Friday, November 27, 2009


When the sun is straight up and brightest, the shadow you cast is small.

When the sun is rising or setting, the shadow you cast is long.

When there is brightness in your life, one does not need an extension of themselves.

When the light is dim, you may need an extension to be seen and heard

As you go through life select your friends well for they will be the extension that defines you as your light dims.

Wednesday, September 16, 2009


Knowledge is a platform on which one can stand more securely.

Read to a man and you control his knowledge, teach a man to read and he will choose his library.

Monday, June 29, 2009


Wisdom is learning to listen to the unspoken word!

Darkness will come in one's life, how long it stays is up to you!

Dream loud!

Look a person in the eyes, for their eyes will let you into their heart!

If you give more than you receive, Celebrate!

An honest friend is a saving's account for your emotions!

Thursday, April 2, 2009

McDonald Hire

Time is short, your back is against the wall, you are down one assistant with pregnancy, one with emergency surgery, and one with pneumonia, what are you going to do?

You have tried everything but giving birth to a full grown nurse assistant. Administration tells you agency is not an option. You have to have staff on the floor. Who will care for the residents?

You open your office door, music from “Chariots of Fire” starts playing, a bright light appears over your desk, and the room fills with the fragrance of fresh cut roses … nay... you are dreaming! It is the same old office and the same old smell. Back to reality!

If there was a quick fix, I would package it, sale it and retire to an island without phones.

On your desk sits 4 resumes of candidates that you pushed aside, but now in the “real light” of day, you think they might not be so bad. Their references are good, they have moved around a lot, but they have no charges of abuse, they are not felons, they are certified and “WHAT” they can start right away!!

The past has taught you these types of candidates will be gone in a month or at tops, three. However, today a month is a very….long time. These are what I call “McDonald Hires”, no one wants a steady diet of McDonald’s food, but when you are real hungry that “Quarter Pounder” looks!

A facility of McDonald Hires would end in disaster just like a steady diet of McDonald’s food. The cholesterol would kill you. Staff that only stay for a month or two would be very unhealthy for the residents! Medication errors would occur, baths would be missed, dressings would not be changed, diets would not be adhered to, etc. Continuity of Care is essential for residents and that can not be attained if staff come and go through a revolving door.

With that said, in times of emergencies, emergency measures must be taken. However, an emergency situation is short lived. The McDonald Hires are only there to give you and the hard working staff a break. Take the break, but know it is short lived. Get strong and then get out there and do what you have to do to develop a pool of interim staff.

When I was a Director of Nursing (I had to walk two miles in the snow to get to work and it was uphill both ways) in the great state of Ohio, there were several nursing homes in a 6 mile radius of where I worked. I invited the DNS’s of these homes to meet with me and discuss developing a pool of interim staff that we could all call on to use during times of shortage. We had to agree to share the on call for this pool, to set the salary the same, to keep the benefits the same, to sign a non recruit and non compete, to serve first called and to have the same job descriptions and requirements.

It took us a while to work through things and a whole bunch of cooperation, but we did it and for the remainder of my time as the DNS (one and half years) in that facility we were able to successfully share a group of staff. We were able to keep the pool staff busy between the 5 facilities.

It really does take stepping outside the box to make things work sometimes.

Remember you can now train volunteers to feed residents, therefore, if you train a few of those to feed and those same volunteers can help escort residents to the dining room, they can serve trays, they can make beds, they can set up the shower room with wash clothes, towels and resident’s clothing and bring the resident to the certified nursing assistants to bathe the resident, etc., etc. These things can help in a pinch and it definitely frees up the nurse and the nursing assistants to do what is required of them. Do not forget to train these volunteers on HIPAA and have them sign off.

McDonald’s anyone?

Written by Peg Tobin

Thursday, March 19, 2009

Long Term Care - How to calculate Nursing hours allotted per day per patient/resident (PPD)


If you want more staff for your department, better equipment and higher salaries, you as the Nurse Manager have to show that your department is capable of helping produce revenue and that you are a good steward of the funds you are entrusted with to run your department.

Federal Nursing Personnel Staffing Requirements for Long Term Care


Nursing Services

The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.

Intent §483.30

To assure that sufficient qualified nursing staff are available on a daily basis to meet residents’ needs for nursing care in a manner and in an environment which promotes each resident’s physical, mental and psychosocial well being, thus enhancing their quality of life.

Procedures §483.30

§483.30(a) and (b) are to reviewed during the standard survey whenever quality of care problems have been discovered (see Appendix P, Survey Protocol, Task 4, for further information and Task 5C for the investigative protocol to complete this review). In addition, fully review requirements of nursing services during an extended survey or when a waiver of RN and/or licensed nurse (RN/LPN) staffing has been requested or granted. Except as licensed nursing personnel are specifically required by the regulation (e.g. and RN for 8 consecutive hours a day, 7 days a week), the determination of sufficient staff will be made based on the staff’s ability to provide needed care to residents that enable the to reach their highest practicable physical, mental an psychosocial well being. The ability to meet the requirements of §§483.13, 483.15(a), 483.20, 483.25 and 483.65 determines sufficiency of nurse staffing.

§483.30(a) Sufficient Staff

§483.30(a)(1) The facility must provide services by sufficient numbers of each of the following types of personnel on 1 24-hour basis to provide nursing care to all residents in accordance with resident care plans:

(i) Except when waived under paragraph © of this section, licensed nurses; and

(ii) (ii) other nursing personnel.

§483.30(a)(2) Except when waived under paragraph (c) of this section, the facility must designate a licensed nurse to serve as a charge nurse on each tour of duty.

For interpretive Guidelines and Probes on §483.30(a) see tag F354

PPD is based on an average acuity level of the whole. This level decides the amount of nursing hours allotted per day in the nursing department.

Do you know your PPD?

Do you know on what your acuity level is based?

Have you seen your nursing budget?

Do you know who is inlcuded in the nursing PPD?

How much of the PPD is for Direct Care Nursing?

How many nurses included in your PPD are salaried?

Once you have your direct care PPD, you can figure

the amount of hours allotted each day.

Take the PPD and multiply it times the

number of residents/patients in the facility.

Once you have a PPD it remains the same

until the acuity of the residents/patients


The allotted hours may change on a daily

bases related to a change in the census.

If the census is 80 you multiply it x 3.2

the nursing department will have 256

hours in nursing allotted in 24 hours.

(76 x 3.2 = 243.2, on so on)

With a grand total of 256 hours, you will still

need to break those hours into RN, LPN, Restorative

Nurses, Restorative Aides, Med Aides, CNA's, etc.

To figure the PPD for each discipline you can either

look at the facility budget or:

  1. Take a look at how many RNs are allotted for a certain census.
  2. Then take the number of LPN's and then CNA's.

If you are allotted 3 RN's in a 24-hour time limit, then take how many hours a day they work and divide the census into that amount - 3 x 8 = 24, then divide 24 by the census 80 = .3, thus the PPD for RN's for the day is .3. If you have 6 LPN's in a day, 6 x 8 = 48, then 28 divided by census 80 = .6, thus the PPD for LPN's is .6

If you are not certain what the PPD is for your unit or facility, then you can reverse things and figure the PPD by using the hours you have scheduled nursing staff and divide that number by the census. If you have 280 hours scheduled and the census is 82, then the PPD for nursing will be 280 divided by 82 = 3.41. To figure the PPD per discipline, you would do what you did in the previous paragraph.

Tuesday, March 17, 2009


Try as you may yesterday is gone, never to be revived. May it have shown you:

• Thankfulness is learned by those that forgive.
• Sensitivity is learned by injustices.
• Importance is fleeting.
• Real life heroes have faults.
• Life continues.

Yesterdays build our todays and goals give us our road maps for tomorrow.

Written by: Peg Tobin