Abundant Living

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

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!

https://nwebsterllc.com/wp-content/uploads/2017/02/The-GOOD-and-The-BAD-Things.jpeg
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.

Wednesday, January 10, 2018

You aren't always sure but you hope

For some weird reason a couple of weeks ago I had been remembering stuff I'd done wrong as a parent.  Every time I'd remember something I'd feel sad and grieve how I'd most likely done some sort of internal "damage" to my children.  It's not like I don't know that I'm forgiven; but there are still consequences to our behavior. Sometimes it's tough being a parent because you know you have such an impact on your children, yet you're broken yourself.  I always sought to have God help me but sometimes I screwed up.

Then out of the blue I got this instant message from my youngest son:

"Hey, I was thinking about how you taught me to serve others without expecting gratitude. Thank you."

I messaged back asking if anything had brought that up and he messaged me back saying he'd just been reading Proverbs 31 and thought about me especially when he read the 31st verse.  Wow. I've always seen that passage as the woman-who's-oh-so-wonderful and felt so much less than when I read it.  Yet here was Daniel saying he'd thought of me....what a blessing!

But it gets even better.

Last week we were talking on the phone and Daniel alluded to that conversation.  Then he said something about how he wanted to say more.  He sounded a bit nervous.  I steeled myself thinking okay here it comes, he's gonna tell me all the ways I was a mess up.  But that's not at all what he did. Instead he wanted to detail out for me all the things he was grateful for that I did for him.  I was so shocked that I can't even remember what exactly he said. But there were a few specific things that he said that meant a lot to me because of the story behind them:

* He said he was grateful that I always talked good about his father.
You know, the truth of the matter is that I did that by faith.  And by God's power.  His dad cheated on me. He said a lot of mean stuff to me (a common thing for a cheating spouse to do because it validates that it's OK what they did since you're so awful).  I was willing to forgive his dad and he wanted to stay in a marriage so he could be with his kids and save money, but he didn't want to remain faithful to me only.  A few years afterward I heard the boys saying the same kinds of things about the girlfriend that their dad had said about me in the end.  I knew they'd heard those things from their dad and were just repeating them.  Soon afterward their breakup became official and he was instantly with another woman. About a year ago something came up and my other son told me that his dad and that next girlfriend (whom he is still with) had an "open relationship". Back when their dad and I broke up I was so heart broken.  I knew divorce is awful for kids, I wanted better than that for my kids....I purposed in my heart to not talk bad about their dad because I didn't want them to be hurt any more. Their dad is super charming and it always seemed like he had fun times with the boys.  He had more money and could take them on fun & exciting vacations.  Sometimes it felt unfair.  But I tried to just run my race and do what I thought God wanted of me and trust Him.  Daniel saying that was validating for me.  I'm grateful that he recognized it.  It was one of those things where I'd never known if the boys would ever realize what I tried to do for them.

* He said he was grateful that I'd brought them up to see what Christianity was really about.
Isn't that what we always want our kids to say?!

* He expressed how much it meant to him, that he appreciated, what I did with World Vision.
It was a big deal to me and I wanted it to be an object lesson for my kids, so I'm grateful that it at least impressed Daniel. (I don't know what the others think of it or if they even remember). We were really blessed when I was single.  My kids needs were always met.  But we lived more frugally than most people.  I was working as an assistant administrator and working toward obtaining my administrator's license.  There's a huge difference between what an assistant administrator and what the administrator gets paid. We were always in church and I always gave and taught them about giving. But when I got my first job as an administrator I got the three of them together and told them how blessed were were and that I wanted to give out of our blessing.  Since there were three of them, we picked three world vision boys who were the same ages as my boys and began to sponsor them monthly.

* He told me that he always appreciated that I didn't favor any of them and treated them all as individuals.  I'd worked hard on that one and was grateful to hear that he felt that way!

I'm so grateful that Daniel told me these things.

So often as a parent you know your kids love you but you're not sure if they really get what you're trying to do or appreciate it.  What a blessing it is to hear that Daniel appreciated me.

I wanted to write it down as one of those things I can look back at and say look what God did.



Saturday, January 6, 2018

John and Natalie

https://images.techhive.com/images/article/2017/03/uber-mentor-and-fast_primary-100711744-large.jpg
Photo from CIO from IDG
John and Natalie are two people with whom I work.  They couldn't be more different than one another.  But they are both significant to me.  Let me tell you about each of them.

John is in his mid twenties.  He's Filipino. He came to this country right after he finished college and has worked at Fidelity Health Care, where we all work, since then.  He started out as a maintenance assistant and now he is the business office manager. His English is super good but sometimes he misses out on cultural inferences that American born people take for granted.  Since more than half of the facility staff were born in another country, it presents less of a problem than would be expected. He lives with his family and walks to work.  Once I said something about how I wish I were Asian so that my kids and grandkids would live with me and he looked kind of excited and said yes that's how they do things. He is smart, motivated, and efficient.  At first I found him resistant toward me but now he seems to have gotten over it; I'm not exactly sure why. After I was there a few weeks John and his office mate Kristine (who I  think is his girlfriend) came to me.  They said they wanted to try marketing to increase the facility census.  They knew I'd been interviewing marketers but they said they were willing to take on the additional duties.  We talk together but I've ultimately let them do it their way and go out marketing whenever they want.  I've made sure that they have all the money they need. I've supported them extensively; praised their efforts, told the team that we have to work harder with more difficult patients to increase our census, and pushed the DON to take most referrals. In the past two months they've worked together with the team and our Medicare (the most desired insurance) patients have increased from 9 to 16. Payment level HMOs have increased from none to 3 patients. About 2 weeks ago they came and asked for a raise.  I appreciated that they showed me their marketing results prior to asking for more money.  I was able to get each of them $2 more an hour. On New Year's eve John texted me "Happy New Year's Ms Tracy" with some party images.  (I actually hate those cute little images but even my beloved husband John uses them). John wants to become a nursing home administrator. In order to do that in California you have to have a bachelor's degree, get a licensed administrator who is certified to preceptor to  preceptor you for 1,000 hours, and pass both a federal and state exam. A previous administrator at Fidelity had started the preceptor program with John and then been let go and decided to move to Arizona; which left John out in the cold.  I meet the requirements to be a preceptor but have never taken the class to become certified to be one in California.  In 3 months the class is being offered in Sacramento, which is a long way from where we are at.  In 6 months the class is being offered in Riverside which is only about an hour's drive from where we are at.  I emailed him this past week that I'm going to take that class in June and afterward I'm willing to preceptor him if he'd like.  He emailed me back that he wants that.  I'm not sure what John's personal beliefs are but I feel drawn to him.  I feel like God wants to use me in his life, so I'm praying about how.

Natalie is most likely in her fourties but is beautiful, fit, and looks younger.  She's African American.  She started out as a C.N.A. in the nursing home business and then became an LVN.  She worked at Spring Valley where I used to work for a few months, but it was after I left.  I hired her not too long ago to be our Director of Staff Development (DSD). Leila referred her to me.  From our first conversation during the interview I liked her and knew she'd  be a great employee. This is her first DSD job. I paid her more than she asked for.  She is super excited, working to get things organized, goal oriented, and easy to work with.  She respects authority and is the kind of person that I can sit down with and problem solve.  She's a team player and we can both dig in and work together - I love working with people like that! She comes in at all times of the day so that she can work with and supervise staff on the various shifts.  She's working to get the staff trained.  I'm working to support her efforts and require that the DON and other nursing staff support her efforts and work with her instead of expecting her to do everything (which would be impossible). She has a handsome husband who I think is her second husband, a teenager, and at least one young adult child who lives back east some where.  She is a Christian and sometimes drops phrases like how she's praying for God's favor. I really like her and find her easy to be around. I feel like God wants to use me in her life, so I'm praying about how.

I feel a deep desire to lift both of these two up in their careers.  I want to be as much of a help to them as I can and maybe, through the grace and power of God, be even more of  a help to them then I would ever think I could.

Right now I'm praying and looking for opportunities.  Today I felt impressed to write each of them an encouraging note. So I'm praying for each of them and about what to say in the notes

I'm looking forward to what God is going to do.


Saturday, December 30, 2017

Favor

I hear teachers and people in the Christian community talk about God's favor.

I've read the story of Joseph and seen what God's favor looks like on someone.  No matter what bad thing happened to that man, he still rose to the top. 

Not too long ago when I was studying in Ephesians I felt impressed to research Bible verses on three specific topics: God's direction, God's ability, and God's favor.  I spent several hours pouring through the Scriptures and came up with a list of verses and passages on these topics. I made a page for each topic and put down my favorite verses for each topic on that topic's page.  At the bottom of the page I wrote down a few brief truth statements based on those scriptures.  I began to read these pages aloud daily.  More recently I've read each page aloud once a week. I'll just add reading a page aloud into my time with God in the morning; so that I'm reading a page on 3 weekday mornings.

As a nursing home administrator I've noticed in the past few years that the department of public health (DPH) has come down harder on my industry than ever before.  Although the relationship between DPH and the facility has always been one of policing, in the past I've been able to develop good relationships with local surveyors.  This has become more difficult to achieve in recent times. DPH has been much more adversarial.  I hear about them citing and fining facilities right and left; even though the industry has made some strides toward overall quality improvement.

On my 4th day on this job DPH came in for their annual survey.  We did not pass.  The reason was tied to an event that occurred the prior July. Although the leadership at that time had not handled that specific event in the best way possible, the fact that DPH caused it to make the facility not pass the annual survey was over the top unreasonable.  I wrote the plan of corrections as well as filled out all the numerous forms and wrote letters to go to a hearing about the actual ruling.  None the less the facility must be re-surveyed and must pass the re-survey. 

DPH took two months to come back to resurvey.  That meant two months of not being able to bill for any new admissions.  If the facility passes the re-survey, then they can back bill for those service days.  If they do not pass the re-survey, they basically provided it for free.  I've got a Director of Nursing (DON) who makes a lot of money and thinks it is a 9-5 with an hour lunch break kind of job.  Even when the DON is there, her head is not really in the game.  She doesn't exude any passion for her job  or take ownership. 

Sometimes my job is stressful.

I got sick this past week. Typically I ignore it when I'm sick and just go in to work.  But this time it was weird.  Every inch of my body ached and I was oh so tired. I most likely had a fever since I couldn't seem to get warm; the air just seemed too cold. All I wanted was to lay very very still.  I was nauseous and had a little bit of vomiting (I'd not eaten in a day so there wasn't much to retch up). At 7AM I texted the facility owner, DON and our business office manager (BOM) that I was just too sick and wouldn't be able to come in that day.  DPH showed up at 9AM.  The maintenance director texted me. I texted back the maintenance supervisor as well as the BOM and DON asking if it was for the annual survey. The BOM replied that it was. So I drug my sorry self into the shower, got dressed, and hustled in to work.

It was one of those days when I prayed for God's strength a lot.  At the end of the day I wanted nothing more than to go home and crawl into bed.  I had not eaten by now in two days, I ached everywhere, and could hardly keep my eyes open.  But I prayed for wisdom and presence and met with all the facility leadership to discuss the day's events.  I did my best at facilitating a strategy planning session. I was definitely not on my A game. Nursing homes are set up so that it is the administrator and DON who provides the leadership - without that presence, everyone would just go their separate ways.

I felt better by the second day. Not 100 percent, but at least I could think better and even managed to eat a little something and drink some tea (caffeine at last!).

One of the things that kept hitting me throughout the day was that it was as if these surveyors were going out of their way to do us good. It was as if they wanted us to pass.  When I talked with them they were reasonable.  A few of our high functioning, lucid, articulate patients went out their way to say good things about me (I know this because they each told me the things they'd said about me to the surveyors when I visited with them that day.  And no, I did not ask!)  The surveyors only noted 4 problem findings; which in recent years in California is very good. For this facility it was unheard of. There were things they could have mentioned that would have been very problematic that they chose not to. 

I think experienced the favor of God.

I won't know the outcome for a few weeks.  A month at most.  The supervisor of the surveyors sets the scope and severity for the deficiencies. In re-surveys it has to be a low scope and severity level in order to pass. Typically the supervisor listens and relies heavily on the surveyors.

I'm praying for God's continued favor.

Watching a little miracle

Photo from The endless disconnect
There's a woman at work. I'll call her Hester.
             
Hester came to our facility about 5 weeks ago.  Our DON didn't want to admit her because her record stated that she originally went to the acute hospital due to suicidal attempts.  It said that she had become withdrawn since her husband died. She had taken knives and attempted to stab herself and tried to jump off a second story balcony.  I felt like we needed to admit her (and it wasn't just because she had good insurance either).  Initially we had a C.N.A. with her constantly one to one.  We removed the call light and gave her a bell. She had plastic serving utensils The DON and I had intense discussions about removing the one to one, but we finally did it (sooner than the DON wanted and later than I desired).  Initially I went in every morning to see Hester but she wouldn't even look at me.  She looked angry.  At first she wouldn't eat. 

Hester only speaks Cantonese. I have staff who can speak Tagalog, Chinese, Vietnamese, Spanish.  I have only one staff person who can speak some Cantonese-Tao. She went in and tried to talk with Hester daily.  At first Hester wouldn't even look at Tao.  She never talked to Tao. I talked to the kitchen on Hester's second day and got them to make her a rice soup porridge type dish that I notice  many of our Asian patients enjoying. After Tao ate one spoonful first, Hester gobbled that right up.  The kitchen kept making that for her since at least she would eat it.  They would make her the regular meals plus the rice porridge soup.  She initially would only eat the soup.  We had to continue to eat one bite first.  Hester wouldn't take any of her medications when she first came.

Her nephew visited on her 5th day.  Hester gathered up all her belongings to follow him out when he left.  She seemed angry that she did not get to go with him. For the first few weeks it continued like this.

Then we stopped having to take a bite of the food first. She started taking her medication. We gave her regular utensils.  She began eating bites of the other food.  She started eating anything we gave her. She began to come to the door of her room if she wanted something such as a snack or roll of toilet paper for her bathroom.

One day she gathered up all her belongings and went to the front hallway.  Eventually we had to take her back to her room.  She started routinely seeking out snacks and occasionally coming out of her room to take short walks in the hallway. She would look at Tao when Tao spoke to her.

The other day Tao mentioned that Hester is now speaking to her a little bit on her daily visits.  Tao said that Hester still won't come into the group activity or dining room for a meal but that she's at least talking with her. Yesterday I saw Hester out of bed and standing beside the bed of her room mate.  She was curiously examining her sleeping room mate.  Hester was taking an interest in someone else!

Hester is going to be all right.



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