Nearly four years after the River Bluff Nursing Home Task Force submitted its executive summary on June 25, 1999, staff morale remains low at Winnebago Countys 304-bed nursing home.
River Bluff Nursing Home, on North Main Street between North Towne Mall and Sportscore 1, houses about 260 patients and employs about 330 workers. The overwhelming majority of the homes patients98 percentreceive Public Aid.
In the late 1990s, the home was plagued by staffing shortages and financial woes, which led Winnebago County Board Chairman Kris Cohn (R) to call for the task force review of the home. In 1998, 92 percent of the homes employees quit within the first year, and the home had a $1.5 million budget shortfall. No guidelines for compliance were given in the task forces executive summary; therefore the nursing home is not bound to follow through on any of the task forces recommendations.
The second part of this series examining River Bluff Nursing Home, its management and its finances examines nursing staff morale. Current and former staff cite staffing discrepancies between the homes four units, weak leadership, a clique atmosphere and mismanagement as the main sources of employee frustration.
Theres always been a clique out there, said Karen Martinez, who was a licensed practical nurse (LPN) at River Bluff for 15 years. Between the staff theres more socializing as opposed to taking care of the people.
Phyllis Schwebke, River Bluff administrator, said she agrees that theres a clique atmosphere, but said it hasnt affected the level of care patients receive.
Remember how it was in high school? Schwebke said. Ive worked in a number of environments in my career. Health care is like my last stop. This is a predominantly female environment. And maybe its not that, but women do form their own alliances, and sometimes theyre aligned against another group. And I think that has happened. And I think that its not unlike high school. And, as a manager, how do you make that better? I dont know how you address that exactly.
There are certainly alliances, Schwebke continued. And I think the unit atmosphere sort of fosters that, and sometimes in a good way. You know, you want people to work together, but you dont want people to work against other people. Its a hard line to manage.
Schwebke, who recently concluded a three-term tenure as County Nursing Home Association president, said, although the home continues to struggle with low staff morale, some indicators show morale may be improving. For example, Schwebke said the average length of service for registered nurses (RN) has increased from 7.02 years a year ago to 8.04 years today. Certified nursing assistants (CNA) have increased from 4.2 years a year ago to 4.8 today. Additionally, wages have also increased. Entry-level positions are now paid $7 an hour, while CNAs now start at $9.43 an hour.
So weve made some real strides, Schwebke said. Part of that is, and I dont kid myself, it has to do with the economy. There arent a lot of other opportunities in our area right now.
In 1999, that was the time when you had Motorola opening, and MCI was moving to town, Schwebke said. So people working in some of our entry-level positions, and even at the CNA level, were certainly qualified to do that work, and it would end up being emotionally less demanding. Now weve seen that turn around, where those people are closing their doors and cutting their staff.
Yet, current and former staff say an imbalance in staff on the buildings four units creates unfair stress on all nurses who work units with fewer staff members.
Robin Albright, who worked for 16 years as an RN and unit coordinator on River Bluffs E unit, said she recalls once working a shift with one other nurse on the E unit caring for 73 patients. Meanwhile, at the same time, she said the B unit had three nurses for 54 patients. Other current and former staff confirmed Albrights claim. One nurse who still works in all units at River Bluff said this discrepancy still exists and that E unit usually has fewer staff than B unit.
Schwebke said: Theyre staffed differently, thats true. E unit, most of the residents over there, theyre the most independent folks we have. Theyre the people who need nursing care or supervision around the clock, or they wouldnt be with us. Theyre the most physically able, theyre the most cognitively able, most of them are either walking independently or they use their own walkers or wheelchairs to get themselves where they need to go. Theyre more knowledgeable because theyre able to keep up better with the things that are going on.
And so we have tried to increase the nurse staffing level on that unit because of the medication needs, but not always successfully because if we have staffing shortages on a daily basis, its the place where we are able to absorb that, Schwebke said. It wont really be easy for them, but the people wont go without their tube feeding or other care. They just have to be working really hard to get the medication out. And it is challenging. There are challenges because we need to work with them more whereas with some other residents, we are doing it for them more.
CNA staffing on that unit, because the residents are more physically independent, it is not staffed at the same level, Schwebke said. So there are discrepancies in staffing, and we try to do that the most efficiently with the licensed staff we have in the building.
Most nurses, however, agreed that the E unit, which houses some of the more active patients, requires more staff than the B unit, which cares for more comatose patients. The E unit is more demanding, said Janice Shelton, a part-time CNA at River Bluff and a full-time LPN at P.A. Peterson Center for Health.
The nursing home also continues to struggle with staff shortages. Although the home has 304 beds, it is only able to use about 260, or 86 percent, of them.
We have a number of empty beds by design, Schwebke said. The countys decision, as far as dealing with staffing shortages, was that we would simply care for fewer residents, or we would care for the number of residents that we have the staff to support. Weve always been way above the minimum staffing numbers. I think weve done a pretty good job of trying to deal with the number of residents we care for with the number of staff we have. And we and everybody continue to struggle with that.
An April 25, 2002, Centers for Medicare & Medicaid Services (CMS) report shows the following with regard to River Bluff Nursing Home in relation to national and state averages:
Average number of residents: River Bluff 254; U.S. 88.5; Illinois 95.6.
RN minutes per resident per day: River Bluff 29.4 minutes; U.S. 42 minutes; Illinois 48 minutes.
LPN/LVN minutes per resident per day: River Bluff 32.4 minutes; U.S. 48 minutes; Illinois 36 minutes.
CNA hours per resident per day: River Bluff 2 hours, 27 minutes; U.S. 2 hours, 24 minutes; Illinois 2 hours, 6 minutes.
Total number of nursing staff hours per resident per day: River Bluff 3 hours, 29 minutes; U.S. 3 hours, 54 minutes; Illinois 3 hours, 30 minutes.
Overall, the CMS report found River Bluff to have five deficient areas with a level of harm rate of two on a scale of four. The state average for deficient areas was six and the national average was seven.
The report found that the nursing home failed to do the following: 1. 1) Hire only people who have no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. 2. Give each resident care and services to get or keep the highest quality of life possible. 3. Give professional services that meet a professional standard of quality. 4. Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. 5. Provide care in a way that keeps or builds each residents dignity and self-respect.
The CMS report and other information about River Bluff and nursing homes in the county can be found at www.medicare.gov by clicking on Nursing Home Compare.
Schwebke said of her staffs performance: Is everybody doing 100 percent every single day? Im sure not, but a whole lot of people are doing 102 percent every single day. The work they do is so hard, most people wouldnt even want to do it.
Schwebke said the nursing home has implemented many programs in attempts to improve staff morale since the task force submitted its executive summary. Such programs include Old Grover tours, the Caught in the Act of Doing Something Good program, luncheons and cookouts.
Old Grover tours are essentially administrative tours of the nursing home.
We do it one day each week in each shift, and we gather and we all go through all four nursing units and other departments in the facility, Schwebke said. We speak to staff, we talk to residents; as a group we sometimes are able to sort of stop and fix things right at the time. So if a resident has a maintenance issue, we meet him and talk to him about it. We also use it to do some monitoring of resident care items. I think its been a success. Its an opportunity for people to see us as just regular people they see every day and for us to meet and greet folks.
The Caught in the Act of Doing Something Good program recognizes efforts of staff when they do something good. Forms are available by the main desk, and anybodyresidents, staff and administratorscan fill them out. The forms dont have to be signed, and the original form is put in the employees file. Polaroid shots are taken of the staff member and then put on display near the facilitys entryway.
Its just a really simple formalized compliment program for people, Schwebke said.
Overall, Schwebke said she feels staff morale has improved, although she said it is still low.
I think I see areas in our facility where people are working together better than ever before, Schwebke said. We have about 330 people. Obviously, many of them are part-timers. Is everybody going to be a happy camper every day? No. Im not a happy camper every day. So I dont expect that everyone will be. But, generally, are people getting along better? I would say somewhat better. We try to do things to make the workplace more fun. Thats really hard when you have hard work to do. Other environments lend themselves more to fun. But we try to do some things that are really just morale boosters.
Repeated calls to Cohns office for comment on this series have gone unanswered.