POST ACUTE CARE SKILLED NURSING FACILITIES Shari Carson

POST ACUTE CARE: SKILLED NURSING FACILITIES Shari Carson, RN, BSN, NHA Interim Director of Nursing

NURSING POSITIONS IN A SKILLED NURSING FACILITY(SNF). THE POSITIONS WILL DEPEND ON THE SIZE OF THE FACILITY Director of Nursing (DON) Assistant Director of Nursing (ADON) Inservice Director/Infection Preventionist MDS Coordinator Unit Manager/ Clinical Care Coordinator (CCC) Restorative Nurse Wound Nurse Charge Nurse CNA Restorative CNA Scheduler Medical Records/ CSR (Central Supply Clerk)

TYPICAL CLINICAL ROTATIONS IN A SNF/SUBACUTE REHAB FACILITY Nursing assistant students from a local training institute or the facility offers their own program First semester nursing students PA or NP students with facility physician group Pharmacy students working with consultant pharmacist/ physician group or as a clinical rotation from the college BS or MS students in Health Care Administration assigned to the Administrator for a semester BSW or MSW students assigned to facility for one or two semesters oversight provided by facility LMSW. Dietician student usually unpaid internship with a Registered Dietician Recreation Therapist student usually assigned with a Certified Recreational Therapist Senior BSN student in Leadership course assigned to a DON Dental Students set up with Professor to do minor procedures, assessments and cleanings etc. .

A group of senior students can come to the SNF and do a leadership rotation. Each week one student is the Leader (rotates) and makes assignments, provides direction, conducts a case study presentation etc. . The MDS Coordinator is responsible for driving the assessment, care plan and payment processes in the SNF environment for both Long and Short stay clients. Students can be assigned to work with the MDS coordinator. This will focus on assessment skills interview skills, care planning, care conference with a focus on person centered care and PDPM the new payment system with CMS for Medicare part A stays. This could be one or two students weekly for a set time or a whole clinical group can rotate in over the semester. It is flexible and can be set up any number of ways. The Inservice Director/ Infection preventionist can work with individuals on providing education to nursing staff. This requires choosing topics, developing curriculum, setting up how to deliver the education and then delivering the education. Tracking of education for all nursing staff and then the evaluation of the education. Also is the whole IP role and learning about surveillance in Infection control, data collection, audits for performance against standards in all departments. Specialized training modules through online courses , antibiotic stewardship, Beers list MCGreer definitions and much more. NEW OPPORTUNITIES FOR PARTNERSHIPS Skilled Nursing Facilities can offer many opportunities to provide clinical experiences outside the acute care environment.

Assignment to work along side the Unit Manager or CCC. This is seeing how a person really supervises individuals on the floor providing direct care. Physician rounds, orders written and confirmed, Medication Reconciliation upon admission and at discharge. Wound rounds if there is not a wound nurse, Restorative nursing role if there is not a separate person for this role. Assist in discharge planning, setting up patient education to ensure Charge Nurses are completing this and documenting the education, employee evaluations, one on one education, coaching, terminations, Quality Improvement audits, work groups, Pips, Risk Management, falls prevention program, Behavior Management programming, Dementia Care and much more. This can be several times a week for several weeks and several students rotating. A project can be done during this time as well. Advance Directive education and education related to DPOA for Health Care versus Guardianships and code versus no code. . NEW OPPORTUNITIES FOR PARTNERSHIPS Continued

NEW OPPORTUNITIE S FOR PARTNERSHIP S CONTINUED If the facility has a wound nurse wound rounds are done weekly on every person with wounds, where measurements are completed, and documentation is done. They also review Braden's for risk and ensure appropriate interventions are in place. Evaluate any new wounds ensure appropriate orders are put in and measurements completed. Over see the wound meetings/nutrition at Risk (NAR) meetings. If the facility has a secure unit for Persons affected with Dementia, there are opportunities to be involved in an IDT group that truly works together and supports each other as well as the residents. Programming is key to successful units. Every caregiver provides activities and follows plans of care that are resident specific. Often Activity Departments need nurses to go on trips or outings of the day. Sending a student along would be a great experience

Remember that the SNF/SAR facilities are the med surg units of yesterday and offer many opportunities for nursing students. Many facilities also have case managers and hospital liaisons which could offer additional opportunities for partnerships. I believe we all can be creative when it comes to scheduling these new clinical opportunities. There may be even more opportunities that I haven not even thought of, but believe everyone will produce some other ideas during our breakout sessions. NEW OPPORTUNITIES FOR PARTNERSHIPS continued