Toward a survey-ready staff: re-examining the health care philosophy - nursing staff

Nursing Homes, March, 1996 by Karen L. Bonn

A common -- and seriour -- concern voiced by DONs across the country is how to fulfill the staffing patterns required by today's regulations. "How many people do I need, how do I train them -- and how on earth do I keep them?" Also, "What if I have to pull these people from required positions to work the floor if someone calls in sick or quits without notice?"

The first thing I would recommend is that we develop, and thoroughly instill in our staff, a basic philosophy of care for our facilities, and then live by that philosophy every day. Here, for what its worth, is my approach to this:

Because of my training as a nurse, I tend to treat any problem with which I am faced as I would treat a patient's problem, i.e., with a care plan. What is the problem? What is the outcome that I want to achieve@ What steps do I need to achieve it? Based on the answers, one develops a plan.

What are some of the problems I hear about? Restorative nurses have told me that, after working diligently to get a program started, they are pulled to the floor or to other duties because of a staff vacancy, and all their hard work goes by the wayside. Not only does this kill their enthusiasm but, if it happens very often, they consider leaving to work somewhere else. I can't help but wonder what this says to the nursing staff in general. If we treat one duty this way (one, incidentally, that is required under OBRA), how will staff judge how serious we are about any of our "convictions?"

Another very common problem: How do we keep staff once we have hired them? During the years that I was DON for a facility that was part of a large nursing home chain, I received volumes of materials aimed at helping me to fulfill my many staff training duties. During a period when the corporate office was stressing holding down nursing budgets, I received a memo describing the results of an independent study on what was needed to attract and retain staff. One question was. "How long do the effects of a pay raise last?" It was found that the positive effects of a pay raise dropped significantly after the employee saw their first pay-check, and dwindled, to almost nothing after the first pay-check was deposited. Another finding of the study was that employees stay in a position where they feel they are doing a good job@ they have been provided with whatever training is needed to do their job, and they feel support and hear praise from their supervisors for the efforts they put out. The timing of the budget announcements and the study findings were coincidental, but the issues they raised were significant.

There is another aspect of this worth thinking about: Since the days of the nursing shortage, when payscales increased dramatically, did some people go into nursing mainly for the money? Are there nurses today who are content to draw their paychecks and do as little as possible? Do they sit at the nurse's station and talk, or do they spend every spare minute working with their residents? If you have any staff that sets a bad example, how does this affect the rest of your staff? Will the aides continue to work very hard if a nurse does not.?

Does even the best staff really understand what you are attempting to achieve? This gets back to your philosophy of care. If we truly live by it, if we are truly holistic and always consider what is best for the individual resident, we can never go wrong. The decision-making process is simple: 1) What will enhance this person's quality of life, now and in the long run? 2) What will promote the best quality of care for all our residents? "If this person were my grandmother, how would I handle the situation?"

With a staff imbued with this philosophy, how can surveyors not see that you are doing your best to meet OBRA mandates? And don't forget first impressions. If surveyors enter your facility and find both residents and staff busy and looking happy, if everyone appears neat and well-groomed and your facility looks and smells clean, you've taken a giant step toward a successful survey.

Karen L Bonn, RN, a former Director of Nursing, is founder and president of Restorative Medical, Inc., Brandenburg, KY.