Angel McGarrity-Davis, RN, CDONA, NHA

How have director of nursing skill sets changed the most in recent years? What should I be concentrating on to enhance my skill sets and marketability?

Healthcare is constantly changing, so the role of a director of nursing is, therefore, also changing. For the past 25 years, the overwhelming focus has been changing primarily from custodial care to skilled/subacute rehabilitative care. Nursing homes’ common residents were the frail “old people” who needed a place to live.  Now, these facilities are taking care of high-acuity patients who used to be staying in the hospital the entire length of stay. 

Over the years, we’ve seen the Nursing Home Reform Act in 1987 initiating oversight of quality of care, quality of life and resident rights in nursing homes.  A set of national minimum standards of care and rights for people living in certified nursing facilities also have been established.

In 1999, the prospective payment for skilled nursing homes under Medicare was enacted to change our system’s payment structure.

Director of nursing skills, for now and in the future, should focus on new and emerging technologies, electronic health systems, new drugs, new medical procedures, new emerging infections, exacerbations of chronic diseases and innovative surgeries.  

Also, be ready to take care of the patients who are leaving the hospital with a much shortened length of stay. The DON and his or her staff must have higher-acuity skills with the knowledge to prevent readmissions back to the hospital.  Depending on the community needs, facilities are also branching into specialty care units, like for dementia care.

Always remember: “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” So said John Quincy Adams.