize any outbreaks that occur. Limiting transmission requires a bundled approach, including the following steps:

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  • Consider Hand in Hand for Fed Dementia/Abuse Training Requirements

    By Caralyn Davis - October 16, 2018

    The Centers for Medicare & Medicaid Services (CMS) recently released an updated Hand in Hand Series for Nursing Homes, a training series focused on caring for residents with dementia and on preventing abuse. While CMS isn’t currently offering continuing education units (CEUs) for Hand in Hand, the agency recommends—but does not mandate—that providers use Hand in Hand to fulfill federal requirements for training all nursing home staff about dementia management and resident abuse prevention, said CMS officials at the Oct. 11 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF).


    “Federal law requires that nurse aides complete in-service training on dementia management and resident abuse prevention,” they explained. “Additionally, facilities must now provide dementia management and resident abuse prevention training to all facility staff, contractors, and volunteers.”

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  • PDPM At-a-Glance Tool

    By AANAC - October 09, 2018
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  • IMPACT Act Call: Hospital Readmissions, Drug Regimen Review, and More

    By Caralyn Davis, Staff Writer - July 10, 2018
    The IMPACT Act of 2014 mandates the rules of the Skilled Nursing Facility Quality Reporting Program (SNF QRP), as well as other post-acute care (PAC) QRPs, so any time officials with the Centers for Medicare & Medicaid Services (CMS) discuss issues related to the IMPACT Act, providers should take notice. Here are highlights from the June 21 "IMPACT Act of 2014: Frequently Asked Questions Medicare Learning Network" call:
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  • 13 Best Practices to Prevent High-Scope Citations for F686 (Skin Integrity)

    By Jessica Kunkler, MA, Staff Writer - June 19, 2018

    Since the new Long-Term Care Survey Process (LTCSP) launched on November 28, 2017, 702 citations have been given for F686 (Skin Integrity). 22% of those tags are a G scope or above. Many of the citations are for:

    ·         Failure to provide care to treat and/or prevent worsening pressure ulcers

    ·         Failure to prevent facility-acquired pressure ulcers

    ·         Failure to develop and/or follow the care plan

    ·         Failure to ensure accurate assessment, obtain treatment orders, or communicate with other professional staff

    ·         Failure to prevent infection of wounds

    Widespread pressure ulcer issues are no surprise when facilities don’t have proper protocols in place for prevention, early identification, and treatment, according to Wendy DeCarvalho, MS, BSN, RN, DNS-CT, Director of Nursing for Scotia Village in North Carolina. As a DNS and clinical nurse consultant in long-term care facilities nationwide, DeCarvalho has worked to improve Quality Measures, including those for pressure ulcer rates. “If the staff doesn’t have protocols in place, pressure ulcers often go unchecked, untracked, and untreated,” she says. She recommends the following best practices.

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  • Fall Prevention: It’s Easy to Miss What You’re Not Looking For

    By Linda Shell, DNP, MA, RN, DNS-CT - June 19, 2018
    Does this sound familiar? Mary, an 87-year-old memory care resident and recurrent faller, has another fall in her room. A housekeeper spots her lying on the floor. Staff members rush to help. Alarm, floor mat, low bed? What will it be this time? The nurse completes an incident report and an intervention is care planned. The same scenario with Mary repeats itself over and over. She falls, a new intervention fails, her family grows concerned, staff members become frustrated, and the resident and facility are at risk.
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  • F700 (Bedrails): Is Your IDT Ready for Surveyors to Review Grab/Assist Bars?

    By Caralyn Davis, Staff Writer - May 22, 2018

    F700 (Bedrails) is one of 17 discrete F-Tags now included under Section 483.25, Quality of Care, in Title 42 of the Code of Federal Regulations. These tags are among the indicators of substandard quality of care, meaning even a single deficiency with a scope/severity level of F, H, I, J, K, or L could potentially trigger an extended survey. Some recent standard surveys under the new Long-term Care Survey Process (LTCSP) indicate that providers may want to review their compliance in this area.

    The new F700 tag has new corresponding interpretive guidance in Appendix PP of the State Operations Manual. The Key Elements for Noncompliance for F700 are as follows:

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  • Hourly Rounding: Why It Should Be Part of Your QAPI Process

    By Linda Shell, DNP, MA, RN, DNS-CT - May 22, 2018

    Clinical staff are incredibly busy completing the tasks that are expected of them every day. It seems there is never enough time to get everything done. As the demand for high-quality care continues to rise, nurse leaders will need to look to the research to identify evidence-based approaches to improving clinical outcomes, increasing customer satisfaction, and maximizing staff efficiency. These best practices are often generated in acute care settings but can be used in long-term care with great success.

    One evidence-based approach that offers value for long-term care settings is hourly rounding. Hourly rounding is the process of ensuring that a resident is checked each hour by a member of staff to ensure he or she is safe, well positioned, and needs are met. Since the first study on hourly rounding was done, the practice has been implemented in numerous clinical settings, including long-term care, in the new-admission process and in programs for preventing falls, reducing call light use, and monitoring residents with changes in condition.

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  • Q&A: Is it necessary for the physician to sign each and every sheet of the physician order sheet (POS)?

    By Amy Stewart, RN, DNS-MT, QCP-MT, RAC-MT - May 22, 2018
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  • Body of Knowledge for the Director of Nursing Services in LTC

    By AADNS - May 09, 2018
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  • Step Up Your GDR Game Part 2: Implementation Strategies

    By Caralyn Davis, Staff Writer - May 09, 2018
    Part 1 of this two-part series on conducting gradual dose reductions (GDRs) for residents receiving antipsychotic and other psychotropic medications focused on team-building and participation. In Part 2, Maureen Kelly, RN, BSN, NHA, a senior clinical consultant for LW Consulting in Harrisburg, PA, suggests strategies that directors of nursing services (DNSs) can use to identify GDR candidates and improve the antipsychotic/psychotropic team’s success rate based on the antipsychotic reduction efforts she led as the DNS for a 33-bed facility:
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  • Q&A: Can a staff nurse place an updated medication direction label sticker over the current medication direction label?

    By AADNS Network - May 09, 2018
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  • Q&A: Do we need to report to ombudsman if a short-term resident was sent out to the hospital for change of condition?

    By Susan Duong, RN-BC - April 24, 2018
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