NURS 4221 Week 5 Discussion
In the scenarios presented this week, I selected the one involving a for-profit nursing home with approximately 100 beds. The specific focus was on a 20-bed unit primarily comprising residents with Alzheimer’s disease. These residents relied on Medicare and Medicaid as their payor sources. This scenario resonated with me personally because of my prior experiences working as a Case Manager, ER nurse, and nursing supervisor in a nursing home. These roles allowed me to witness different aspects of this scenario.
As an ER nurse, I frequently encountered nursing home residents being sent to the ER for conditions and symptoms that could have been managed within the nursing home. While we admitted some residents, most were treated and then sent back to the nursing home. As a case manager, I noticed that many residents had stays of less than 12-24 hours, which often resulted in readmissions. Readmissions were frowned upon by the Center for Medicare and Medicaid (CMS) and could be costly for the facility.
NURS 4221 Week 5 Discussion
The Hospital Readmission Reduction Program, established under the Affordable Care Act, aimed to improve healthcare by linking payment to the quality of hospital care and incentivizing hospitals to improve communication, care coordination, and post-discharge planning (CMS, 2018). Drawing from my past experiences as a nursing supervisor in a nursing home, I made efforts to educate staff on maximizing their scope of practice before resorting to sending residents to the ER.
As the nurse leader for this unit, the most effective leadership style/strategy I would apply to successfully implement the recommendations is the Model Analysis. While many nursing homes typically utilize the functional nursing model, I believe this model can lead to missed information about the residents. Based on my experience, when the charge nurse or nursing supervisor is notified of a resident’s worsening condition, it requires additional time, effort, and resources to bring the resident’s symptoms under control.
NURS 4221 Week 5 Discussion
Implementing the Model Analysis approach would involve transitioning to 8 to 12-hour shifts with one nurse, facilitating continuity of care and effective communication with the resident, their family, and providers (Yoder-Wise, 2015). This model would foster trust between the nurse, resident, and family, enabling the development and implementation of a comprehensive care plan aimed at achieving specific goals (Yoder-Wise, 2015). Additionally, the one-on-one nurse-resident relationship encouraged by this model would allow the nurse to detect even subtle changes in the resident’s condition (Yoder-Wise, 2015). This heightened awareness would enable the nurse to promptly address and manage symptoms, reducing the need for sending residents to the ER by providing early intervention and hopefully preventing the escalation of care.
References:
Center for Medicare & Medicaid Services. (2018). Hospital readmissions reduction program [HRRP]. Retrieved from
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HRRP/Hospital-Readmission-Reduction-Program.html
Yoder-Wise, P. S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Mosby.
