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When working with a healthcare organization, proposing an intervention for staffing needs can be a daunting task. First of all, the organization must be made to see that the current staffing numbers and culture is inadequate. I would start my proposal with all of the legal requirements which a healthcare organization must meet, and the legal liability the organization faces if a shortage of staff or the kind of staff needed are not available.
For example, I just placed an elderly cousin for whom I have power of attorney and health care into an assisted living/memory care facility. I toured many facilities, watched how the staff interacted with residents when they were not aware I was watching, met with the director, the medical staff, the kitchen staff, the medical assistants and the housekeeping staff. Many were quickly eliminated because they didn't meet basic hygiene needs for my cousin or didn't have the medical staff on site to provide for my cousin's needs. Legally, if he fell out of bed, they would be liable for not having the medical staffing to take care of him at night. Your proposal needs to show the legal responsibility for a resident's safety. Also, the staffing has to be checked for their background as an 89 year old woman in Minnesota was just vindicated when one of the night staff was convicted of raping her when originally the staff did not believe her. The culture of the staff was also one of the intangibles I was looking for when touring facilities. As a teacher, being observant is required to be successful. I watched the interaction of staff and what happened if a problem arose while I was there. Did they work together to solve the problem? Were the medical assistants asked for their views and listened to when they spoke? The social environment is also critical for patients. Are their needs for social interaction considered?
Your proposal must consider where the facility is lacking, and how more or better or different staffing is required. As the patient's need for help rises, more staffing hours are necessary. Is the need for RN's on staff, LPN's on staff, a resident doctor who isn't just a once a week on call physician but there every day, or for medical assistants who help a patient dress or go about the tasks of daily living. Is a physical therapist available for the increasing needs of patients? Is the memory care different than a nursing home? Is the facility capable of being locked for safety reasons and staff available day or night to keep track of wandering patients? Gather your information carefully, check with other successful facilities for their programs, get your current staff behind the idea of a few changes, and then approach the administration with your proposal and the reasons it is necessary.
The number of choices available is growing, and if your organization wants to keep being successful, they must change with the current expectations. After touring more than ten facilities, and closely interviewing three facilities, I feel lucky to have chosen the one I did as it meets all my expectations and keeps us closely informed about my cousin who, at 85, has no one else to help him.
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