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.  

  • 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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  • Staff Didn’t Accept Flu Vaccine? Get a Declination Form

    By Caralyn Davis, Staff Writer - December 03, 2018
    Long-term care staff continue to have lower rates of influenza vaccination coverage (67.4 percent) than staff working in all other health care settings, according to “Influenza Vaccination Coverage Among Health Care Personnel — United States, 2017–18 Influenza Season,” a panel survey conducted by the Centers for Disease Control and Prevention (CDC) that was published in the Sept. 28, 2018, Morbidity & Mortality Weekly Report. In comparison, flu vaccinations among healthcare workers achieved a high of 91.9 percent in hospitals, followed by 75.1 percent in ambulatory care, and 74.9 percent in other clinical settings.
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  • CMS Alerts States re: SNFs/NFs With Potential Staffing Issues, Etc. (12/18)

    By CMS - December 02, 2018

    Payroll Based Journal (PBJ) Policy Manual Updates, Notification to States and New Minimum Data Set (MDS) Census Reports

    • Notification to States –

    The Centers for Medicare & Medicaid Services (CMS) will provide CMS Regional Offices (ROs) and State Survey Agencies with a list of facilities with potential staffing issues to support survey activities for evaluating sufficient staffing and improving resident health and safety.

    • Updates in the PBJ Policy Manual and Frequently Asked Questions (FAQs) – We are expanding the guidance on the meal breaks policy to ensure consistency. In addition, we are adding guidance regarding reporting hours for “Universal Care Workers.”

    • Additional Technical Support for Facilities – New MDS-based census reports in the Certification and Survey Provider Enhanced Reporting (CASPER) system.

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  • NNHQIC Sets Dementia Care & Psychotropic Medications Goal (11/18)

    By NNHQIC - November 26, 2018

    The National Nursing Home Quality Improvement Campaign's new quality goal to improve care for individuals living with dementia focuses on knowing the person, building on strengths, filling days with positive moments, and proactively addressing unmet needs.

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  • Infection Prevention and Control Audits: Start with Hand Hygiene

    By Caralyn Davis, Staff Writer - November 26, 2018

    Nursing homes can have the most beautiful policies and procedures for infection prevention and control in the world, but if staff aren’t following through on them, they are a waste of paper, notes Deb Patterson Burdsall, PhD, RN-BC, CIC, FAPIC, an infection prevention and control consultant and faculty member at the Association for Professionals in Infection Control and Epidemiology (APIC) in Arlington, VA.

     

    “So monitoring and auditing infection prevention processes in the facility is a critical component of quality care,” says Burdsall. “Unfortunately, the focus on infection prevention has not always been well-supported because infection surveillance, monitoring whether proper supplies are available and used correctly, and watching whether staff are performing hand hygiene and correctly using personal protective equipment all take time, which means the effort costs money.”

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  • 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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  • 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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