Published: Dec 01, 2020
6:30 AM: I wake up and do typical morning stuff (exercise, shower, eat breakfast, and check news and e-mails), then head to work.
8:30 AM: Review and respond to e-mails and voicemails.
9:00 AM: Morning meeting with my department heads to discuss admissions, discharges, patient and staff issues, and upcoming events. I receive status reports on projects (e.g., food service implementing a new tray distribution system, maintenance painting part of the facility, etc.) and responses to my requests for information, such as admissions from a specific hospital or physician, or the number of residents receiving speech therapy.
9:30 AM: I meet with the director of nursing and assistant director of nursing to review incidents, issues, and projects.
10:00 AM: Budget meeting. I review expense reports on a biweekly basis, and meet with department heads to develop plans of action to reduce expenses whenever necessary. It’s important to stay on top of labor costs, particularly overtime and the use of agency staff, so that we can stay within our facility’s budget.
10:30 AM: Another meeting with department heads. We’re launching a customer service initiative to improve service. Our service ratings are stellar, but there’s always room for improvement. Aspects of the initiative include visits to residents and family members to identify and address concerns, staff training to improve communication with residents and families, and the development of a complaint management program to help address complaints effectively. All the department heads seem to be excited about the initiative, and several made good suggestions, so I’m happy.
11:30 AM: Conduct rounds throughout the facility to identify and resolve issues, and speak with staff and residents and physicians.
12:00 PM: Lunch presentation to 50 physicians at a local hospital. Maintaining a high level of occupancy is one of my key responsibilities. I speak with the physicians about the services we provide and answer any questions or concerns they have. During the presentation, I’m assisted by my admissions director and her staff, our director of marketing, and a nurse liaison. Next week, we’ll make a similar presentation to a local chamber of commerce.
1:30 PM: Meet with director of food service to discuss issues and plans for improvement. We’ve had several requests from residents lately (e.g., adding a vegan option to our meal plans, offering earlier dinner times, etc.), and we work together to address these requests. We also revisit this morning’s discussion of the new tray distribution system.
2:00 PM: Utilization review meeting with directors of admissions, socials services, rehabilitation, and nursing heads.
3:00 PM: Compliance meeting with the director of nursing, medical director of the facility, and management staff. I must continually monitor the facility to assure that all regulations are being met in all areas, from nursing and therapy, to food service and maintenance. The nursing home is surveyed annually and there are unannounced visits from state surveyors, so there must be ongoing monitoring of all aspects of the facility. This includes things such as food temperature, environmental temperatures, documentation and investigation of all resident accidents and incidents (e.g., falls and skin tears), adhering to infection control protocols, as well as to resident rights. To accomplish this, I’ve established a quality improvement program to review all aspects of resident care as well as the physical environment and support departments (food service, admissions, etc.).
4:00 PM: Rounds to speak to staff residents and family members. I want to be a familiar face not only to my staff, but also to family members. It’s important that they know that someone cares and is ready to address their concerns. It’s not easy to have a family member in a nursing home, and I want to make this process as smooth as possible.
4:30 PM: I speak to admissions staff and external case managers regarding admissions, bed availability, and other issues.
5:00 PM: Return phone calls from family members, respond to e-mails, and review mail.
5:30 PM: I head home, but I’m ready to go back to the facility at a moment’s notice, if necessary. This rarely happens, but I’ve been called back a few times when the power has gone out during a storm and for other reasons. We have a backup generator, but it’s important that I’m on-site during such situations to monitor the issue and demonstrate leadership. No storms tonight, so I have a nice dinner with my family.
8:30 PM: After some family time (it’s important to have a good work-life balance), I begin working on my executive portfolio to renew my Certified Nursing Home Administrator (CNHA) certification. The portfolio documents the continuing education classes I’ve taken to become eligible for recertification. The CNHA certification is a great way to demonstrate your skills and experience, and my employer requires all the administrators at their long-term care facilities are certified.
10:00 PM: I call the night manager at the facility to check in. No problems, but I want my staff to know that I’m available at all hours should there be a problem. Then I do one last check of e-mail and voicemail and head to bed.
Generally speaking, there is no "typical day" for a physical therapist, since career paths and daily routines vary so widely. After two or three years of general practice, a physical therapist may find a special area of interest and devote energy and training to a specific patient population or specific treatment technique.
Olivia Breef, RN, BSN, OCN, is a charge nurse in the oncology department at Memorial Hermann Memorial City Medical Center. At the youthful age of 27, she has her oncology nursing certification (OCN) and manages a staff of TK nurses on her nightly shift from 11 p.m.
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