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Wanted: Qualified nurse leaders

April 30, 2014
by Julie Thompson
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Michael Bobbit has one of the most demanding jobs as the director of nursing (DON) at the busiest nursing home in the Dallas metropolis. His schedule is anything but typical: On average he manages to oversee staffing issues, budget concerns, clinical matters and sporadic complaints among the 75 admissions and 30 discharges that come in and out of the facility during his 50-hour work week.

It’s a jam-packed schedule that might drive many people crazy, but for Bobbit it’s simply what he loves.

“I worked for hospice shortly after becoming a nurse and then made my way into long-term care (LTC). That is where I found my true love,” said Bobbit, MSN, RN, who now works at Presbyterian Village North. “This really is a calling that sticks with you and is something that is in your gut.”

Those who surround Bobbit love him as well. It’s an admiration that extends beyond the residents, each of whom is personally given his cell phone number on the day they arrive.  Bobbit is also indispensable to the top tier decision makers within his community. In his role, Bobbit has helped lead Presbyterian Village North to receive numerous regional and national awards. The community has been recognized by U.S. News & World Report as one of the best senior-care communities for the past two years and recently Bobbit himself was named the Nurse Administrator of the year by the National Association of Directors of Nursing in Long Term Care (NADONA/LTC).

Bobbit’s awards are impressive, but his day-to-day accomplishments are not isolated. Increasingly, LTC nurses are becoming valued resources beyond passing medications and are being groomed by the communities that understand the rich resources they have in their nurses. They are being encouraged and educated for leadership—whether that be on the frontlines or in the boardroom. Nurses are no longer people who merely carry out orders, but are instead key participants who engage in collegial relationships with both clinicians and administrators.


Nurses comprise the largest proportion of LTC employees. Residents at senior care communities require nursing care more than any other service provided in these settings. However, nurses have not always had a strong voice in decision making or have been provided the opportunity to learn how to lead properly, said Robin Arnicar, RN, president of NADONA/LTC.

“When I first became a director of nursing 17 years ago, the role was more like that of the head nurse of the facility,” Arnicar said. “I became DON literally because I was the nurse in the building they liked and they thought had potential. So, they tapped me on the shoulder one day and said they would like me to be their director of nursing. I love to share the story about how one day I was a nurse like everyone else and the next people were coming up to me and asking me questions like somehow magically overnight I knew something more.”

Slipping into the DON role was daunting for Arnicar as a 27-year-old nurse. However, she was blessed that the role simply involved staffing. “The majority of my role was making sure there were enough nurses to help run the facility,” she said. “I had to figure out leadership skills on my own through trial and error.”

The DON position has drastically changed over time, along with the industry.The complexity of running an LTC community has increased to include new areas of focus such as regulatory demands, compliance issues, MDS and surveys. Likewise, a  DON’s responsibilities have expanded from just staffing concerns to include risk management, infection control, staff education, customer satisfaction and budget and finance.

Arnicar will quip that she isn’t the best clinician in her community called Charlestown, an Erickson Living Community in Maryland. However, she believes the DON’s expanded responsibilities have served the LTC community for the better. “You see the bigger picture,” she said. “You are no longer just looking at your department, but you are looking at how nursing impacts dining and rehab and programming and how nurses impact the bigger team. As a result, all the teams within the community are starting to work together more.”

In his role as DON, Bobbit has fostered significant change among the training of his nurses. The first thing he noticed when he arrived at his community three years ago was that training was not up to par for the level of acuity coming through the facility’s doors. His first initiative as DON was to increase training for nurses so that they could adequately handle these cases.

Bobbit has also helped foster communication between different areas of the community in order to increase resident satisfaction, said Dr. Mary Bean, associate executive director at Presbyterian Village North.

“Mealtime is very important for residents because it is not only a social time, but it’s also a time for them to maintain a certain level of health through the food they take in,” Bean said. “But from an operational standpoint, mealtime can also be challenging because the food service may set a time that doesn’t always work with the staff and residents. So, Michael worked very intimately with the dining director to establish a time that would work best for everyone.”