Abundant Living

In John 10:10 Jesus promises His followers abundant life. This blog is about my life as His follower.

Saturday, August 3, 2019

A letter to my son's girlfriend

Last Sunday the Pastor's sermon was finishing the last part of the last chapter in 1 Thessalonians.  As I listened I was caught by that phrase in 1 Thessalonians 5:14; to "encourage the disheartened".  Gosh, the disheartened are everywhere I look: where I work and where I live.  I felt impressed to make that my mission each day.

Surprisingly, what I saw happen was how truly crabby I can be!

But I also got a specific impression to write an actual letter on paper to mail with a stamp to my middle son's girlfriend.  She functions like a wife; they've lived together for 3 years and have been engaged for 2 years.   There are things about her that make her not the person I would have chosen for my son, yet, she has a lot of great qualities.  I also know from what my son and she have told me that her mother has made some positive changes in her life and is a good person today but was an over the top critical person when the girlfriend was growing up.  I think that because of this she has a whole her soul that craves affirmation.

So this is what I wrote in the letter to the girlfriend:

"I want you to know how much I appreciate you.

Sometimes in life I find that I think good things about people in my head, but fail to ever communicate those thoughts.  I want to make sure I explicitly let you know how much I appreciate these specific things about you:

  • How you love my son Dylan
  • How you sincerely love Lilly and Lincoln
  • The way you inspired Dylan to get involved with Altig; the career he’s come to value
  • Your creativity that expresses itself through * Doing all kinds of things that make every Birthday special,  * Coming up with so many fun ideas that make every holiday and special event wonderful and memorable, * Bringing joy into every day life
  • The way you look at each child and see their gifts and leanings and seek to involve him/her in classes or events that nourish those parts of them
  • The value you place on being a mother and wife
  • The fact that you accept, (and model that acceptance for those around you), everyone for who they are and don’t require them to be who you want or think is “right”
  • What a great home decorator you are
  • Your sensitive heart that is moved by the pain of others
  • Your willingness to run point on dealing with crazy (Dylan's ex's name was here; she's the biological mother of Lilly & Lincoln)
  • All the extra work you do because of the split custody situation
  • Your willingness to forgive others when they wrong you
  • Your willingness to engage in self awareness efforts and your heart to want to constantly grow, change and improve
  • Your desire for connection with the spiritual part of life
  • Your appreciation of beauty

I love you (girlfriend's name) and just want you to know how grateful I am that you’re in all of our lives,"

May God use this letter to encourage her.

Tuesday, January 1, 2019

Thoughts of Mom

I'm one of those people who's great in an emergency.  I'm calm and competent. That ability to suppress my feelings and do what needs to get done is useful.

In March 2017 my mom died.  It's only been these last couple of months that I've felt anything.  Prior to that I've basically been numb.  I naively thought that I just didn't feel anything because she'd gone down hill in the last few years and was 92; that none of us lives forever and it was just her time to go.  The truth was that I was just numb. 

It hasn't been heart wrenching lately - it's just that I miss her.  I especially miss the person she was prior to the last few years; let's say the woman I knew my entire life until she was around age 89.  She wasn't perfect.  One of my life regrets is that I spent too much of my time focusing on her failings instead of enjoying all the good.  There was lots of good.

We weren't super close as some mothers and daughter are.  Yet, we had our moments....she was really something.  Keen intellect, opinionated, energetic, and loyal.  Every day she liked to "read the Bible a bit" - what a wonderful legacy that was that she gave me.

What I miss most is getting to go for walks with her and just talk.  She loved that and so did I.  Wish I would have done more of that.  Wish I would have spoiled her more near the end.

Glad that I have so many good memories.  Things she gave me such as a love for reading, always learning, and never being pretentious.

Saturday, March 17, 2018

I want to remember this one

Photo from Inspirational Christian Blogs
Had an experience yesterday that I want to remember.

Every morning before work I sit in this specific beige chair that's next to the bed at where I'm staying during the work week.  Every morning I take time to spend some time with God.  At different times in my life I've approached this time differently. Right now during this time I have this routine:
  • Set my phone timer for 3 minutes during which I try to just quiet myself down and spend time being "still" and knowing that He is God.
  • Spend time thanking God for specific blessings and good things in my life.
  • Read a chapter in the New Testament.  Typically I try to read it out loud. Right now my goal is just to make my way through the New Testament one chapter a day.
  • Reflect on what those verses taught me about God and how God is speaking to me through those verses.
  • Pray
This is not a lot of time, maybe only 10-15 minutes.

These last couple of weeks have been just brutal at work.  One thing after another and then another.  I've been working long hours 5 days a week and coming in for a couple of hours on Sunday evenings.
A HFEN with the California Dept of Public Health (CDPH) had come in on Thursday in response to an incident which we had self reported.  Initially I felt very comfortable because the DON and I had worked hard to make sure we went over the top to handle this situation and document everything excessively.  I thought of it as a nothing berger. Then CDPH comes in and gives me an intent to cite behind the situation.  He said we did everything right but that the regulations changed in this past November and now we have to report anything that is anywhere in the realm of an "abuse" allegation within 2 hours of the incident - no matter what day or time. For years and years and years the regulation has been within 24hours unless bodily harm occurred and then within 2 hours.  In this situation it was not even an allegation - it was witnessed by the 2 patients involved and an LVN and RN.  The LVN and RN had intervened when the one patient went to hit the other so that no contact was made.  There really was no abuse involved but I reported it as an unusual occurrence.  The HFEN told me that I didn't know that the abuse didn't happen until I investigated when one of those patients told me about it on Monday.  I explained that it had been witnessed and the reason the nurses didn't call me was because no abuse occurred.  He pointed out that one of my interviews showed that a C.N.A. said that the 2 patients used "bad words" and that one patient saying bad words to another patient is resident to resident abuse and should have been reported in 2 hours.  I felt frustrated and angry because these type of things keep happening with DPH at this facility.  It is difficult not to feel like they are out to get us. I've been an administrator for many years and never had this type of incessant problems with CDPH.

Anyway, I was all upset.  I complained.  I allowed myself to get a bad attitude. Some other annoying things happend too.

In my time with God yesterday I read Matthew 7. Typically I've been reading NIV in my devotion times, but when I started this series I decided on the 3rd day to start reading the Message paraphrase for a while just to change it up a bit.  Yesterday these words from Matthew 7, starting with verse 7 caught my attention:

Don't bargain with God. Be direct. Ask for what you need. This isn't a cat-and-mouse, hide-and-seek game we're in. 

When I read those words I just had to stop reading and do what it said.  I started asking God for what I needed: forgiveness for my bad attitude, a change of heart, His peace....on and on it went  But suddenly as I was praying I head myself saying words that hadn't been what I'd anticipated.  It was like the Holy Spirit started giving me the words to pray.  I've had that happen a few times in my life, not many. Then I begin to cry as I prayed.  It was as if the tears washed out my heart-all the anger and bitterness and frustration.  I felt clean.  But even more than that - I felt His presence.  I know that the Holy Spirit lives within me and God is always present.  But I don't always feel His presence.  Yesterday morning I felt Him there and it was so very precious.  His peace grew like an outward flow from the depth of my being.

It was a special time.  One of those times I want to remember.

That's why I recorded it here.

Sunday, January 28, 2018

The Change

Graphic from Quanta Magazine
I kind of feel embarrassed to even mention this word: Menopause.

For a while now I've been trying to pretend that it doesn't affect me in any way, but the truth is that it does.  Symptoms include: hot flashes, night sweats, troubled sleep, anxiety, fatigue, and the sometimes over the top emotional response to situations.

I have to be on my guard for the emotional thing so I don't respond to what I feel. I have to stop and say to myself - yes I know this situation/person is really annoying, but do you think that the intensity of these feelings is much more than the situation warrants?  When I realize that this is the case I pray.  If it's at work I also take a walk outside for 10 or more minutes.  Basically I just don't let myself act on those feelings.

In 2 Corinthians 12:1-10 the apostle Paul talks about his ow famous "thorn in the flesh".  I keep thinking about the 9th verse when Paul is relating how he asked God to remove his thorn in the flesh and what the Lord said to him: 

Each time he said, "No But I am with you; that is all you need. My power shows up best in weak people". Now I am glad to boast about how weak I am; I am glad to be a living demonstration of Christ's power, instead of showing off my own power and abilities (TLB)

I keep reminding myself that this is an opportunity to really depend on Him, 'cuz I really can't control this.

I pray that He would use me any way.  I'm more weak than ever before in my life.  I don't have control over what I'm feeling or how my body is acting.

Saturday, January 20, 2018

Drama and forgiveness

Graphic from Greater Good Magazine

It's easy for me to think about being a kind, forgiving, person - until someone does something to me where I'm hurt and it's hard to forgive.  That's where I'm at right now.  

My prayer is that God will change my heart. Until that happens I will keep a guard on my actions and make sure I act in a kind and forgiving manner; kind of like the old saying fake it 'til you make it. 

Here's the story behind this:

This past Tuesday was, as usual, a super busy day at work.  At 2:30PM I hadn't gotten a chance to eat yet and was really hungry. I walked a block to a little food place and got a sandwich which I brought back to my work.  I always keep my office door open when I am at work, even if I am not in my office.  I have a couple of locked cabinets so there's nothing anyone could get into and I always want to feel approachable.  I want to send the message on those rare occasions when the door is closed that I am not to be disturbed. I took my food into my office and closed my door.  I just wanted 20 minutes to relax, repose, and eat. To be refreshed. I needed that time.

I was one bite into a chicken, carrot, jalapeno teriyaki sandwich when a knock sounded on my door.  I set the sandwich aside where it was in plain sight and opened the door.  It was our activities director. He saw my food and said "oh you're just now having lunch? Well here, I want to give you this." He handed me a closed envelope.  I just got a funny feeling and said jokingly "well as long as it's not a letter of resignation" to which he replied "it is".

I opened it up and read a very short letter saying he was quitting effective immediately.  I asked him to sit down.  I told him that even if he has another job to quit, after being at this facility for more than 10 years, without giving a 2-week notice was irregular.  I asked him what was going on.  He went into a long story about the maintenance director saying bad things about him to the dietary supervisor.  The dietary supervisor is best friends with the activity director so she went and told him what the maintenance director had said.  The worst thing about it was that the maintenance director called the activities director a "faggot" when he was talking about him.  It was all said in Tagalog but that's the basic translation. The activities director said he doesn't mind when people call him that teasing but not when they're mad, it's just too much. That's one of those words we all know that you are never supposed to use.  It's up there with the word "nigger"; you just don't use those words.  I never tolerate that kind of talk in the work place.  So here I was hungry, tired, feeling depleted and having this situation thrust on me.  So I silently prayed and began talking with the activities director.

It was obvious that the activities director wanted to be heard.

I already knew that the activities director had a thing with the business office manager (BOM) and admissions/case manager (CM).  He'd texted something that was inappropriate and hurt the CM's feelings and, since she and the BOM are close, he was also offended.  The activities manager had apologized and the CM had said she would still work with him, but it was going to take some time for her to get over it.  The  BOM and CM almost didn't go to the work Christmas party behind all of that.  I had gone into their office, closed the door and let them know that they were not the rank and file, they were part of the facility leadership, and as such they pretty much had to go to the Christmas party.  I'd told them that I technically couldn't make them go but would be beyond disappointed in them if they didn't go. To which they'd replied: "So you want us to go Ms Tracy?"  "OK we will go for you".  (Honestly these folks I work with are so emo!) After the Christmas party the BOM, CM and activities director, dietary supervisor and her husband all went out dancing so I thought that drama was all over with.

Instead I was now having to listen to the activities director talk about how the CM and BOM had repeated something that the activities director said during the AM stand up meeting to the maintenance director.  The activities director said that they had taken it out of context and made it sound as if he'd been talking bad about the maintenance director and that was what had made him angry.  I wanted to bring the maintenance director into my office and have them talk together.  The activities director wanted to talk more first.  I understood-he's the kind of person who needs to vent so I was willing to be there for him and let him get it out of his system. One of the things is that I make sure every couple of weeks to take time to be with the people I directly supervise one to one.  I don't make it formal, I just make sure to be with them and be available if they need to complain about how hard their job is, talk about their plans, share their struggles - whatever it is I just make sure that I give them my undivided attention and talk with them.  (As I think about it right now though, I don't do that with the dietary supervisor as much as everyone else so I'm going to start doing that more with her.  It's always uncomfortable with the DON but I still approach her and make the opportunity).

The activities director was very polite but he obviously wanted to let me know that he felt the problems he's having at work are my fault. He told me how important my job is and the he knows I am a nice person but that I need to really open my eyes. He said that people are taking advantage. He said that no other administrators let department heads work on holidays but that I did and that they didn't do any work they just came in and played.  (The story behind that is that the BOM & CM came in and worked on Thanksgiving and then took off the day after.  All managers are paid for Thanksgiving even though they don't work. Since the BOM & CM took off Friday, it was same financial impact as if they didn't work on Thanksgiving. I liked them working because I wanted someone at the facility on a holiday. Typically a lot of patient's families visit on holidays. The CM and BOMs office is at the front door so they could keep an eye on things and make sure none of our wandering patients went out the more frequently opened front door in all the coming and going.  Plus they provided a presence when people came in the front door.  I was also at work for 4hrs on Thanksgiving morning. I don't know how much work the BOM & CM accomplished on Thanksgiving, but I'd be willing to wager that several of the other managers didn't work too hard on that Friday when I wasn't there.)  He also said that since I let people work 6 hours instead of 8 when they work a weekend manager they are coming in just for 30 minutes and leaving (When I came in and started working here 3 months ago I required all department heads to sometimes work a weekend day as manager of the day so that we have leaders in the building on the weekends.  They take a day off during the pay period to compensate. I knew that people don't like doing weekend manager but feel it is necessary to be excellent so I'd sweetened the situation by telling them they could clock in but not out and work 6 hrs instead of 8).  He said that when the other administrators were here he never had any problems with the other department directors, they all ate together and were friends but that now it had become a terrible place to work. (The medical records director had told me that prior to me coming the old administrator & all the department directors were Filipino and brought in Filipino food and had lunch together.  She'd told me that even though she's Filipino she never went because they would eat and visit for hours and she has too much work to do.  I know that when I first came in the activities director had said that he and the other directors like to bring food in and eat it together and could they still do that.  I told him that of course they have a lunch break and can eat together if they chose to.) He stated that I make all the department directors do room rounds 3 times a week and that means he's helping other departments not his own, but that he never complains.  He said that here he is helping other departments but that no one helps him.  He said that he keeps complaining that the C.N.A.s are not coming in as scheduled to help watch the prone-to-fall patients during activities.  I asked if he feels that our new DSD is helping him with that and he reluctantly admitted that she is.  He said that he hadn't gotten enough help during the resident Christmas party. He said with other administrators he'd always gotten plenty of help because they made everyone help and I did not.  I requested that in the future whenever he had an upcoming event would he please list out the jobs he needs others to do and bring that list to AM stand up meeting for volunteers.  If he isn't getting enough help I would step in and make sure that he has staff for each listed duty. (This is a style preference. He wants me to make a declarative statement such as everyone has to be at the activity event the entire time. I find it more effective to assign people to specific tasks so that we ensure that everything is covered.  I believe that this way I am making him take the leadership for his department and planning what he needs rather than having everyone there and then deciding what needs to be done.) He also mentioned that he's been sick for the past 3 weeks (he'd taken 2 separate days off during this time for sick days). I acted calm.  I listened.  I reflected back what I heard him saying.  I made sure that I was not defensive.  I took notes.  I asked some clarifying questions.  I asked if he thought I should just make weekend managers work a straight 8hrs and clock in and out.  He didn't look happy with that idea.  I didn't explain anything about any of my actions.  I let him talk as much as he wanted.

Then I brought in the maintenance director. As they talked it became very obvious that the real catalyst behind the verbal explosion of the maintenance director was some rift between the maintenance and activities directors.  Apparently all of them - the activities, social services, business, case management, and dietary managers had been very close before.  They'd even gone on trips to Solvang and other places together with some other staff.  They used to eat lunch together every day.  It seemed that maybe 4-6 months ago something had happened between the two of them and now they weren't talking.  The hurt feelings made both of them predisposed to see anything that the other one did  in the worst possible light.  The maintenance director kept focusing on how hurt he was by the fact that he'd felt like the activities director had been like his brother and now there was nothing.  They hashed it out and by the end they still weren't friends but there was the clear understanding that we all have to act professionally at work.  We agreed that the maintenance director would come for the first part of stand up meeting. The maintenance directly clearly received the message that he can never call people names at work, this will never be tolerated.

Then the 3 of us went into the CM & BOMs office because their shared office is larger than mine.  I clearly let them know they can't stir up situations. They maintained that they did not.  Pretty much they all agreed to act professionally at work no matter the state of their personal relationships together.

I went with the activities director back to my office  This whole thing had taken close to 2 hours and the owner had been calling me.  I let the activities director know that I was putting off the owner to take care of this because it was important. He said he thought he still wanted to quit. He had been struggling with cold symptoms so I told him why not take off a couple of days to get to feeling better and then see what he wanted to do.  He said he's already used up his sick days but could he use vacation and I agreed.

First thing the next morning the dietary supervisor came to me.  She talked to me about the whole situation with the activities assistant. I let her know that although I understand why she  told him what the maintenance director said, I think it was unwise.  I explained that typically repeating ugly things one person says to about another just causes more problems and hurt feelings. She said that these two had problems for several months and that the maintenance director is just too quick with his temper so she never directly goes to him about anything (Unknown to her I've counseled and even given written warning to the maintenance director about this issue). We talked a little while.  She said that the activities assistant has been unhappy with his job for awhile.  I asked if it's been since I came.  She said that oh no it's been for around the past 5 months or so.  That it's been going on a long time.

The activities director texted me at 8:30AM that he's made his decision and is not staying but that if I want he will give a 2 week notice.  I texted asking if we could talk at 11AM and he said yes.  When I called at 11AM he did not answer.  His voice mail was not set to accept messages.  I texted that I'd tried to call and could not leave a message. At 12:25PM he texted me that he'd fallen asleep and missed my call.  I texted back that I was glad he got the rest since he'd been sick. I let it go at that.  I was oh so busy that day.  I figured he needed some time to cool off.  I also thought he could reach out to me if he choose. 

That day the BOM came and talked with me.  He makes it a habit to come to me with problems, concerns, anything he thinks I need to know, or  suggestions.  He comes in, closes the door, sits down and talks. He's always prepared, concise and unemotional. One of the things he told me is that the department directors tend to be jealous in their relationships. He reminded me of an event that happened the day of the staff Christmas party. (The MDS coordinator had texted me during stand up meeting that her daughter (who is a Sr. in high school) wanted to come to the Christmas party and was that all right.  I'd been delighted and was about to text back that of course I was excited to meet her.  But some thought in the back of my mind made me decide to first put it out to the department directors at the meeting.  Right away the dietary manager said that's not fair because her husband and her had to make arrangements for her daughter who is in 10th grade (who gets a baby sitter for  a 10th grader?). The activities director told me that his son was 14 but tall for his age and he wasn't coming.  So I'd texted the MDS coordinator back that I wanted to say yes but that the other managers felt upset because they weren't bringing their teen children since we said it was an adult party. I apologized and said I was trying to be fair and consistent.) The BOM told me that when the last administrator was there, the activities assistant had been her favorite. But then he had the falling out with the maintenance director and felt she wasn't giving him enough attention.  He told me that these people are just always jealous and he doesn't understand.  I explained to him that this happens a lot in SNFs. I said that he doesn't understand because he is different - he started as maintenance assistant 4 yrs ago, now he is BOM and will become an administrator. As administrators we can't be emotional or put our feelings first. If we do, we won't be effective.

Around 6:30PM that day the dietary supervisor texted me that she'd just talked to the activities director and that he just waiting for my call.  I texted back that I was glad she told me, that I'd call him the next day, & thought he might need some rest so I hadn't wanted to call him. She texted back that he was just waiting to talk to me and that she'd told him how busy I was. She said she was crossing her fingers and hoping it went well when I talked with him.

I finally got a chance to call him the next day  He basically said he didn't have another job.  He assured me that he's had offers but wants to stay here.  I said great because I want to work together. I told him to go ahead and take off the rest of the week since he's sick.  I didn't say it to him, but wanted him to have that time to think and cool off.  I was also feeling really irritated and felt like I needed the time but didn't say that.  There was a major monthly activities event that I was staying late to do that night since he was gone.  I felt like I'd spent way too much time on this whole thing.

Right after we hung up Leila the company resource nurse called me.  She wanted to know if the activities director quit and what was going on.  I told her it was a lot of drama but we worked through it and he is still working for us.  I specifically refrained from telling any specifics.

I feel like everything came out OK.  But when I look at my own feelings, if I let myself, I will feel resentful toward the activities director.  I'd felt so hurt about all the things he basically said about my poor leadership.  He'd hit right on my Achilles heel. I have concerns that because I am really nice, people don't fear me and so might not perform as well as they would if I had a more commanding presence  Yet, at the end of the day I am who I am.  I am not the type who has a commanding presence that causes people to sit up straight.  I try to be competent, kind and a servant leader.  I seek to hold people accountable.  I try to get people to participate in the decision making process.  I try to create buy in when I make decisions. This way of doing things is a lot more difficult, but it is where my heart is.  However, I am human and fallible.  So I really grieved over what he told me and went back through my mind over all my actions since I came to the facility.  I looked to see what I could have done differently or what I'd done wrong.

Then  I find out from the dietary manager and BOM the next day that the activity manager didn't tell me the truth.  They didn't know what he'd said.  He was very specific that he'd not had any problems at work when the other administrators were there because they'd provided the kind of leadership needed.  But both of them had told me that this problem between him & the maintenance director had happened before I ever showed up. His friend the dietary supervisor had told me that he'd been unhappy at work for more than 4 months. In my head I know that people are just like this.  I also know that since the BOM and CM have taken on additional duties and successfully marketed to increase the census, I have praised them.  I recognize that he's jealous. Yet, I'm irritated.  If I don't watch myself I could be less responsive toward this director.

Writing all this has helped me process.  I need to sit down and talk to him when he comes back.  I need to let him know:
  • That I am happy he is still going to work with us because I value him.
  • Reiterate that I need him to list out duties with which he needs help for his special events so I can support him in getting the help he needs.
  • Reiterate that my door is always open and he can come to me if he has any concerns or just needs to talk.
  • Bring up something I'd like to see him develop for the activities department.  I want him to have an activity that allows the residents to help others in the community. I've brought it up before and he liked the idea but didn't seem to want to do the extra work. (I'd talked to one of his assistants and he loved the idea)  I'll do some of the foot work for him and bring a mostly developed idea that he can use or come up with one of his own
  • My reasonsing for people working on Thanksgiving and how it did not create any negative financial impact.
  • Reiterate that this business lost $950,000 prior to November of last year (I came October 9). Reiterate that we have to make changes to ensure we at least break even and then move on to make money. Reiterate that census mix is one of the big keys. Explain that I don't favor the BOM or CM but do appreciate their help to change our census mix.
  • Inquire if he wants me to change the MOD to a straight clock in and out 8 hour situation.
Just writing this all down has helped me get all my feelings out so I don't feel so weighed down by resentful feelings.

I pray that God empower me to keep my heart right.  That He make me an effective leader to His glory.

Monday, January 15, 2018

I want to be a good leader

leadership-vs-management-difference-article.jpg (848×477)
Graphic from Simplilearn

Today the medical records supervisor came to talk with me about some things.  We talked about  business details and then she clued me in on a situation with one of the nurses. I appreciate the low key way that she sometimes lets me know about issues with staff.  Small things, but the kind of small things which if they continue over time could cause problems. The kind of stuff I might not be in a position to see.

She told me that one of the LVN charge nurses named Dustin seemed a bit upset.  She said that she noticed he'd been different lately.  I asked her if she knew why and she said that she thinks the DON wrote him up for his medication audit.  I felt a twinge of guilt. I've been applying pressure on the DON to get her to do her job.  The only way I know to do that with someone like her is to point to very concrete things such as how poorly the medication audits are.  I informed her a couple of weeks ago that I will be monitoring to ensure that she decreases the volume of errors.  I didn't say it but previously she'd basically been ignoring the audits. Apparently the way she chose to approach that was to write staff up.  Dustin was one of those staff.

Dustin is one of our best nurses.  He's got two things that make him steller: he's got a caring spirit and loads of common sense.  I don't want a good staff to feel unappreciated.  So I prayed about how to approach him. I didn't exactly plan out what I'd say, I just prayed that God would give me the words. I waited until later in the evening and approached Dustin and asked if he had a couple of minutes.  He followed me into my office.  I told him that I wasn't quite sure how to bring something up but was just gonna be transparent with him 'cuz that's how I work. I said I'd heard he received a write up and didn't want him to be discouraged.  I told him that he's one of our best nurses because he obviously truly cares for patients and has common sense.  We talked for a bit. We even talked about the medication audit results.  I explained that I'd put pressure on the DON to produce a decrease in error findings.  He admitted that he understands that it's a liability for the facility to have so many errors.  I agreed with that and also said that God forbid that these weren't just signing errors - what if some of them represent medications that weren't given to patients?  But we also talked about how much I appreciate him and how great he is as a nurse.  He talked about some of his challenges on the shift today and I gave him empathy about his struggles.  He told me that he was so glad that I talked with him because he feels appreciated.

I'm so grateful that it turned out.  I want to have people held accountable, and I also want caring, good people to be commended.  I want them to feel heard and appreciated.

Saturday, January 13, 2018

We passed!

Graphic from N & W Associates
Life always includes both the good and the bad.  Yesterday was a great example of that.

I called the local department of public health (DPH) yesterday. A woman there said our 2567s (the written problems noted during the survey are put onto a government form called a 2567) weren't done being written up yet and we'd get them either today or Monday.  But she was kind enough to verify that we did pass the survey!

I couldn't stop praising God!

This means that as soon as I obtain the 2567, write a plan of correction (POC), and provide verification of those corrections, DPH will issue me what they call a 2567B. The lady I spoke with promised she'd even fax me a copy of the 2567B so that I could get it more quickly.  Once I have the 2567B we can contact CMS (centers for Medicare and Medicaid) and get paid for all our new admissions since November 15.  Wow-what a relief! I hate to even think about what would have happened if we had not passed...

I'd called the owner's son and told him and he told the owner (he's actually the owner as well). Later in the day the owner called me and I was thinking she was going to rejoice with me or perhaps even thank me.  The survey that we didn't pass came on my 4th day and the problem situation occurred back in August - so I was in no way at fault.  But I've worked hard together with everyone else, and by God's grace provided the leadership to get things fixed.

The owner has  4 other facilities. DPH is doing a survey at one other the others and it is going very terribly.  The owner was upset and distraught.  In my head I understand what stress this must be for her.  I know that this building I'm running lost a lot of money last year and then with this denial of payment for new admissions since November, it's made her short on cash.  It must be extremely stressful.  At the same time, I found it difficult yesterday when she was yelling at me on the phone.

She was talking, talking, talking about all the problems and then telling me how I need to reduce the number of licensed nurses are are running on the AM and PM shifts.  I reminded her that we are barely meeting the state required 3.2 nursing hours per patient per day and she told me that I needed to meet that requirement through C.N.A.s instead of licensed nurses.  I didn't even get into it with her that I think we need to keep the number of licensed nurses AND increase the numbers of C.N.A.s.  Instead of just meeting the required 3.2 we should be running at 3.6 - that's part of how we become a 5-star facility.  I didn't say it because I didn't think this was the time to tell her that.  The she started telling me how I need to get the census up.  I reminded her about the steady increase in the census every since I came, to which she countered that I need to have 30 Medicare. Her message was that you may think you're improving but it's not good enough. I let her know we are working together and it takes time.  I didn't even get into the fact that this building is a 2-star in a 5-star system and all the other issues.  I just said the truth - that I am doing everything I can to provide the leadership to make it better and it is getting better.

 I'm kind of mad at myself because I let her get to me. I felt hurt.  In my head I know that I work unto God and not the owner.  In my head I know that God has chosen to put His blessing and favor on me and that, by His grace and through a lot of hard work and strategizing, we are doing a great job at improving. In my head I know that it is "never enough" with these owners.  But it was 1:30PM and I hadn't had lunch.  It was Friday and I was tired from a hard week.  I was still struggling with cold symptoms.  I felt angry over top of sadness.  There were 2 checks I needed to cash for the facility so I went to lunch and then to the bank While out, I called and talked with John my husband.  I prayed.

By God's grace I strive to remain emotionally even.  I'm 57 and have my own hormonal issues so I'm reminding myself not to be so hard on myself for feeling upset.  I didn't act on those feelings or tell others at work about them.  Although I did mention to John our business office manager that I'd just gotten off the phone with the owner and instead of thanking me she was yelling at me. I tell him things because he wants to become an administrator and he'll have to deal with owners. I also told him that the truth is that we all did great with the survey and he and Kristine are doing a great job at increasing the census.

The owner is difficult.  I believe that this is where God has me now so I look to Him for the grace to be able to deal with her.  God has blessed me with favor with DPH on that re-survey and I am grateful.  I'm looking forward to what's going to happen in the coming days.
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