Guest Columns

Does an administrator affect the success of a director of nurses?

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Peg Tobin
Peg Tobin

My company, Tobin & Associates, is currently conducting a training program for nurse leaders funded through the Civil Monetary Penalty Grants.  Funding was awarded through the grants to train long-term care nurse leaders in Ohio on tools and behaviors needed to be an effective leader.

In our first class we had 12 students.  Of the 12 nurse leaders:

  • Six said they had supportive and participatory administrators. They met with their director of nurses at least weekly and involved themselves in the training the nurses were receiving.
  • Two administrators refused to have weekly meetings with their director of nurses.
  • Two administrators did not support the program, therefore, did not make attendance a priority.
  • One administrator remained a micromanager even after one-on-one conversation with the mentor.
  • One vocalized that directors of nurses needed to understand that the nursing department is their responsibility and if they do not have enough staff they have to work the floor. This director of nursing was filling in at a minimum of two times a week (the door was not opened for the mentor to review staffing levels).

Yet among this group, the following occurred in a four-month span. Seven of the facilities experienced:

  • Reduced turnover of front line staff (3%)
  • Reduced nursing agency usage (10%)
  • Reduced skin breakdown (7%)
  • Increased applications from nursing assistants seeking positions (10%)
  • The development of a Nursing Assistant Advisory Committee
  • Involved nursing assistants in shift to shift report with the nurses instead of separate reports
  • Nurse leaders improved communications through one on one meeting with their nursing managers, which in turn resulted in reducing daily interruptions by 30%
  • Set up a library of leadership books for all associates to check out and read
  • There was some turnover of staff (7%) that had been in the facility for over 10 years that did not like the changes. For the three facilities the nurse leaders left their facility before the program was complete for a better position, or did not provide statistics.

    Two facilities did not totally commit to the program, voiced dissatisfaction with the training program or the DON did not attend the entire program.

    In one of the facilities the administrator continued to refuse to meet with their DON but the DON attended the entire program. Nursing turnover reduced in this facility by 4%. Communication improved between nurses and nursing assistants. Morale improved. The DON was promoted to regional position.

    The nurses that completed the program stated:

    • They learned to actively listen.
    • They learned “if you want associates to care, you have to first demonstrate you care.”
    • Everyone needs to be involved when setting goals.
    • You can stand up and it does not have to be confrontational, but you must stand up.
    • Organizing my day does matter.
    • Risk and make changes.
    • In spite of the lack of supervisor support, you can make a difference
    • Let go and grow others.
    • Teach, don't always do.

    The class sessions are going extremely well for those who are able to attend.  The consensus of the director of nurses attending this program is that this program would be beneficial to all who become director of nurses. They think it would be positive for administrators to be included in the training.

    Even though I am happy with the positive results, I am saddened that there is such a lack of buy-in by so many LTC administrators. This program is free to the facilities and yet many LTC Administrators will not allow their directors of nurses to attend or even apply.

    I understand that administrators have challenging jobs, and I don't want to trash them. But I do want to point out: If we were able to get these results out of seven nurses that were supported by their administrators and encouraged to attend the program, think of the difference we could make in the lives of the residents if we could get the support of all 12 administrators for each session?

    Margaret (Peg) Tobin, RN, is the president of Tobin & Associates. She is an author and keynote speaker based in Columbus, OH.

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