Guest Columns

What DONs wish administration knew

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Jackie Cochrane
Jackie Cochrane

Sometimes social etiquette requires that you just keep quiet.

Have you ever been accused of not having that filter, the one that separates every thought you have from only the ones you should speak? As a professional, the skill is more than social etiquette — it is a necessity.

Directors of nursing are often stuck between a rock and hard place, forced to weigh the truth and what they want to say, against a watered-down and polite version. The desire to scream at administration when they propose impossible initiatives is suppressed by this internal filter.

The filter aggregates expletives into small nuggets with rounded edges made up of only what an administration wants to hear. Additionally, patients and families bring every complaint and concern to nursing management and, again, as a director of nursing, you temper what you wish you could say with a healthy dose of professionalism and courtesy.

But we can only do that for so long. Company officers and administrators, listen up! Long-term care proprietors, take note! Your team has had it quiet for too long. The filter is off, and the words are rushing out.

Here is what we wish you knew:

Coordinating staffing is a full-time job. An owner/operator cannot cut staffing coordinator positions and assume that clerical staff, human resources and nursing management staff can absorb other roles. Nursing is already numerically low in bodies entering the profession.

There is an intolerable rate of turnover among RNs in long-term care, and especially nurse unit managers. Add to that the difficult role of staffing, and you will definitely burn your nurses out at lightning speed.

Your directors of nursing want you to know that co-ordinating staffing is not a one-and-done task. Staffing is a full time job. Even then, the best scheduling software, which can populate the schedule for weeks and months in advance, is only as good as the information entered into it.

Census changes daily, the patient acuity, sick days, vacation requests, emergencies and mandatory trainings can all be handled more consistently, productively and efficiently if there is a staffing person or team dedicated to those tasks. 

Maintaining a float list and a mandation schedule for CNAs is also time consuming. It should not be left to someone with an already-full plate who now has to extend her workday to get everything done. The staffing coordinator should be a dedicated role.

Nurse managers should not be working on staffing. They can work on care plans, audit MARs and hold a staff meeting if they are not busy chasing staff down to work overtime. Trying to find staff to work can be daunting and thankless. This leads to dissatisfaction for the unit managers.

Imagine this: Even one hour less of work per day for these unit managers may mean they can leave before dinnertime and actually have a life outside of work. If you remove staffing duties from roles of more senior staff like supervisors and the director of nursing, then even more return on investment would be visible since those roles often sacrifice QA initiatives and risk management tasks for the more urgent staffing duties.

Your employees want you to know that “X” percent of your staff will call off between Friday and Sunday. Look at your facility statistics and pad your staff for those days. Understand that while Mother's Day, Father's Day, Halloween and Super Bowl Sunday are not national holidays, everyone still wants those days off. Be creative to solve the issues. You should pay more or over-staff for those dates, or you will end up short. Most facilities already track this data but administrators are not looking at it or using the data meaningfully.

If you are considering eliminating staffing coordinator positions or schedulers, think of this when notifying your team. While you sit at your conference table, proposing the preposterous, your staff will be biting their tongues and refraining from shaking their fists at you.

They know that you want to hear, “OK, we can do it.” But they also know and now you know, too: Staffing is a full-time job.

Jackie Cochrane, RN, is a nursing veteran who has been a director of nursing and also held a variety of positions in long-term care and acute care settings. She also has a master's degree in healthcare informatics administration.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.