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.  

  • Antipsychotic Medication Use Quarterly Data Updated (3/19)

    By CMS - March 02, 2019
    CMS has released two reports: National Partnership to Improve Dementia Care in Nursing Homes: Antipsychotic Medication Use Data Report (January 2019) and National Partnership to Improve Dementia Care in Nursing Homes: Late Adopter Data Report (January 2019)
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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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  • Taking a Person-Centered Approach to Drug Regimen Review

    By Linda Shell, DNP, MA, RN, DNS-CT - December 03, 2018

    Nurses are critical to the health and well-being of residents in long-term care, overseeing all aspects of care, including residents’ physical, mental, social, and spiritual wellness. Although members of the interdisciplinary team (IDT) assist with their respective disciplines, the nurse is ultimately the one with 24/7 oversight of resident care. Nurses are the eyes and ears of the physician in the long-term care setting and serve as advocates for the residents during the drug regimen review (DRR).

    Since the most recently updated CMS guidelines regarding DRR which includes medication reconciliation in the skilled nursing facility were released, facilities have struggled to understand the rules. One of the significant drivers behind these new regulations is the increased rate of medication-related adverse drug events (ADEs). One critical item, however, is still missing from the updated requirements—the resident perspective on medications. The CMS guidelines address DRR and identify the medications that must be reviewed, the scheduling of reviews, clinically significant medication issues, the facility-designated person responsible for conducting the DRR, and communication between the physician and nurse. Little to no mention is made of resident preference and choice related to medications. Do residents want to take all those medications? Is their quality of life improving?

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