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.  

  • 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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  • PDPM At-a-Glance Tool

    By AANAC - June 19, 2018
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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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  • QI Team Development: CDC Performance Improvement Training Course (4/18)

    By CDC - April 09, 2018

    Quality Improvement Team Development is one part of the Performance Management Series. The work of a QI project is accomplished by a team of individuals, which is known as a QI Team. The purpose of the team is to design, manage, and monitor performance improvement activities to achieve the aim of the QI Project.


    At the end of this tutorial you will be able to:

    1. Describe the importance of QI Teams
    2. Describe how to choose effective members for a QI team
    3. Define roles of QI team members
    4. Describe stages of group development
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  • APIC/SHEA Position Paper Links Infection Prevention and Antibiotic Stewardship

    By APIC - March 26, 2018
    Arlington, Va., March 26, 2017 – Infection prevention and control (IPC) and antibiotic stewardship (AS) programs are inextricably linked, according to a joint position paper published today by the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Infectious Disease Pharmacists (SIDP) in APIC and SHEA’s peer-review journals, theAmerican Journal of Infection Control and Infection Control and Hospital Epidemiology.

    This paper is an important update to a 2012 paper that affirmed the key roles of infection preventionists (IPs) and healthcare epidemiologists (HEs) in promoting effective use of antimicrobials in collaboration with other healthcare professionals. The new paper highlights the synergy of IPC and AS programs, including the importance of a well-functioning IPC program as a central component to a successful AS strategy.

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  • Q&A: A medical records consultant suggested that I should complete a fall investigation worksheet form on paper after every fall to keep in my office. Is this common practice?

    By AADNS Network - March 07, 2018
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  • Show Yourself a Little Love!

    By Linda Shell, DNP, MA, RN, DNS-CT - February 20, 2018

    In his children’s book Happy Birthday to You, Dr. Seuss eloquently wrote, “Today YOU are YOU, that is truer than true. There is no one alive who is youer than YOU.” The book was intended to encourage children to celebrate who they are and the ability they have to shape the course of their lives. Those same words can also be powerful in the life of a nurse leader. The long-term care environment is challenging, chaotic, and tumultuous, and that is on the good days. Changes in regulations, staff, processes, and census come fast. Nurse leaders need to celebrate who they are and their ability to shape the course of their lives. Nurse leaders need a little love!

    “There is no one alive who is youer than YOU.” So what is your YOU and how can it be used to guide your leadership role? You can begin to identify your YOU by asking the following questions:

    (1)   What are my strengths?

    (2)   What do I do well?

    (3)   What energizes me? and

    (4)   How do people say I make them feel?

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