Long-Term Care Survey Alert

Find out how this facility went from 'famine to feast' with its pool of nursing applicants.

J.F. Hawkins Nursing Home knows the road to stellar quality and survey outcomes is paved, not with good intentions, but with successful efforts to attract and keep top-notch staff.

"The facility had some tough surveys with deficiencies that were cleared in March 2004," reports Holly Sox, BSN, RN, RAC-C, the MDS coordinator for the Newberry, SC nursing home. But the facility had also developed a staffing morale problem that was translating into high CNA turnover and an increasing reliance on temporary agency staff, Sox says.

"And temp agency staff can create survey problems by not knowing the facility's policies/procedures and also by failing to follow through on physician orders because there's often no continuity in staffing," Sox points out. In addition, residents may be more likely to develop decubiti when they receive care from a revolving door of caregivers who focus more on daily care than the "big picture" in preventing skin breakdown.

To shore up its staff, J.F Hawkins found these three key changes to be invaluable:

1. Hire a nursing supervisor to help oversee daily care.  This person makes sure staff delivers high quality care. Previously on weekends, the facility had a nursing supervisor on call, but lacked that "leadership presence" on the floors, Sox reports.

2. Develop a nurturing work environment. "Facilities have to support CNAs in crisis," Sox says. CNAs also need extra support during the first several weeks on the job, even though they have gone through training. "Most of them have no idea of the reality of working day-to-day" in a nursing home, says Sox.

Another strategy: Mentoring has also been shown to improve CNA retention rates, says Francis Battisti, a clinical social worker who has helped facilities implement a state trade group-sponsored mentoring program. "We did a pilot study testing an eight-week mentoring program for CNAs offered by the New York State Association of Homes & Services for the Aging, and found that if you can get CNAs through the first difficult six weeks, they will stay for at least three years," he says.

3. Implement a "shining stars" program.  Allow people (staff person, resident, family member) to nominate a staff person whom they caught going the extra mile. For example, Sox says she might nominate a CNA whom she sees give a resident a foot soak and scrub as an extra caring touch just because the resident likes it. Recently a person in housekeeping won the award because someone saw him respond to a resident's request to get him his mouthwash. "The man also took some time to chat with the resident, who responded very well to the interaction," Sox says.

J.F. Hawkins' approach to staffing is earning it a reputation in the community as the nursing home for which to work. Frontline staff have other options in town, Sox notes. "And we now have people calling us about jobs, so we have gone from 'famine to feast' ... and can afford to be more choosy with our staff again."