Individuals that are in need of rehabilitation therapies, nursing services or medical care are more than likely to be admitted medical care, nursing services, and rehabilitation services are likely to be admitted to nursing homes. In particular, when these services are not easily obtained in community-based settings. These services form the core of care delivery in a long term care facility. In addition, there are several key staff members that ensure that nursing homes are run properly as well as legally. When one or several of these critical key members are no longer employed at the facility, it poses a chain reaction of violations that have a negative impact on the success of the nursing home facility.
Prioritizing Staffing Needs
“Numerous studies in the past 3 decades have explored the relationships between staffing levels in nursing homes and quality of care measures” (Bostic, 2006 p.366 ). BNH is experiencing a shortage in their staffing. They are in the process of filling positions for a DON, receptionist, and dietary aid at the facility. Priority should be placed on filling the position of a DON at the facility first. This is not to minimize the importance of filling the other positions. However, not having a DON at the facility has placed the facility in a noncompliance status because the interim DON does not possess the requirements of a DON. Once the DON is hired they will be able to replace the dietary aid next, since they impact residents as far as assisting with providing proper meals. Lastly, a temporary receptionist can be hired until a full time employee is hired.
The position of a DON is extremely important within a nursing facility. The (Singh, 2016) DON is a key member of the top management team, second only to that of the administrator (p.223). A DON has the responsibility of establishing how the nursing home facility is run which has a direct impact on patient care. It is imperative that the caregivers within the nursing home spend as much time as possible caring for their patients. The DON is able to free them up from any administrative duties in order to spend that time with patients. The DON takes on administrative task that caregivers may be tasked with, in an effort to free them up to spend that time caring for patients at the facility. In addition, (Singh, 2016) “During the administrator’s absence the DON is in charge of the facility” (p. 223).
Inappropriate Conduct in the Workplace
In order for BNH to address inappropriate violations that can occur within the workplace, a human resources policy will need to be formulated to address inappropriate conduct and how to report it. Additionally, there should be a list of consequences for violating any part of the policy that all staff will need to sign showing that they acknowledge it. Furthermore, training or informational classes will need to be held to thoroughly go over these policies and possibly provide examples through video skits or in class demonstrations.
Inappropriate conduct can occur within the workplace at any time as well as from any level of staff within the organization. It is important that the human resources department at BNH clearly defines in writing what is expected from employees and the consequences for violating these policies. In addition to drafting a policy that defines inappropriate behavior, there can be an anonymous whistleblower hotline setup to report any violations. Not only will this hotline be available for employees but it will be available to family members and visitors at the facility. This will allow the human resources department to investigate and formulate a corrective action plan to address these unacceptable patterns of behavior. The outcome of these investigations, depending on if the staff member is found to be in violation, will be in the form of corrective training, a write up, or immediate termination of employment from the facility.
As a result of setting up these policies the human resources department will allow BNH an opportunity to attract and retain good employees. Additionally, this may assist them in not being out of compliance and prevent possible lawsuits from family members of residents at the facility.
Leadership and Management Skills
Leadership Skills
“Effective leadership of healthcare professionals is critical for strengthening quality and integration of care” (Sfantou, Laliotis, Patelarou, Pistolla, Matalliotakis & Patelarou, 2017 p.73). There are several ways that the administrator at BNH can demonstrate quality leadership and management skills. Havig (2011) states, “leaders in nursing homes should focus on active leadership and particularly task-oriented behavior like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care”.
Sfantou et. al. (2017) believes that “effective leadership is among the most critical components that lead an organization to effective and successful outcomes (p.73). Furthermore, Sfantou et. al (2017) several studies have stressed the importance of leadership style for quality of healthcare provision in nursing homes (p.73). The administrator at BNH will need to demonstrate leadership skills by meeting with the staff directly to discuss what has transpired. In addition, the administrator will need to articulate how going forward, there will be a more thorough discussion with the H.R. department. This is in an effort to establish preventative measures relating to employee misconduct in the future.
By following this process, it will assist the staff in answering questions about the incident if asked by any of the residents. Additionally, it will let the staff feel as though they have support and develop trust and confidence in their leader. Second, the administrator can set up a meeting with the family members of the residents at the facility to discuss the incident. Typically, being proactive and upfront opposed to being reactive and appearing to be evasive gives others the impression that you are honest and you are making an effort to be as transparent as possible.
Management Skills
Management skills are essential for any administrator to operate a thriving a nursing home. There are several management skills that the Administrator at BNH should possess to ensure the success of their facility. Incorporating these particular skills within the day to day management of the facility will have an effect on the morale of the staff as well as the survival of the facility.
According to Slipicevic ; Masic (2012), “Extremely complex health care organizations, by their structure and organization, operate in a constantly changing business environment, and such situation implies and requires complex and demanding health management” (p.106). They further state, “Therefore, in order to manage health organizations in a competent manner, health managers must possess various managerial skills and be familiar with problems in healthcare” (Slipicevic et. al., 2012 p.106). In order for the administrator at BNH to be an effective manager, they should possess four main types of healthcare management skills; interpersonal skills, information skills, analytical skills, and action skills.
Interpersonal skills should be used to communicate effectively to the staff in regards to the disciplinary action that took place and the need to implement policies at the facility. The administrator will need to be able to motivate the staff and sell them on the idea of the need to implement changes at the facility. Information management can be used to deal with the display of misconduct as well, at BNH and to listen with an open mind and come up with solutions to rectify the problem. Analytical skills can be used to assimilate new information which in the case of BNH would be new human resources policies. Action skills can be used to identify the new goals and standards set at BNH going forward and the ability to direct and implement actions.
Using the Quality Indicator Survey

Developing a strategy for BNH to use the Quality Indicator Survey to improve administrative practices and ensure future compliance at the facility will be extremely beneficial. The Quality Indicator Survey is the most comprehensive regulatory change to the nursing home survey process since the Omnibus Budget and Reconciliation Act of 1997 was enacted. It is a computer assisted long-term care survey process used by selected State Survey Agencies and CMS to determine if Medicare and Medicaid certified nursing homes meet Federal guidelines for nursing home care. “It was designed to produce a standardized resident-centered, outcome oriented, quality review” (Singh, 2011 p.108). QIS protocols and tools range from staff, resident and family interviews, resident observations and facility-level tasks.
The QIS can be used by BNH to:
Improve consistency and accuracy of quality of care and quality of life problem identification by reducing subjectivity and using a more structured survey process.
Systematically review requirements and objectively investigate all triggered regulatory areas.
Provide tools for continuous quality improvement.
Specifically address concerns that are a priority to the industry, residents and family members.
Enhance documentation by organizing survey findings through automation, ultimately moving to a paperless survey process.
Also, as a best practice for the facility to implement while adopting the QIS process is to make sure that they motivate and educate their staff on the process. This is to ensure that there is a full understanding as to the importance of the process which will ultimately benefit the entire facility. In addition, educating the residents and their family members on the process will aid in the facility gaining their trust. It will demonstrate that the facility does care about the residents and want to ensure that everyone is aware of the steps that are being taken to properly care for residents at their facility.
Ensuring that the nursing facility is in compliance and that all staff members adhere to company policies at all times should always be a top priority for every administrator. When one or several of these key members are no longer employed at the facility, it poses a chain reaction of violations that have a negative impact on the success of the nursing home facility. The need for rehabilitation therapies, nursing services or medical care are more than likely to increase as the years go by. People are living longer through new medical treatments and therapy. This means the need for nursing facilities may continue to increase in order to care for the aging population.

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