Page 8 - One Nursing Home's Journey

Early Challenges Easier Now
While new challenges arise, earlier problems are resolved as staff becomes more accustomed to the new model. Heath no longer has to hunt down nurses for report; “We kind of know where people are,” she says.
Her job gets easier as the neighborhoods take on more respon- sibility: “I’m not problem solving; I no longer need my fire hat and extinguisher to put out fires. That part of my job is pretty much gone.”
A sense of cooperation has replaced much of the competi- tion between neighborhoods. Also, coordinators are shifting more of their load to other neighborhood team members and not feeling as overwhelmed as before.
As for Raymond, she has chosen to move from the job of neighborhood coordinator to that of a neighborhood nurse leader with additional responsibilities in infection control. Action Pact has found that the combination of nurse and coor- dinator is often difficult because of the conflicting demands in the house. Instead, a partnership between a nurse leader and a household (or neighborhood) coordinator filled by a non-nurse is often a more ideal combination.”
Heath is especially pleased about the way quarterly care conferences are now handled. Mandated by law, they previously were held in a conference room with only the Interdisciplinary Team, MDS nurses and family in attendance. Now they are held in the neighborhoods and also include the neighborhood coor- dinator, the care nurse and nurse aide—“and we’re working on getting the homemaker in there,” says Heath.
“We get more information and the CNAs hear when the family has good things to say. They really need to hear that families appreciate everything they’re doing,” she says.
Lenawee’s success is being noticed beyond its four walls. “We have a waiting list for residents, whereas other nursing homes in this area have empty rooms,” says Heath, “and people are banging on our doors (for employment).”
V. Three Years After Move-In:
We Are Households
“Professionally it’s a challenge for me...that’s the way you want any job to be. You don’t want the same old experience. You want something that’s going to make a difference in somebody else’s life. That’s why anybody chooses this type of profession; you want to make a difference.”
–Suzanne Hiltner on her dual role as Clinical Dietitian & Household Coordinator
Hiltner recalls her pre-move jitters about becoming a neighborhood (now household) coordinator, and how often over the last three years she felt her leadership role distracted from her chosen profession as Clinical Dietitian.
Though stress is still part of her job, experience and per- sonal growth have cut it down to size.
“I worked into it a bit better...delegating more to the dietary managers and getting them involved in some of the hands-on supervision,” she explains.
As for sacrificing some of her dietitian duties to household coordinating, “I think it’s a decision each individual has to make about what they’re comfortable with and how they want to balance their job,” she says.
Hiltner sees a bigger picture with more options and shades of grey.
“It’s not the black and white, straightforward, do this, put the food out, count our numbers, meet the regs. It’s definitely more people-oriented now,” she says.
All interviewees agree the road is much smoother after the first bumpy months of transition.
“Everybody working together made a huge, huge differ- ence...I know things are getting done because the CNAs are taking ownership,” says the DON.
“The nurses trust us more...I don’t have to go to the nurse every time for permission,” says a CNA. Cont. on next page.
Going To Households:
“The Right Path for Elders”
“I used to come in and worry about how I’m going to get everyone up and in the dining room for breakfast by the time the trays come down the hall, and who is going to yell at me if I’m not there. Now it’s very, very less stressful.”
–Wendy Meijer, CNA
Wendy Meijer has the unique per- spective that comes from working simultaneously in a Household Model and an institutionalized nursing home. While serving as a Certified
Nursing Assistant at Lenawee, Meijer also attends nursing school. She is performing the clinical portion of her studies in a conventional facility.
Experiencing the two models side by side “opens your eyes to the fact we are on the right path for elders (at Lenawee),” she says.
Meijer welcomes the increased responsibility and autonomy that falls to household team members, and the opportunity for personal and pro- fessional growth it brings.
“I feel now I can take that role and really expand on it because I have more time with the residents, and I feel more organized,” she says.
She also is less intimidated by nurses and others in formal leadership positions and is comfortable making decisions.
Initially, she was concerned “breakfast-on-demand” would be overwhelming, but she is pleased with how other team members have pitched in.
She recalls telling her nurse lead- er she was afraid her teammates were upset because Meijer was too busy with residents to help clean up the dining room. The nurse leader assured her the residents come first. Also, other team members proved more than willing
to clean up.
“Now I don’t feel I have to rush down to the dining room because my number one priority is the residents, not the dirty dishes on the table,” she says.
Having someone with whom to discuss your concerns is vital for a smooth culture change transition, she adds. Otherwise, the pressure becomes too great.
“If you go home and you’re over- whelmed with everything, you’re not going to come back the next day in a very positive mood. But if you can find somebody to talk to and explain things, that will be very helpful,” she advises.
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