Director of Nursing, Skilled Nursing

Job Title

SNF Director of Nursing (DON)

Department

Skilled Nursing Facility (SNF)

Reports To

Chief Nursing Officer (CNO), or CEO Designee

FLSA Status

Exempt / Salaried, Executive Exemption (HR-014, HR-015)

Pay Range

$156,000 - $183,414 Annual Salary (Hourly Equivalent $75.00 - $88.18 at 2,080 Hours, or $83.33 - $97.98 at 1,872 Hours for a 12-Hour Clinical Shift Schedule), Based on Verified Years of Nursing Leadership Experience and Qualifications

Work Location

Southern Inyo Healthcare District Skilled Nursing Facility (33 Licensed Beds)

501 East Locust Street; Lone Pine, CA

Job Summary

The SNF Director of Nursing plans, organizes, directs, controls, and coordinates nursing and health services in the 33-bed Skilled Nursing Facility. The position is accountable for management responsibilities that include staffing, leading, staff morale, resident and family satisfaction, quality, organization, and regulatory compliance. A key component of success is the ability to partner with District departments, including Quality, Compliance, and Patient Financial Services.

The DON is the designated full-time Registered Nurse responsible for nursing services under federal and California requirements. The position oversees the nursing leadership team, staff development and CNA training, MDS and care planning, infection prevention, medication safety, QAPI, and survey readiness, and reports to the Chief Nursing Officer (CNO), or CEO designee.

Essential Duties and Responsibilities

1. SNF Operations and Policy

• Maintains SNF Operations Guidelines by Reviewing, Writing, And Updating Policies and Procedures
• Oversees SNF Operations by Initiating, Coordinating, and Enforcing Program, Operational, and Personnel Policies and Procedures
• Ensures Compliance with State and Federal Regulations and Investigates and Corrects Problems, Issues, and Concerns
• Serves as the Designated Full-Time Director of Nursing for the Facility and Only this Facility

1. Clinical Quality and Documentation Oversight

• Reviews and Audits Dietary, Pharmacy, and Resident Medical Records, and Documents and Communicates Actions, Irregularities, and Continuing Needs
• Attends And Documents the SNF Quality Assurance and Infection Control Meetings and Leads Nursing Participation In QAPI
• Oversees the Quarterly Medical Review and Ensures Physician Orders, Visits, and Medication Regimen Reviews are Completed and Acted on
• Reviews Clinical Outcome Indicators Monthly, Including Falls, Pressure Injuries, Weight Loss, Antipsychotic Use, Infections, and Hospital Transfers, and Directs Improvement Actions

1. Resident Protection and Safety

• Develops and Interprets Infection-Control Policies and Protocols and Oversees the Infection Prevention and Antibiotic Stewardship Programs
• Reviews and Enforces Medication Administration and Storage Procedures and Controlled-Substance Regulations, in Partnership with the Pharmacist-in-Charge
• Ensures Nursing Compliance with Procedures, Rules, and Regulations Regarding Patient Safety, Infection Prevention, and Sanitation, in Partnership with the EVS and Life Safety Teams
• Ensures Every Allegation of Abuse, Neglect, or Exploitation Is Reported and Investigated as Required by Law

1. Staffing And Staff Development

• Plans And Posts Nursing Staffing to Meet Minimum Direct Care Service Hours Per Patient Day, Resident Acuity, and Regulatory Requirements, and Reviews Payroll-Based Journal Data
• Participates in The Screening, Interviewing, And Selection Of Staff, And Makes Or Recommends Hiring, Discipline, Promotion, And Separation Decisions
• Conducts Annual Staff Evaluations And Periodic Reviews Of Job Descriptions
• Develops And Oversees The Director Of Staff Development (DSD)
• Supports the DSD in Developing and Running Training Programs, the CNA Certification Program, and Staff In-Service Training Programs
• Defines, Directs, and Supervises the Nursing Leadership Team, Including but Not Limited to the RN Clinical Care Coordinator, Charge Nurses, MDS Coordinator, Social Services, Activities Director, and DSD
• Conducts Regular SNF Department Meetings with the Broader SNF Leadership Team, Including EVS, Dietary, Quality, and Nursing Leaders, Covering Clinical, Social, Environmental, and Operational Aspects of Facility Operations
• Ensures Daily Morning Huddles Are Held and Are Informative and Productive

1. Resident Care Requirements and Coordination

• Identifies Resident Care Requirements and Coordinates Services with Community Agencies, Physicians, Families and Residents, and Other Departments
• Supervises Resident Admissions, Resident Assessments, MDS, Discharge Planning, the Activities Program, and Care Plans on All SNF Residents
• Ensures the RN Clinical Care Coordinator Maintains Regular Communication with the Medical Director on Resident Care, Policy, and Provider Issues
• Directs Dietary Services Jointly with the Dietary Manager and the Consultant Dietitian on Nutrition and Weight Concerns

1. Fiscal and Administrative Responsibility

• Participates in the Annual Nursing Budget and Monitors Labor Hours, Overtime, Agency Use, Supplies, and Equipment Against Budget
• Partners with the District Quality Department on the Facility's Response to Regulatory Surveys and on the Development and Implementation of Plans of Correction
• Ensures Adherence to All Plans of Correction in Conjunction with Quality Department Recommendations and Oversight
• May Perform Other Related Duties as Assigned and Deemed Necessary by the CNO

1. Communication, Compliance and Mandatory Reporting

• Immediately Reports Suspected Abuse, Neglect, or Exploitation and Resident-Safety Events as Required by Law and District Policy
• Maintains Confidentiality of All Proprietary and Confidential Information and Complies with HIPAA and District Privacy Policies
• Participates in the Compliance Program and Code of Conduct, and Does Not Participate in or Allow Retaliation Against Those Who Report Good-Faith Concerns

1. Professional Standards

• Displays Integrity and Professionalism, Completes All Compliance Training, and Understands and Follows District Policies, Including Harassment and Compliance Procedures
• Displays Effective Team-Building Skills and Exhibits Excellent Customer Service and a Positive Attitude Toward Residents, Families, and Co-Workers
• Performs Other Duties Reasonably Related to the Position and Consistent with the Incumbent's License, Qualifications, and Department Needs

Knowledge, Skills and Abilities

Knowledge of

• Nursing Administration Practices and Procedures and the Laws, Regulations, and Guidelines Governing Nursing Administration in Skilled Nursing Facilities
• In-Depth Knowledge of Legal Policies and Regulations in the Healthcare Industry, Including 42 CFR Part 483, California Title 22, and Health and Safety Code Staffing Requirements
• Geriatric and Post-Acute Clinical Care, MDS and Care Planning, Infection Prevention, and Medication Safety
• Budgeting, Staffing, Labor Relations, and Employment Law as They Apply to Nursing Leadership
• Quality Assurance and Performance Improvement (QAPI) Methods and Survey Readiness

Ability To

• Lead, Motivate, and Hold Accountable a Nursing Team and Function at an Expert Level in the Field of Practice
• Make Independent Decisions When Circumstances Warrant and Exercise Sound Judgment Under Pressure
• Communicate Effectively with Physicians, Residents, Families, Regulators, Nursing Staff, and Other Leaders
• Respond to Common Inquiries or Complaints from Residents, Patients, Physicians, Peers, Regulatory Agencies, or Members of the Business Community
• Collect, Analyze, and Manage Data and Use Data to Drive Improvement
• Work Independently and Collaboratively and Manage Multiple Priorities in a Small Rural Facility
• Read, Write, Speak, and Understand the English Language
• Ability to Lift, Move, or Transfer Residents as Necessary, Including Assistance with Mobility, With the Ability to Lift Up to 50 Pounds Occasionally (More When Using Assistive Devices or a Team Lift)
• Sit, Stand, Bend, Lift, Push, Pull, Stoop, Walk, Reach, and Move Intermittently During Working Hours

Minimum Qualifications

License and Education

• Current, Valid, and Unrestricted California Registered Nurse License Issued by the California Board of Registered Nursing, Maintained in Good Standing Throughout Employment
• Bachelor of Science in Nursing (BSN) Required
• Eligible to Serve as the Designated Full-Time Director of Nursing Under 42 CFR A7483.35(b), Health & Safety Code A71250(c), and Title 22 CCR A772103

Certification, Experience and Development

• Minimum of Two Years of Experience in a SNF Nursing Leadership Role (Required)
• CPR/BLS Certification Upon Hire or Obtained During Orientation, and Kept Current During Employment
• In-Depth Knowledge of Legal Policies and Regulations in the Healthcare Industry

Other Requirements

• Satisfactory Completion of the Conditions of Employment Under HR-032, Including Criminal Background Clearance as Required by California Law for Long-Term-Care Personnel, Drug Test, Tuberculosis and Other Required Health Clearance, Physical Exam, and Satisfactory References
• Ability To Meet Immunization and Health-Clearance Requirements Applicable to Long-Term-Care Personnel
• Ability to Communicate Clearly, Orally and in Writing, in English
• Ability to Work Independently and to Respond to Common Inquiries or Complaints from Residents, Families, Physicians, Peers, and Regulatory Agencies

Preferred Qualifications

The following are not required but will be given favorable consideration:

• Master's Degree in Nursing, Healthcare Administration, or a Related Field
• Long-Term Care or Gerontological Nursing Certification, Including Director of Nursing Services-Long Term Care (DNS-LTC) or Similar
• Experience with Regulatory Surveys, Plans of Correction, and QAPI in a Skilled Nursing Facility
• Experience as a Director of Staff Development or Infection Preventionist
• Experience in a Rural or Small-Facility Setting
• Bilingual English and Spanish Communication Skills

Working Conditions

• Works in the Skilled Nursing Facility and Administrative Offices
• Subject to Frequent Interruptions and On-Call Availability
• Attends and Participates in Continuing Education Programs
• Involved with Residents, Associates, Visitors, Government Agencies and Personnel, and Others Under All Conditions and Circumstances
• Subject to Hostile and Emotionally Upset Residents, Family Members, and Others
• May Work Beyond Regular Working Hours, on Weekends and Holidays, and in Other Positions Temporarily as Necessary
• Subject to Falls, Burns from Equipment, Odors, and Similar Hazards throughout the Workday
• Exposure to Infectious Waste, Diseases, And Conditions, Including Exposure to Bloodborne Pathogens Such as the AIDS and Hepatitis B Viruses

Reasonable Accommodation Will Be Considered Consistent with Applicable Requirements.

Role Authority and Escalation

The Director of Nursing directs SNF nursing services and exercises independent clinical and managerial judgment within District policy and the authority delegated by the CNO or CEO designee. The DON makes or recommends hiring, discipline, and separation decisions in accordance with District policy and Human.

Resources review, and does not independently approve compensation changes or make decisions outside delegated authority.

Resident-safety events, suspected abuse or neglect, survey and compliance concerns, staffing shortfalls, significant outcomes, and HIPAA or privacy concerns must be escalated promptly to the Chief Nursing Officer (or CEO designee) and, as applicable, the Administrator/CEO, the Medical Director, Compliance/Privacy leadership, or Human Resources.