The disposition last year of the case of Tennessee’s now-former nurse RaDonda Vaught was a wake-up call for any organization that’s struggling with the worsening shortage of medical professionals, and with nurses in particular.
Operators of senior living communities — just as, if not more, hampered than primary care providers by the shortage — need to be ready to manage the fallout from the Vaught case and all the risks that are intensifying during the staffing crisis.
It’s not just individual errors such as Vaught’s that they have to guard against. It’s being on top of the necessary checks and balances practiced by the staffing agency partners they increasingly depend on, risks that aren’t under the operators’ direct control.
Vaught’s case and the damper on medical professionals
Vaught was stripped of her nursing license and sentenced last May to three years of probation, charged with criminally negligent homicide after administering the wrong medication to a patient at Vanderbilt University Medical Center in 2017. In overriding the electronic dispensing system when she couldn’t find the needed one, she mistakenly grabbed the wrong medication.
Every institution has medication administration policies spelled out, and every nurse is trained in and should be aware of best practice protocols. But the harsh criminal charges made the Vaught case a major issue, intensifying concerns over mounting pressures on nurses and other healthcare professionals at a time when they are leaving in droves.
The average turnover rate among nurses was 27.1% in 2021; 13 million are needed globally over the coming decade to stem the tide. Meanwhile, there’s also a shortage of faculty, staff and budget to train new nurses. In 2019, nursing schools turned away 80,407 applicants. The Vaught case made recruitment efforts more challenging, given the inevitability — and costs — of human error, especially when there are fewer bodies to do more work.
Impact on senior living
Nursing-related occupations, from registered nurses to licensed practical nurses and licensed vocational nurses to nursing assistants and aides, are critical to the senior living and care sector, accounting for about 52% of all employees in 2021, according to the National Investment Center for Seniors Housing & Care.
The same pressure is on senior living and care to recruit qualified caregivers as is on health systems, having lost 210,000 jobs between February 2020 and December 2022. A return to pre-pandemic staffing levels isn’t expected until 2027.
Increasingly, operators have turned to staffing agencies to fill shortages. By 2021, as the industry was still reeling from the pandemic’s impact, 38% of senior living providers and 69% of nursing homes said in one survey that they counted on agencies to supply their manpower needs.
An expanded perspective of risks becomes that much more critical given the trends as it’s not uncommon for these staffing agencies to not carry insurance on their contracted people, pushing the risk — however unintended — on to their clients.
Assessing clinical staffing firms
Hospitals are required by accreditation organizations to develop tools to determine the competency of nurses provided by staffing agencies, augmenting the ongoing nurse evaluation processes of staff and agency nurses alike. Operators of senior living communities can avoid significant exposure by conducting similar assessment of their clinical staffing agency partners.
Here are areas the evaluation should cover:
1. Agency leadership. This part of the assessment explores how the organization is set up and sets the tone for best practices. An organizational chart, for example, should specify which individuals are responsible for quality of service. Also important is a documented code of ethics that covers conflicts of interest and a methodology for resolving complaints from staff and clients. Written policies and procedures on managing safety risks should be checked, and whether the agency keeps a log of reported accidents, injuries and safety hazards.
2. Human resources management. Written policies should be in place to confirm qualifications and competencies fit job assignments and responsibilities; similarly, they should cover current licenses, certification and registration, along with education, training and experience. Criminal background checks are critical, as are proof of identity and compliance with health screening and immunization requirements.
The agency should provide thorough orientations for clinical staff. Also important are a path for staff members to request reassignment and the agency’s openness to making job modifications to ensure competency. The agency should satisfactorily describe how it establishes and maintains the staff’s clinical competency, whether it facilitates ongoing education and conducts periodic performance evaluations. Along these lines, it’s also important to have a comprehensive plan for improvement that uses client input.
3. Information management. It’s key to establish the adequacy of the agency’s IT processes for internal and external needs. Similarly, health and HR records for every staff member should be maintained, backed by a written policy to protect the privacy and security of staff and client information. Regular backup and storage to protect against information loss also should be checked.
Gigi Acevedo-Parker is National Practice Leader – Clinical Risk Management, for global top 5 insurance brokerage Hub International. She is a nurse executive with more than 30 years as a healthcare clinician, nursing leader, healthcare consultant and educator with a focus on healthcare risk mitigation and patient safety. She has experience in many diverse aspects of risk management and compliance, including loss prevention and mitigation, patient safety and quality, claims and litigation management, corporate compliance and privacy.
Gerald Stoll is the US Senior Care Segment Leader with Hub International. He specializes in developing comprehensive insurance and risk management solutions for the long-term care industry, including assisted living, independent living, nursing homes, clinics and urgent care centers.
The opinions expressed in each McKnight’s Senior Living marketplace column are those of the author and are not necessarily those of McKnight’s Senior Living.
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