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How the NAC and DNS Can Work Together to Ease the Strain of the Staffing Shortage in Long-Term Care

The widespread staffing crisis in nursing homes across long-term care has put a strain on everyone, from leadership positions to the floor nurse. Staff are working overtime, covering extra shifts, and are often being called to work outside of their assigned roles. They are experiencing stress, burnout, and even considering leaving nursing and long-term care altogether. Until additional staff can be hired though, there are some strategies that the director of nursing services (DNS) and nurse assessment coordinator (NAC) can take to work together to make this situation more manageable and ensure that residents receive the care that they need.

Focus on Communication First

If the issue arises, it’s important that the NAC speaks up to let the DNS know that they are struggling to complete MDS-related tasks due to the staffing shortage. The NAC’s role is crucial to the financial well-being and regulatory compliance of a facility, and if they are unable to fulfill their duties, there will be consequences that the facility will have to manage.

For example, if assessment reference dates (ARDs) are not set timely and/or not set appropriately, this can result in lower reimbursement for the facility. This reduction in reimbursement may impact monthly financials if MDS assessments from the prior month are delayed (a facility can’t bill for services without the MDS being completed and transmitted).

Therefore, the DNS should focus on identifying and communicating with other healthcare personnel (HCP) that could step in to help if needed on the floor before enlisting the NAC.

Share Responsibilities

The DNS and the NAC both have very important roles, but during a staffing crisis and despite efforts to fill roles with other HCP, they may each need to fill vacancies of other staff members occasionally. When this occurs, it’s important to share this responsibility to make covering shifts manageable. No one can do it all. The DNS should support and cover the NAC role if the NAC and their backup person must be pulled to the floor, and the NAC and administrator should help the DNS with duties such as investigations of adverse events if the DNS is pulled to the floor.

Acknowledge Priorities

Depending on the severity of the facility’s staffing shortage, the DNS may need to make some tough choices. Those choices may involve:

  • Adjusting shift hours
  • Hiring agency workers
  • Managing census to meet staffing levels
  • Accepting that safe patient care is a priority over census

Facility leaders can also review the “COVID-19: Considerations, Strategies, and Resources for Crisis Standards of Care in Post-Acute and Long-Term Care (PALTC) Facilities” and adapt some of the recommended strategies regarding staffing to their facility if they are currently experiencing contingency or crisis conditions due to low staffing levels.

Develop a Plan to Improve Staffing

No one can work in a crisis forever, so it’s important to make every effort to improve hiring practices and staff retention in the facility.

All staff can improve success with hiring and onboarding by having a positive attitude, encouraging new staff, and voicing any complaints in private.

Other strategies to consider are:

  • Consider sign on, referral, and loyalty bonuses and ensure all staff know of these changes once implemented
  • Host an open interview or job fair to increase applicants
  • Implement flexible schedules and allow staff to choose what works best for them
  • Ensure a strong appreciation and recognition culture is in place

For more resources for employers who are looking to hire new staff or for potential employees looking for open positions, visit the AAPACN Career Resources page.

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