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Healthcare Training Institute - Quality Education since 1979

Section 2
Track #2: Developing Clout with Nursing

Table of Contents | NCCAP/NCTRC CE Booklet
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Note-Taking Exercise

Why should you meet with your administrator before scheduling a meeting with your DON?

Rate on a scale of 1-10 how likely it would be to get the following response from your DON if you have not met with your administrator first.  1 indicates highly unlikely, 10 indicates highly likely.
"Well, you know we were short-handed yesterday.  So that's why Mary Sue the CNA on A-Wing just didn't have time to transport Esther.  And you know, those shower schedules are set and we just have to take the residents when it's their time for a shower.  We're so short-handed!  How can my CNA's be expected to have time to give yarn winding to a resident?!"

1          2          3          4          5          6          7          8          9          10

What four points should you include in a brief document regarding Culture Change guidelines to hand to your DON during your initial meeting?
1.

2.

3.

4.

Transcript of Track 2

On the last track, I mentioned a way to get department head and staff support is to start with your administrator.  Administrators are interested in building a census, or having a filled beds in the facility; and complying with state and federal regulations.  I proposed that you acquire a recent copy of surveyor guidelines.  Then, schedule a meeting with your administrator to review the portions that relate to activities receiving support from other departments.  The basic premise for doing this is to start at the top of your facility’s organizational ladder to gain support for Culture Change compliance.

Since your administrator is interested in compliance with CMS regulations, I assume he or she will be interested in your getting department head and staff support to comply in the six areas listed on track one.

On this track, we will discuss gaining clout or influence with nursing by approaching your Director of Nursing.

The organizational structure within your facility is like a pyramid, with usually your administrator at the top.  Why start with your administrator?  Well, in case it is not obvious to you, after you have clarified federal guidelines for activities with your administrator, you ask, “Mr., Jones do you feel I should discuss these with Cindy, our DON?”  You now have a specific reason to schedule a meeting with your Director of Nursing to discuss the same six points.  However rather than saying “I would like to discuss Culture Change with you,”  you state to Cindy, “Mr. Jones felt I should discuss Culture Change requirements with you.”  Do see the difference in the attention-getting, clout-building potential by referencing your meeting with your administrator? 

Depending on how often your see your corporate consultant, you might get further clarification regarding regulatory compliance from your consultant as well.  However, by far your administrator will be more important to your director of nursing than your activities consultant is.  Agree?  So don't feel you can bypass talking to your administrator by acquiring and discussing surveyor guidelines only with your activity consultant. 

In the meeting you schedule with your director of nursing you, of course, “name-drop,” so to speak, the name of your administrator, indicating his or her support, when you tell your D.O.N. the specifics of what you need to have happen in order for your department to be in compliance with federal guidelines.

Let me digress a minute.  You notice I keep referring to this meeting with your director of nursing as the "meeting that you schedule."  Since you are actually now creating a key cornerstone for building a dynamic support system for your activity department, even though you may be in the habit of having impromptu chats over coffee or in the hall with your administrator or director of nursing; you do not want this impromptu, casual atmosphere to permeate this all-important cornerstone meeting.  So, send an email and request a meeting to talk about "Activity compliance to prepare for survey" Tuesday at one o'clock, for example.  Try and give the meeting as formal an atmosphere as possible, in order to maximize the seriousness with which the D.O.N. or administrator will take it.

Now that I have convinced you that you are scheduling a formal meeting with first your administrator, and second with your director of nursing, perhaps via an email, let's compare one D.O.N. meeting, in which you haven’t met with the administrator, with another scheduled meeting in which you have done your homework, so to speak, and met with your administrator, prior to this D.O.N, meeting.

With no previous administrator meeting, and no federal surveyor guideline basis, see if your meeting with Cindy, your D.O.N., might go something like this.

"Gee-e-e, Cindy, Esther really likes to go to Bible Study, but was not transported.  Effie had to leave the Sing-a-Long early because she was taken to her shower.  Ellen has yarn winding in her room, and the CNA did not give it to her after she was dressed."  Cindy's response might be something along the line of, "Well, Cathy, you know we were short-handed yesterday.  So that's why Mary-Sue the CNA on A-Wing just didn't have time to transport Esther.  And you know, those shower schedules are set and we just have to take the residents when it's their time for a shower.  Also we're so short-handed!  How can my CNA's be expected to have time to give yarn winding to a resident?!"

Rate on a scale of one to ten how likely it would be that your D.O.N. would give you a reply like the one above.  Rate yourself a number one indicating it is highly unlikely that your D.O.N. would respond this way; and ten indicating extremely likely your D.O.N. would give a similar type of response.  The problem with disputing your D.O.N.'s excuses as to why the activity program is not being supported by nursing is the fact that what she said is true.  It's no secret, at times nursing is short handed.

So to get staff support, how does your activity program become important enough to be at the top, rather than the bottom of the list of important things the CNA needs to do?

Let's go back to our scene now with your Director of Nursing.  Think how differently she would have reacted if instead, you would have said the following:
"Cindy, thanks for taking time for this meeting.  I know in about six months we are due for a survey, and I want to make sure my department does not receive any deficiencies, because it hasn't in the past.  I spoke with Mr. Jones, our administrator, a few days ago about the most current surveyor guidelines for activities.  Here's what we discussed..."

At this point, you hand to Cindy, your D.O.N., not a huge document of all the interpretive guidelines; of course, your D.O.N. doesn't have time for that.  But you have cut and pasted into a Word document pertinent points regarding those mentioned on Track 1,
#1.  transporting residents,
#2.  CNA's doing activities with residents,
#3.  shower and medication schedules coordinating with resident's attendance at activities,
#4.  and any other guidelines which you feel require the support of nursing.

Thus the first way I suggested you develop clout or influence to get the support your department needs with your director of nursing is to have had a meeting with your administrator prior to talking with her, and to mention that administrative meeting to your director of nursing.  The second way I suggest you develop clout or a position of power to get the support your department needs with the director of nursing is to provide her with a hard copy of the portions of the surveyor guidelines, and indicate the guidelines suggest that the surveyors observe nursing's support of activities.

Do you see how you have repositioned yourself into a position of power or clout through the meeting with your administrator followed up by a meeting with your director of nursing?  It no longer is just you, Cathy, the activity director who is seemingly asking for these three favors:
#1.  to ple-e-e-ase! have the CNA transport residents; or
#2.  to ple-e-e-ase! have the charge nurse shift the shower and medication schedules to accommodate resident attendance;  or
#3.  to ple-e-e-ase have CNAs give certain residents their one-to-one activities that have been left in their room. 

Maybe I'm being a little overdramatic here, but I think you get my point.
When you present Cindy, your D.O.N. with her copy of these guidelines for her reference and her file, it is no longer you, Cathy, the activity director, who is asking, it is the federal government telling your activity department what you must do  in order to continue to qualify to receive federal money into your facility.

Of course, nothing happens overnight, and don’t allow yourself to fall into the excuse or poor-me trap of saying to yourself. "Well, gee!, I talked to Cindy yesterday!, and Esther still wasn't transported to an activity!" 

You have to follow through.  There is a long history of behavior here.  When there is no follow-through from nursing after your meeting with Cindy, it's easy to throw your hands in the air and say, "nothing will work!  I'll never get support from nursing!  I've done all I can do!"  

However, I feel, it's up to you to make a system of staff support work, and this course, especially when combined with others in the series, provides you with specific proven  techniques regarding how to get not only nursing, but other  staff support you have perhaps been longing for.

So on these first two tracks hopefully I have convinced you of the absolute necessity of starting at the top with your administrator and then the absolute necessity of referencing that meeting when you talk to your Director of Nursing, as well as providing your director of nursing with her own copy of excerpts of federal surveyor guidelines mentioning staff supporting the residents' activity program.

It all has to start with your administrator, then your D.O.N.  Have I convinced you?  The next track will help you to get prepared or psyched-up for these two meetings which are crucial and become the cornerstones for building department head and staff support.