I want to share the top 10 best practices that I feel make a successful facility. I do not take credit for these and have learned many of them through working in many settings. I feel that if you implement these into your daily practices you will be successful and have good survey results.
1. walking team rounds
a. include nursing manager, MDS, social services, activities and dietary
b. review nurses notes, telephone orders, 24 hour report, check MAR's/TAR's for holes errors medication availability, labs, x rays, ADL documentation
2. guardian angel program with daily rounds
3. morning meeting with all department managers
4. all hands dining
5. weekend manager program
6. monthly open door meetings
7. routine mock survey utilizing specialty service such as ABAQIS
8. stop and watch program with all staff involved to identify resident condition changes early
9. quick responses to all concerns including resident, responsible party and staff
10. an effective ongoing staff education program
Thursday, April 14, 2016
Friday, April 8, 2016
Being Fired
I have to admit I was not sure if I would share these stories but I feel as a leader we are always faced with the possibility that our performance does not meet or match what a company may expect from us. First I want to share my encounters with being fired. Yes I am admitting it and hope that I learned and have grown from them. I was actually terminated twice in my 40 year career. They were about 20 years apart.
The first time that I was fired I was a director of nursing in a small nursing home. I had worked there for 3 years. The company I worked for had 5 facilities. During that time I had developed a good team and had good results for surveys. This was just as OBRA was coming into play. During this time I worked for 3 different administrators. I had what I thought was a good relationship with the owners. I was actually sent to some of their other facilities. In 1 capacity I did the CPR training for our other facilities and I also covered as the director of nursing. Shortly after the third administrator started he came to me and said something like I have evaluated your services and we are going to let you go. He asked if he could pull my car up and got me a box for my things. Being a small facility I had to go by everyone and told one of my nurses I was leaving and wouldn't be back. She looked at me and said stop pulling my leg. I told her I wasn't and then broke down and cried. I left quickly and quietly and never looked back. I never was quite sure what happened but after a bit of searching I found work as a part time supervisor in a larger facility with a larger company. I was always honest about what had happened.
The second time I was terminated was less than 2 years ago. I had been doing independent contract work for over 1 year and loved it. Unfortunately my husband developed colon cancer and I had to find work that offered insurance. I became the administrator in a larger facility with a large corporate organization. During my time there I had a complaint survey almost monthly related to a disgruntled resident. I had 4 different regional directors. Was sent to help with yet another problem facility to help with their follow up survey. My building was census challenged therefore financially challenged. The last regional I had brought on a great regional nurse as well. I really felt like we were going to finally start seeing improvement. I had to fire several nurses for poor performance during this time but felt we had finally started to turn the corner. During the last few weeks I was employed I worked 10-12 hours per day 5-7 days per week and was starting to feel beat down a bit.
I remember the night before I was fired I felt like I got a second wind and had written up a plan and assignments to go over with my team. When I arrived that morning I asked the corporate nurse if she minded if I met with my team alone and she told me no. I guess I should have figured something was up. I then did my morning meeting and talked about goals and assignments. Again I should have figured something was up they were too quiet. I don't think they all knew but obviously some did. After the meeting I had someone to see me. The regional said they needed to talk to me and I asked if it could wait till I met with the people waiting on me and they said yes.
I met with my guests and then invited the regionals into my office. The regional vice presidents gave me a piece of paper to read. This paper said that I had basically caused the facility to loose money and failed to improve census and clear survey issues. I was told I could sign the paper or write up my resignation. They told me if I did that they would pay me my earned vacation days. Of course I wrote a resignation.
My parting was a little bit funny to me. They asked someone to get me a box for my stuff and they brought a giant box. I had driven my little car so loading it I knew was going to be a challenge. I stuffed everything in the box. The regional said he would carry it and did. I know it was super heavy and my car was so small. He managed to get it in the car after a little bit of a struggle.
Well that is how I ended up doing what I am now as a floating administrator and director of nursing for problem buildings.
Here is the irony for those 2 situations. The first building I was fired from became one of my facilities as a regional vice president and regional nurse. The second building I was fired from was where I was working when at that time a different company sent me to school to get my administrators license and paid 100% of my tuition. If I learned anything from this it was to never burn a bridge. I never did or will speak badly of either of those facilities. Every thing happens for a reason.
The first time that I was fired I was a director of nursing in a small nursing home. I had worked there for 3 years. The company I worked for had 5 facilities. During that time I had developed a good team and had good results for surveys. This was just as OBRA was coming into play. During this time I worked for 3 different administrators. I had what I thought was a good relationship with the owners. I was actually sent to some of their other facilities. In 1 capacity I did the CPR training for our other facilities and I also covered as the director of nursing. Shortly after the third administrator started he came to me and said something like I have evaluated your services and we are going to let you go. He asked if he could pull my car up and got me a box for my things. Being a small facility I had to go by everyone and told one of my nurses I was leaving and wouldn't be back. She looked at me and said stop pulling my leg. I told her I wasn't and then broke down and cried. I left quickly and quietly and never looked back. I never was quite sure what happened but after a bit of searching I found work as a part time supervisor in a larger facility with a larger company. I was always honest about what had happened.
The second time I was terminated was less than 2 years ago. I had been doing independent contract work for over 1 year and loved it. Unfortunately my husband developed colon cancer and I had to find work that offered insurance. I became the administrator in a larger facility with a large corporate organization. During my time there I had a complaint survey almost monthly related to a disgruntled resident. I had 4 different regional directors. Was sent to help with yet another problem facility to help with their follow up survey. My building was census challenged therefore financially challenged. The last regional I had brought on a great regional nurse as well. I really felt like we were going to finally start seeing improvement. I had to fire several nurses for poor performance during this time but felt we had finally started to turn the corner. During the last few weeks I was employed I worked 10-12 hours per day 5-7 days per week and was starting to feel beat down a bit.
I remember the night before I was fired I felt like I got a second wind and had written up a plan and assignments to go over with my team. When I arrived that morning I asked the corporate nurse if she minded if I met with my team alone and she told me no. I guess I should have figured something was up. I then did my morning meeting and talked about goals and assignments. Again I should have figured something was up they were too quiet. I don't think they all knew but obviously some did. After the meeting I had someone to see me. The regional said they needed to talk to me and I asked if it could wait till I met with the people waiting on me and they said yes.
I met with my guests and then invited the regionals into my office. The regional vice presidents gave me a piece of paper to read. This paper said that I had basically caused the facility to loose money and failed to improve census and clear survey issues. I was told I could sign the paper or write up my resignation. They told me if I did that they would pay me my earned vacation days. Of course I wrote a resignation.
My parting was a little bit funny to me. They asked someone to get me a box for my stuff and they brought a giant box. I had driven my little car so loading it I knew was going to be a challenge. I stuffed everything in the box. The regional said he would carry it and did. I know it was super heavy and my car was so small. He managed to get it in the car after a little bit of a struggle.
Well that is how I ended up doing what I am now as a floating administrator and director of nursing for problem buildings.
Here is the irony for those 2 situations. The first building I was fired from became one of my facilities as a regional vice president and regional nurse. The second building I was fired from was where I was working when at that time a different company sent me to school to get my administrators license and paid 100% of my tuition. If I learned anything from this it was to never burn a bridge. I never did or will speak badly of either of those facilities. Every thing happens for a reason.
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