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MediPreneurs: Geriatric Long-Term Care Nursing

Sherrie Dornberger

Sherrie Dornberger

In this MediPreneurs profile, PharmPsych.com decided to feature Sherrie Dornberger, RN, GDCN, CADDCT, CDP, CDONA, FACDONA, executive director of the National Association of Directors of Nursing Administration/Long-Term Care, Inc. (NADONA) based in Cincinnati, Ohio, who has served in this capacity since 2011 after being its president from January 2005 to January 2012.

Dornberger, 58, is a lifelong New Jersey native and a geriatric/senior long-term care nurse by training. She has been director of nursing administration (DON) of Pitman Manor, one of the United Methodist homes of New Jersey. Dornberger worked in their Pitman, N.J. facilities in Gloucester County from 1975 to 2003. She worked there as a geriatric long-term care nurse for 28 years since 1975 until she became too ill to perform physical nursing work in 2002.

While preparing to enter a master’s degree program in nursing administration this year and despite her physical disability, Dornberger wants to help set national standards of practice of geriatric long-term care nursing and to attract and guide more young nurses into her field.

The following is an Aug. 29, 2014 phone exchange between PharmPsych.com and Dornberger from her long-time home in Mullica Hill, N.J.:

1. The last time I spoke with you, I was interviewing you for a story on intellectual development of seniors in assisted living and long-term care. This was the summer of 2011. In that time, you served as president of National Association of Directors of Nursing Administration/Long-Term Care (LTC)/. Now, in 2014, you are executive director of NADONA/LTC. Tell me the difference between the two roles for the organization in terms of your leadership and wanting to improve the field of nursing across the country.

The president is an elected position while the executive director is appointed by the board. When I was president, I was acting in charge of the board. I led the mission statement and goals for NADONA. The board sets the goals to get from point A to point B. I hire and fire staff. I’m [also] in management.

I have been with NADONA for 25 years. I relied on NADONA as DON (director of nursing administration) when I needed someone to listen to me. Some days, we all need that. I want NADONA to be the organization that people turn to when they need help. They don’t want to hear [certain remarks] when they are dealing with different families or employees. They just want someone to listen.

I always called on my colleagues to help me. It’s important for leaders and DONs to stick with each other. No one knows what you go through each day except your colleagues . Unlike your colleagues, your spouse wants to fix it for you. You don’t want to hear what you did or did not do, according to your spouse, unless they too are a nursing Administrator/DON in long term care, but you want to hear that you did a good job.

2.What is your mission or vision for the field of nursing? In particular, what is it for nursing in gerontology, geriatric medicine or senior long-term care? What do you want to accomplish as an executive director that you did not as president? In the time that we last spoke in 2011, what has changed in the field of nursing, particularly in senior care? Has the picture improved in the last three years? If so, what? What else needs to improve in your view? The nursing shortage, especially in terms of senior care? The immigration process for some nurses? The quality of care in the long-term care facilities? The quality of home health care? How has the Great Recession affected all of this in your view?

I would like to have NADONA develop a standard of practice and, actually, I can now brag that this is happening at this time. A standard of practice for Nursing Administrators/Nurse Executives is being developed by a hardworking NADONA committee. I would like to increase the number of nursing administrators we have certified. If I had a choice to hire the certified DON or master’s-degree-prepared nurse, I would hire the certified nursing administrator/DON. A person can have a master’s degree in anything. He or she could have a master’s degree in basket weaving for all I know. Nursing administrators I know care for and are serious about caring for the elderly. They will step up their education to care for them more effectively.

The other thing is that I would like to recruit more young nurses into the field because the average age of a nurse is 57 years. We really need to recruit fresh blood. But geriatric care is the flavor of the month. The White House and the AARP were involved along with Susan Reinhard, (senior vice president of the public policy institute and chief strategist for the Center to Champion Nursing in America at AARP) in the White House Conference on Aging. We are getting support and bringing [the field and issues to the] attention of young nurses. Two registered nurses in long-term care [with NADONA] will approach the National Student Nurses Association and we will be going to the next conference to bring guidance and to recruit more into the profession. If we’re invited, we’ll go.

[The National Student Nurses Association] has a great website. I used to be an executive director of the New Jersey group. Nursing students have a place in my heart. I love their energy. i I love their attitude. There are a lot of nursing schools in New Jersey, currently somewhere around 44.

One of the things that has affected us is the talk of [Medicare/Medicaid] reimbursement. Insurance is paying for less because a lot of people are losing jobs. People don’t have coverage. If you’re dealing with a person putting his or her parents in long-term care, they don’t understand Medicare A, B and C or D. They don’t understand skilled nursing care. People think you don’t need anything other than Medicare. They [seniors] are in the hospitals because the they get caught in the revolving door of care, from home care to the ER to rehab and post acute care, needing more help or getting ill along the revolving door, and they land back in the hospital again, using up precious Medicare coverage. All of these healthcare stops cost the patient/resident lots of money without the proper coverage. Emergency room care and ambulance are no longer totally covered. [It can cost] $20,000 for emergency room care.

A lot of anguished families or loved ones didn’t think Medicare would not pay for everything. A lot of facilities are hit by Medicare cuts and [costly] transportation back and forth. Because of the Recession and Medicare cuts, it has forced [the hand of] the profession — not the industry because you deal with humans, not paperwork.

The facilities who are doing a good job get the concept of transitional care nursing. They (the transitional care nurse) go to the hospital. They make sure of the hospital or medical climate and evaluate the beds, linens and specialized tube feeding that the resident being admitted to their facility needs. [In some cases,] you [as a patient] don’t get the proper equipment needed when admitted if that facility does not have it in stock at the time of admission. [The facility staff can say that they] don’t have specific tube feeding equipment ordered by the specialist. The job of the transitional care nurse would be to assure the equipment is ready and available when the resident is admitted to the facility. Therefore, there is no break in treatment. The same high quality of care may continue to be administered for the benefit of the resident.

We in LTC have been avoiding unnecessary admissions as much as possible. People get better care because of that. The hospitals have gotten their nurses to be more geriatric-care savvy through training and education. The LTC facilities are getting more geriatric nurse practitioners on board,which is also helping with unnecessary admissions to the hospitals.The entire team working together as one (i.e: doctor, nurse practitioner, nurses, aides, rehab, dietary, activities and social service) to excel for the residents’ needs, makes for a high-quality, highly caring professional team who can work wonders!

Now we are in the electronic age. We used to have government hospitals perform beta [imaging of patients]. Now we do [more accurate imaging of patients], print out paperwork or take photos [of the patient] in the LTC facilities. The digital age has gotten us better and more efficient. [We now] have computers and ask more questions. [We] do better, more timely assessments.The savvy facilities have all the equipment hooked up to check blood sugar, BPs, temps and INRs, and it is downloaded into the special software as it is taken .Nurses now don’t [have to make a special effort. To document everything individually, the computer gives printouts, alerts you of abnormal readings, and will give you a printout of the last weeks, months of readings that you can send over to a doctor’s or nurse practitioner’s office for further orders, if needed. It’s all set up. It is ready to go.It’s a good thing and saves lots of time for the nurse documenting these numbers. There are also fewer chances for error as the machines are downloading the information. It takes the clerical errors away!

We are using music therapy and iPods to help us with [nursing home] residents who have Alzheimer’s and dementia. [When we] play music, we can decrease the need for drugs because the [residents] appear happier when there is music in their lives. Not just with pet therapy but with music therapy and aroma therapy all used, facilities have been able to reduce the need for a large number of residents to have their psychoactive medicines decreased or discontinued!!. I know how it feels laying in bed [all day] as I was hospitalized for one year.You don’t hear the music, just sounds of machines and the overhead call system in the hospital or the nurses on the call system looking for one another. You also don’t feel “good” touches. The only time you are touched is to have a procedure done to you and most of those procedures hurt!. [When we hear nice music,] we remember the happy feelings we get from the songs, and therefore get in a better place. Music is so intertwined in our daily lives and, just because we are hospitalized or in a LTC facility, we should not have to give that up.

Dan Cohen, [MSW, founder and executive director of Music and Memory, a nonprofit organization promoting the use of digital music in senior care], is doing a good job with his website, musicandmemory.org. He is doing excellent work. He’s getting iPods and ITune [songs] sold to him at cheap [rates] if the facilities need them.

[I remember one elderly male resident in the nursing home] who used to do back up for [jazz legend] Duke Ellington [and benefitted from the use of the iPods and ITune songs]. I cry when I see this video.It’s phenomenal! [This same resident who used to sing with Ellington] is now leading the [nursing home’s music] small therapy group. [Before the use of the iPods and iTune songs,] he was sitting in a fetal position.

Dan has done wonderful work. It’s things like that, that excite me about LTC nursing. In the 1970s, we used to put them [senior patients] in the Geri [geriatric clinical] chairs and expect them to walk eight hours later in the day with no exercise or a chance to walk until someone thought about attempting to walk them to the bed, bathroom, activity, or just a short walk down the hall. We didn’t know any better at that time. We’ve come a long way, baby! LTC is doing some very exciting things!

3. You have worked in different capacities throughout your nursing career. According to your Linkedln profile, you have worked as director of nursing, registered nurse and GCNC. What does GCNC stand for? You may have worked in hospitals as well as medical settings with senior citizens as your patients.

I am certified to teach nursing aides as a CNA Instructor [ certified nurses aides in the state of] New Jersey. I am certified to [provide] clinical instructions and classroom and skills teaching of [certified] nursing aides.

I’d like to see more standardization among the requirements for certified nurses aides. Each state has its own laws and regulations and [this affects reciprocity]. Hours [of study, testing and certification] are different from state to state. For instance, if a state requires 120 hours of required study/ clinical and, with having the three states of Pennsylvania, Delaware and New Jersey close, all with different requirements. Nurse aides move from place to place. It’s hard to get the certification needed for another state, if that particular state they are moving to requires more hours than the state they received their certification from, making reciprocity extremely difficult in many cases.

As far as continuing education for registered nurses, I really feel [the states] should change the hours required to be consistent from state to state. Some states have continuing nursing education required, while others do not. I’d like [that], if you’ve been out of school 20 years, and I don’t care who you are — you need training to keep up on. Many nurses don’t take [the training, study and certifications] unless they are required. It helps everyone involved [from] patients to facilities when nurses are trained. No matter the number of hours, whether that is 50, 100 or 120 education never harmed anyone.

[You must] stay up on what is happening in your profession!

4. What is it that inspired you to enter the field of nursing? Were you inspired by a member of a family or friends? If so, how and why? In particular, why did you choose to enter the nursing specialty of long-term care, geriatrics or gerontology, of all specialties? Did you feel compelled to make a difference in the way seniors were cared for?

At first, I wanted to be a mechanic but Mom said good girls don’t hang out in places [like mechanic’s shops].

I worked in the hospitals. I did not like [it] as I did not like just “pushing pills” and hanging IVs, and that is what I felt like took most of my time while working in acute care. It paid the bills, but did not make me happy at the end of the day I loved long-term care as I thoroughly enjoyed getting to know both the resident and their family. [As a child], I lived across the street from an elderly woman. I’ve been infatuated with the elderly since I was young. The lady was as close to me as my grandparents. When I saw her, I felt as though I was visiting my grandparents. She taught me lots about life, and helped me know that it was the elderly I wanted to work with “when I grew up.”

I applied for a job in a nursing home because of my grandparents and the lady. I love geriatrics. I like to get to know the residents in my facility. I knew one [elderly person] who once worked in vaudeville. She would act all the time. She was blind and her husband deaf. They were married for 65 years and put on a show daily for the staff. She had a little “ditty” she would say all of the time. It goes like this: “The Bee, she is a busy soul. She has no time for birth control. That’s why you see, in days like these, you see so many “sons of bees.” She celebrated her 65th anniversary with her husband with a party [at the nursing home].

I worked in Pitman Manor [nursing home] in Pitman, N.J. from 1975 to 2003. It was so good that I stayed until I was ill and could no longer work there due to physical limitations. I actually was admitted to my own facility after a long acute care admission where I was in an 18-day coma to get rehab, wound care and pain control and was discharged after seven months.

I was president of NADONA at this time, but looking back on things, I now see that God had a bigger plan for me. I always loved assisting my colleagues, and when NADONA was in need of an Executive Director, the board knew that NADONA was my passion, and when I applied they graciously accepted. As Executive Director of NADONA, I now have the ability to assist nurse executives on a daily basis, making me incredibly happy! I was totally content [working for Pitman Manor] and I would have never left there. But, as I said God had other plans for me, and now I can say with a huge smile, I am so glad he did!

I want to make a difference in long-term care, and working with NADONA. I am getting to do just that!

In the last few years, [in the nursing field, we have had more] online classes popping up. They’ve opened up a lot of nursing [course] availability. [It costs] a little less money to take the classes online. The average age of the nursing instructor is 65 and there are not enough nurses going into the teaching nursing students. Because of this, schools are limited to the number of nursing students that can be accepted to the programs. Thus, we are graduating fewer nurses than we need for our future needs. Recently, through many efforts, the number of applicants to nursing schools and for higher degrees, have increased significantly, which is wonderful. Utilizing online education will also assist with getting more nurses educated. If we stick to the brick-and-mortar schooling only, we will go back to the 1970s with the numbers we can accept into the programs and the number of nurses we graduate! In New Jersey, we would always say, “The Garden State GROWS great nurses.” We still do, even online!

Magnet-status hospitals are driving nurses to get higher degrees. For a hospital to be considered magnet, one of the many requirements of the American Nursing Credentialing Center states that a hospital has to have a certain percentage of the hospital with staffed, degreed personnel. They make it a requirement for a certain number of nurses to have a bachelor’s or master’s degree. The newly-hired nurses have to have nursing degrees. Back in the 1970s, diploma nursing degrees were most prevalent. Now those diploma schools have either closed or merged with an associate degree or bachelor degree nursing program to survive.

The good majority of today’s registered nurses have bachelor’s degrees. It’s easier now [to obtain these degrees] because of the increased number of nursing schools, on-line education and taking a class here and one there to get the preliminary credits out of the way. Some colleges are also giving portfolio credits for your life’s work. It has added to the leadership as we know it. Nurses now have the ability to apply for nursing jobs in– besides LTC — home health care, the American Red Cross, hospices, doctor offices, sports teams, same-day surgeries, missions overseas, nursing teaching, and the pharmacies.

It’s good and bad that there are so many different type jobs available to a nurse. Unfortunately, job stability have produced people who don’t care, the way I feel they should care for the resident or patient they are caring for, but [are in] nursing. Typically, they will not stay in one place too long, especially with hands-on care. It will take some time but [eventually] they will get weeded out of hand on care, and do something where they can collect their check and use their degree but do not need to show the compassion most nurses need to have to be successful!

5. You were a native of New Jersey, correct? Did you study there? Did you graduate? What degrees did you obtain? What skills did you learn?

I grew up in Deptford, New Jersey, a small town. I went to the county college [ in Gloucester County] and took classes nursing] over two years. I’m obtaining my master’s degree in nursing administration now, I will study online as I am [disabled] in a wheelchair and still live in Mullica Hill, N.J. — eight miles from Deptford, N.J. where I grew up.

I had a daughter, a great career and did not move far, and I loved my house. My daughter [is going to] medical school to become a doctor of osteopathic medicine. Apart from medicine and family, she pitches softball and holds NCAA records. [Many of her] friends — [also in athletics] — got hurt from not exercising and training. [She will] graduate in 2015. My husband helps take care of me, the household and my therapy dog, a Labrador named “Star”.

6. You once worked for the American Red Cross. What were you able to achieve in that capacity?

I volunteered with the American Red Cross. I was nominated SAF Volunteer of the Year [in 2006 and 2008 with the Gloucester County Red Cross in Sewell, N.J.]. I worked with them in training volunteers and doing military cases. If a person is stationed and has a family at home, I assisted with working with their commanding officer to get them home for the emergency. The motto for the ARC is “get to know us before you need us.”

7.In scouring the Internet, I found that you write extensively about nursing issue. The issues you cover include medication, medical procedures, long-term care, home care, pain management, safety, hospice care and vaccines. Is it important to you to instruct and advise nursing students and young graduates about proper medical setting processes and procedures?

It’s McKnight [Long-Term Service News]. I always try to share what I know. Some people are afraid just to ask. They all might have the same questions. I get questions from McKnight or [people] asked me [questions] as a mentor for NADONA.

I figure: why not share the information if you have it, along with answering the question?I try to give other resources, such as websites, articles, and product locations people can go to and find out more information about the topic of the question for the month. It goes to others. For NADONA, I represent the Board on Advancing Excellence. I [especially] enjoyed working with the tool kits for infection control and MRSA.

I assisted with writing a new chapter on MRSA [infection control for nursing instruction publication] for APIC in LTC. I loved being an infection control nurse too.

People don’t think enough about germs. [For example, when people go shopping,] they put perishable goods [in an area of a shopping cart where a child may have put his or her feet or buttocks as they sit in the built-in area near the push bar of the cart. If the child has had a soiled diaper, I am sure there is E.Coli all over the area you just laid your lettuce or fresh soft bread. ] Then they wonder why they get sick with diarrhea. Anti-bacterial soap is not the end all, be all. Good hand washing and alcohol gel certainly helps!

8. Have you ever taught in nursing school? If so, where? If not, why not? In the time that I have last spoken to you, do you see enough nurses teaching in the nursing schools or colleges? Do you see enough nurses serving in leadership and management roles such as Director of Nursing? If so, why or why not? Is it part of your mission to assist in increasing the number of professors in the nursing schools and nurses as leadership and management roles across the country?

I have not taught in nursing school. I have instructed CNAs [certified nursing assistants] and mentored [students] in nursing school. In my facility [Pitman Manor], I knew a lot of students. My facility had [relationships] with three nursing schools [who came through for clinical training]. I tried showing them what’s good about long-term care.

Long term care seems to be the story of the week if a paper needs something negative to write about. I can tell you a lot happens in acute care too. If anyone was admitted for a long time, you would see that it’s not all roses. Mistakes happen. Medications are delivered later or not at all, and some staff may speak gruffly. [The media and established society keeps] picking on long-term care. [Our facilities nationally] are never clean enough, never good enough and never fast enough [with medical service].

It kills me to see negative stories about [long-term care]. We [the geriatric long-term care specialty] have made a difference in recent years. Then they [the media] come out with [something] negative about LTC. We have 90- year-old [nursing home residents] who are active, swinging, exercising, into the arts, making PowerPoint presentations, [doing] needlework and [putting out] the facility newsletter. They [the residents] do a lot of good that [the public does not pick up on.].

[We want and need] some positive media. NADONA along with many other organizations are is trying to do an image campaign.Nurses typically nurture and care. Yet they are strong and are who people lean on in their time of need or illness. [The organization is drawing from an analogy to an acorn growing into an oak tree in its campaign.] An acorn [sapling) tree] can grow up to be a mighty oak. You don’t do it on your own. You need nurturing, support, and tender loving care. [The rules set as standards by the government] are rigid. [Geriatric long-term care nursing, nursing homes and the long term care continuum form] the most regulated industry in the country, surpassing nuclear waste.

9. What advice would you give college graduates entering the field of nursing and your professional peers in terms of their approach to their day-to-day nursing work, especially in long-term care, geriatrics or gerontology?

I would tell them that it is an exciting field. Think outside of the box. Get certified. Your choices for certification are many, including Nursing Administration, Diabetes, Assisted Living, Dementia Practitioner, infection Control or MDS coordination [Minimum data set coordination, which is a comprehensive assessment required for all residents who reside in facilities who receive Medicare and Medicaid payments] through a specialty nursing organization.

Education is the way to go. If you want to be a leader [in your field], education is fundamental for doing [it]. I encourage all nurses to join a specialty organization. You can’t do all of this alone, It takes a village. All [of us] need mentors, and we all need people to listen to us and feel needed and wanted.

Pick someone who inspires you and go for it. When someone says [something] to compliment you, it can make you feel great. We all need to feel needed, [including] nurses. You know the famous line: “You may no longer remember what someone was wearing or what they looked liked but, years later, you will remember how they made you feel. It is sooooo true!

Pick someone you want to be like. You don’t have to follow everything [he or she does]; it is nice to be a trailblazer, make a difference to one person at a time and make your own footprints in the sand!

NOTE: (PharmPsych.com offers up MediPreneurs, a news series featuring medical professionals and allied health employees of all specialties, especially the field of pharmacy. MediPreneurs are leaders and managers in a variety of medical fields who often use their talents to start their private practices or businesses or challenge themselves to transform and improve community health as board members, group founders, mentors or college professors. Our MediPreneurs series seeks to draw on and explore the expertise and experience of these medical heroes and put them in the public spotlight, one professional at a time.)

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Last updated August 2014

Sherrie Dornberger

Sherrie Dornberger

Vladimire Herard, M.S. (99 Posts)

A print journalist for 21 years, Vladimire Herard freelanced for the National Senior Living Providers Network, (nslpn.com), the Guidance Channel and Longtermcare.com. Under CD Publications, Ms. Herard wrote about senior health, substance abuse prevention, and elderly housing. Under Inside Washington Publishers, she covered health care financing for Inside HCFA and food and product safety issues for FDAWeek. Ms. Herard also covered education, crime, and county affairs for daily newspapers such as the Chicago Defender. She currently covers senior long-term care, the pharmaceutical industry and issues and education. Ms. Herard resides in Chicago.


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