RETAINING EFFECTIVE DIRECTORS OF NURSING By Duncan McDougall

The role of the Director of Nursing (DON) in long-term care is becoming more critical just at a time when fewer seem available to take on or even remain in the job. Some organizations are making significant adjustments to assure stability in the nursing department going forward.

Some of the trends affecting the Director of Nursing include:

• A concentration of shorter-stay, higher acuity residents in skilled nursing facilities.
• A general shortage of qualified nurses (and nursing assistants) in many market areas.
• An increasingly important role for nursing in assuring accurate payment for care provided. The assessment, documentation and follow-through requirements of MDS, Medicare and most Medicaid programs are placing new burdens on clinical programs.
• With higher acuity and therefore more vulnerable residents, regulators seem to focus more on clinical programming. Care issues including wound management, incontinence, assessment and care planning alone have resulted in numerous correction orders, fines and untold organizational stress.
• The nursing budget continues as the dominant variable in operational financial success.

How can organizations address these mounting pressures and real risks associated with the increasing burdens placed on the Director of Nursing?

Some approaches that help to relieve the pressures include:

• Redefining and clarifying the role of the Director of Nursing to help make the job seem manageable. Emphasizing a focus on the "handful" of required outcomes is a great place to start re-tooling a nursing program. The job has to be seen as something that can be accomplished.
• Strengthening the critical "partnership" between the DON and the Administrator. A renewed understanding and approach to this relationship can prove most beneficial in these changing times.
• Structuring the nursing department to most effectively achieve the clarified department goals is another important step. The Directors of Nursing who have their trusted "team" of direct reports focused and accountable towards the achievement of common goals find it is a huge stress-reliever.
• Quality is always a key. Achieving and maintaining high standards of quality is critical not just for the residents but for clinical staff as well. Some organizations are developing specific definitions of quality that are measurable, manageable and positive. Maintaining regulatory compliance through endless cycles of surveys is simply not motivating for many modern professionals - they want more!
• Many Directors of Nursing feel alone and at times overwhelmed. Providing the necessary levels of clinical, management and emotional support is increasingly important for keeping a Director of Nursing. Often, it is regular contact with other nurses that makes the difference.

Pathway Health Services is largely a "Nurse's Organization" with a deep respect and sharp understanding of DON issues. Pathway has the experience, the expertise and the proven track record in assisting clients to strengthen nursing management while helping to ease the burden on these committed professionals. For more information on how to address your nursing department needs, contact 651-407-8699.

Duncan McDougall is a managing partner of Pathway Health Services, Inc. He has 30 years of management experience in the long-term care industry.