566-Bed SNF Nursing Director Says New Clinical Skills Needed for LTC

At a time when nursing homes across the country have had to limit admissions due to staffing shortages, Monroe Community Hospital director of nursing Kristen Schulmerich has created new roles at her facility to avoid staff burnout.

Establishing career ladders — or a process to formally progress a staffer to promotion and growth in health care — for RNs, LPNs and CNAs has been another effective strategy for the facility to bring in new staff.

Sixteen non-nursing personnel from other Monroe Community Hospital departments now work alongside LPNs and RNs at the facility with opportunities to further pursue CNA training.

“August and September have been my two largest orientation groups during the entire pandemic,” Schulmerich told Skilled Nursing News. “I am choosing to see the positive at the end of this incredibly long, horrific storm that this is the second month in a row I’m seeing increased numbers in the nursing department in our orientation classes.”

As director of nursing services for a 566-bed skilled nursing facility in Rochester, N.Y., the 14th largest SNF in the country, according to Monroe Community Hospital spokesperson Colleen McCarthy, Schulmerich helped get the facility’s staff vaccination numbers up to nearly 94%.

She has seen firsthand that the patients heading into SNFs now are higher acuity and more clinically complex. She spoke with SNN last week on how working in a nursing home has changed over the course of the pandemic and what she thinks the job will look like coming out of it.

What have been some effective strategies that you’ve implemented at Monroe Community Hospital to help with staffing during this time?

We moved towards 12-hour shifts with the option for the employee, if they want to work 12-hour shifts, or if they prefer to continue with eight hour shifts. We gave them the ability to make a choice on that.

We hired a nurse recruiter.

We’re continuing to work to have a CNA training program here on-site. We are hiring individuals who want to be what we call a CNA trainee. We pay them hourly, we send them to a local community college, where they attend a CNA training program. When they complete their CNA training, and have their certification, they come back to our facility and get a pay increase and work full-time in a CNA role.

We’re trying to encourage people to actually come into the nursing profession to use a career ladder.

We created a position called hospital mobility technician. They are going to be working in pairs of two and go unit-to-unit to help assist with things like getting our residents in or out of bed based on our resident’s preferences.

That helps take some of the workload off of the nurses.

We’ve created what we call unit aide positions. They work as support staff to the nurses and the CNAs. They are an extra set of hands for the unit and help answering phones, put laundry away, tidying up rooms, helping them write letters and help them turn on their computer.

How important is it for the industry to look at establishing better career ladders for entry level roles?

I think it’s crucial, I think we, by nature, are nurturers and this seems absolutely perfect.

I think we’re so good at taking care of patients as nurses. We absolutely have to get better at taking care of each other as well as ourselves.

Have you experienced staff burnout? How do you avoid it or is it just a reality in today’s shortage?

I think that everybody is experiencing a lot of those issues.

We talked about staff burnout and have done a lot of on-site things. We’ve tried to institute all of these new positions to kind of pull a little bit off of the nursing department, and I have to say if it wasn’t for the other departments of this facility jumping in to help us in the nursing department, we would have struggled even more.

How do you think the role of a SNF has changed?

There are probably more people who were able to discharge to their home. When we specifically talk about those individuals that needed ongoing care, that they were no longer at the acute care level, we became that in between.

One of the things that was incredibly helpful to us is at MCH, we have our own on-site cardiopulmonary department, we have lab services that work right here on our campus in our facility. We uniquely have this large facility, which, it can be a double edged sword to be so large, but it really did allow us to have more partners to work with, for increased support of the nursing department and ultimately our patients and our residents.

Do you see the push to the home as a threat or as a way to evolve for the skilled nursing industry?

I think it’s a way to evolve and move forward.

We’re working on discharge planning processes that have a lot of patient teaching and family teaching because we want people to be successful and don’t want you going through a revolving door. We want to get you home and have some skills and the telephone numbers of who to call to triage what you should do next.

We want to maximize people’s quality of life and that interdisciplinary care team is not limited just to the employees of a facility. It is every single discipline that helps to take care of that patient or resident, including their family. I think that that’s the key to be successful.

I don’t think that it is a threat to the long-term care industry. I think that the typical patient is evolving into being a more complex patient.

How do you think the job of CNA or nurse in a SNF will be different 10 years from now?

I think that the patients that we see, I think they’re going to be more medically complex. I predict and expect to see them more educated in their disease management, or injury management and medical management of their own care. I truly expect that nurses and CNAs in the long-term care setting will be using all of their skills to the max ability that they can within the scope of their practices in the long-term care setting.

I expect 10 years from now in the long-term care setting that our nurses and CNAs will really be using every clinical skill that they’ve ever been taught. I think that long-term care facilities are preparing to have more clinical skills that we traditionally haven’t been doing in the long-term care setting.

Have you had to use agency staff during these staffing struggles?

I pulled some numbers earlier in this year, we were using quite a bit of agency initially.

We have always used quite a bit of agency staff, contracting as much as we can.

However, we took a drastic, sharp turn at the beginning of the pandemic, of barely using any agencies. We work with several different agencies locally here in our area and they were all experiencing tremendous staffing challenges.

It didn’t take long for us to realize we’re not going to be able to have this support any longer.

We really needed to become self-sufficient as fast as possible. Career opportunities, career ladders, creating new positions, increasing shift differential, increasing all the nursing department salaries.

I’ve heard from a few operators that have said that this is the first time they’ve used agency staffing in 30 years in the business so to hear that you guys kind of went in the opposite direction is interesting.

Yeah, the complete opposite direction for us.

This news is republished from another source. You can check the original article here

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