Leader. Lifelong learner. Top-notch clinician. All ideal qualities for a skilled nursing facility’s director of nursing (DON).
Finding – and keeping – a person with all those qualities is a daunting challenge.
“I can only tell you, DONs in the post-acute skilled nursing world are very rare and they’re a treasure,” said Nancy Schwalm, chief business development officer at Lakewood, Colorado-based Vivage Senior Living, which has skilled nursing facilities in Colorado and Missouri. “Many of our really strong nurses who choose to be a nurse and also to be a leader, they’re very rare.”
Staffing is a major problem in nursing, with the labor pool trailing the growth of the aging population. The shortage has led to a particular pinch in the DON position.
“The average age of a DON is 58 or 59, so we have to find our replacements,” said Sherrie Dornberger, executive director of the National Association of Directors of Nursing Administration. “We’re like an endangered species.”
But there are steps SNFs can take to groom and hold onto these valued employees. These include building a sense of community and fostering the DON/administrator relationship.
One of the most prominent difficulties in DON retention is the job itself, according to Mary McNevin, the chief people officer of Louisville, Kentucky-based Signature HealthCARE. Signature provides rehabilitation, assisted living, home health, skilled nursing and cognitive care services in 11 states.
“From a retention point of view, because it is all-encompassing, a person as a DON can be getting calls on the weekend, at their child’s birthday party,” McNevin said. “It’s a tough job for a lot of people.”
Schwalm cited the difficulties of navigating bundled payment plans and understanding high-acuity patients. But she also noted increased competition for talent.
“In Colorado, the lowest unemployment rate in the nation, millennials are going to other industries,” she said. “With hospitals kind of reinventing themselves and setting up more freestanding departments and urgent care, we’re also competing with all those other levels of care.”
Dornberger said low staffing is the top reason DONs leave a position, which is not always something a facility can control. But there are other workplace aspects she says can cause frustration.
“With the director of nursing, if you’re going to make this person responsible for the budget, they need to have some input on the budget,” she said.
SNFs can’t control the labor market, but they can take steps to foster a better working environment for their DONs.
Given the demands of the position, having a community of people who know the role is crucial, McNevin believes. This has been a focus at Signature, which established communities of practice to provide DONs the chance to ask questions and receive support.
“You’ve got to learn so fast in that job, so to have a trusted network, it can really help when you have tough situations, which a lot of nurses do,” McNevin said.
Signature is also emphasizing the relationship between the DON and the facility administrator, which McNevin believes is an overlooked factor in the quest for the best DONs. Signature is currently conducting Speed of Trust training, based on the book by Stephen M.R. Covey about how trust and establishing it is essential for an organization. Signature also has administrators and DONs go through leadership training together, to further bolster the relationship.
Vivage puts DONs and administrators on the corporate payroll, which Schwalm said provides better pay, perks and prestige. And like McNevin, she believes networking is crucial for making the job easier for DONs. Vivage established a “DON Affinity Group” to provide a place for peer mentoring and support.
“I can’t stress how important it is that our directors have a support group,” she said. “Because they will go somewhere where they feel more supported.”
With the nursing labor shortage, facilities may be better off growing talent from within their ranks to rise to leadership positions, Dornberger believes. It’s an idea seen in Signature’s Rx4Success initiative.
The program, which is still being implemented, “is designed to elevate the average floor nurse into a facility leader,” according to the course materials. The effort is intended to expose the learner to facility leadership, allowing them the chance to observe and interact.
“It’s got everything from clinical skills to communication skills and hitting people so they’re really communicating and helping to grow the nurses around the DON,” McNevin said. “The more people you train around the DON, the easier it is for the DON to do his or her job.”
Vivage brings in doctors from local hospitals, technology experts and other guests, taking education to DONs rather than forcing them to travel to their learning. Signature also emphasizes education, providing webinars for nurses and having nurse practitioners teach classes.
Why they work
Another quality of great DONs: passion for their job.
“They really have to care about our elders and residents and care about making sure the entire team gives excellent care,” McNevin said.
“If a great director of nursing has the compassion and care for the elderly, nothing is going to beat them down.”
Written by Maggie Flynn