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McKnight's Long Term Care News
Peg Tobin
September 21, 2018

Hold on to your ‘hats’, we have ‘stats’!

In my previous blog, I discussed our training program for nurse leaders. Now, the statistics are in for the first completed class of the Ohio Civil Monetary Penalty Grant Nurse Leadership Training Program. For this training, Tobin & Associates partnered with Ohio Health Care Association.

Enrollment Requirements

  • Limited to 12 facilities per session to allot for one on one interaction
  • Limited to facilities 50 to 130 residents
  • Facility nursing staff turnover rate greater than 30%
  • Facility resident/family satisfaction survey less than 85%
  • Applicants must be a registered nurse (RN) with at least 2 years of experience in a long term care.
  • If participants leave the facility before the training is completed, they will be unable to continue in the Nurse Leadership Training Program.

Expected Outcomes

  1. Decrease each participating facility’s direct care staff turnover rate by 5% for CY 2018, with additional 1% decreases in CY 2019 and in CY 2020. This will be measured using facilities’ human resource records and documentation.
  2. Increase each participating facility’s Resident and Family satisfaction survey scores by 7% each for CY 2018, with additional 2% increases in both surveys in CY 2019 and in CY 2020. This will be measured using the Tobin & Associates Resident and Family surveys that have been developed specifically for this project.


  1. Nurse staff turnover (percentages provided by facilities).
Facility Initial Nurse Turnover Rate % Final Nurse Turnover Rate % 18-May 18-Jun 18-Jul
Convalarium of Dublin 47.00% 15% 20.7 Improved 32%
Delaware Court 35% 2% Improved 33%
Echo Manor 62% 10% 10 10 9 Improved 52%
Friendship Village 56% Did not complete program
Heartland of Bellfontaine 64% 23% 24.29 7.14 37.94 Improved 41%
Otterbein Gahanna 45% 40% Improved 5%
Otterbein New Albany 70% Did not complete program
Prestige Gardens 52% Left company
Summit’s Trace 91% 5% 3 6 6 Improved 86%
West Park 85.70% 6% 3.77 13.21 1.96 Improved 79.7%
Whetstone Care Center 67% 3% 0 2.78 6.06 Improved 64%
Winchester Care 73% <97%> 93.75 98 101.4 <Digressed 24%>
  1. Resident/Family satisfaction surveys (provided by resident and families)
Facility Initial Resident Score% Final Resident Score %
Convalarium of Dublin 63% 92% (improved 29%)
Delaware Court 78% 90% (improved 12%)
Echo Manor 68% 78% (improved 10%)
Friendship Village 65% did not complete program
Heartland of Bellfontaine 70% 82% (improved 12%)
Otterbein Gahanna 66% 96% (improved 30%)
Otterbein New Albany 61% did not complete program
Prestige Gardens 64% left company
Summit’s Trace 51% 93% (improved 41%)
West Park 60% 87% (improved 27%)
Whetstone Care Center 67% 90% (improved 23%)
Winchester Care 60% 86% (improved 26%)

The six-month Nurse Leadership Training Program with follow up mentoring programs are written and taught by Mary Taylor, RN, LNHA. Esq. and myself. The OHCA Nursing Core of Knowledge training session included in this program has multiple professional presenters (of which I am one) and is the property of Ohio Health Care Association.

This CMP Nurse Leadership Training Program has presented evidence that proper Training of Nurse Managers can make a ‘significant’ difference in nursing staff turnover and resident/family satisfaction. Therefore, what do you say long term care industry, shall we ‘all’ get on board and give our nurse managers the tools to be successful?   

The second class is half way through their sessions and not one of the participants has left their position nor dropped out of the program.  Currently, the average nursing turnover rate for the 12 facilities involved in the second training program has already decreased by 7%.

Am I excited? You bet I am!  One nurse, one facility at a time!  I am not certain all the classes will yield these top notch statistics but I do believe each class will yield positive results.

I appreciate this training program is making a difference but I am not foolish enough to think that staff turnover rest solely on the ability of the nurse mangers to lead. I am aware that there are many components that affect turnover; it is for certain we cannot continue to do what we have done in long term care and think everything will be OK!

Onward and upward! We are slated to teach five more classes, and I can’t wait to see the results.



McKnight's Long Term Care News
Peg Tobin
August 01, 2018

Does an administrator affect the success of a director of nurses?

My company, Tobin & Associates, is currently conducting a training program for nurse leaders funded through the Civil Monetary Penalty Grants.  Funding was awarded through the grants to train long-term care nurse leaders in Ohio on tools and behaviors needed to be an effective leader.

In our first class we had 12 students.  Of the 12 nurse leaders:

  • Six said they had supportive and participatory administrators. They met with their director of nurses at least weekly and involved themselves in the training the nurses were receiving.
  • Two administrators refused to have weekly meetings with their director of nurses.
  • Two administrators did not support the program, therefore, did not make attendance a priority.
  • One administrator remained a micromanager even after one-on-one conversation with the mentor.
  • One vocalized that directors of nurses needed to understand that the nursing department is their responsibility and if they do not have enough staff they have to work the floor. This director of nursing was filling in at a minimum of two times a week (the door was not opened for the mentor to review staffing levels).

Yet among this group, the following occurred in a four-month span. Seven of the facilities experienced:

  • Reduced turnover of front line staff (3%)
  • Reduced nursing agency usage (10%)
  • Reduced skin breakdown (7%)
  • Increased applications from nursing assistants seeking positions (10%)
  • The development of a Nursing Assistant Advisory Committee
  • Involved nursing assistants in shift to shift report with the nurses instead of separate reports
  • Nurse leaders improved communications through one on one meeting with their nursing managers, which in turn resulted in reducing daily interruptions by 30%
  • Set up a library of leadership books for all associates to check out and read
  • There was some turnover of staff (7%) that had been in the facility for over 10 years that did not like the changes. For the three facilities the nurse leaders left their facility before the program was complete for a better position, or did not provide statistics.

    Two facilities did not totally commit to the program, voiced dissatisfaction with the training program or the DON did not attend the entire program.

    In one of the facilities the administrator continued to refuse to meet with their DON but the DON attended the entire program. Nursing turnover reduced in this facility by 4%. Communication improved between nurses and nursing assistants. Morale improved. The DON was promoted to regional position.

    The nurses that completed the program stated:

    • They learned to actively listen.
    • They learned “if you want associates to care, you have to first demonstrate you care.”
    • Everyone needs to be involved when setting goals.
    • You can stand up and it does not have to be confrontational, but you must stand up.
    • Organizing my day does matter.
    • Risk and make changes.
    • In spite of the lack of supervisor support, you can make a difference
    • Let go and grow others.
    • Teach, don't always do.

    The class sessions are going extremely well for those who are able to attend.  The consensus of the director of nurses attending this program is that this program would be beneficial to all who become director of nurses. They think it would be positive for administrators to be included in the training.

    Even though I am happy with the positive results, I am saddened that there is such a lack of buy-in by so many LTC administrators. This program is free to the facilities and yet many LTC Administrators will not allow their directors of nurses to attend or even apply.

    I understand that administrators have challenging jobs, and I don't want to trash them. But I do want to point out: If we were able to get these results out of seven nurses that were supported by their administrators and encouraged to attend the program, think of the difference we could make in the lives of the residents if we could get the support of all 12 administrators for each session?

    Margaret (Peg) Tobin, RN, is the president of Tobin & Associates. She is an author and keynote speaker based in Columbus, OH




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