Hiring The Right Clinical Manager: Its Much More Than Just Promoting Your Best Staff Nurse.
shelly • July 3, 2021
I remember vividly being told one day, "You take all the best clinicians out of the field". At this time, the statement struck me. It is something I had not really considered. It was just what made sense. Your best clinical staff fill positions of management as they become open. Why wouldn't you want the responsible, hard-working, reliable people in these positions? Right? Well, you have to consider if this is the right decision for your agency and your patients. Let's look at some things to consider when hiring or promoting a clinical manager.
Choosing A Clinical Manager:
The best clinicians don't always hit the mark of a good clinical manager in today's home health climate. It is not to say that your best clinicians can't be great clinical managers. It is more about not assuming they will be. Here are our top 4 considerations for setting yourself up for success:
- How well does the clinician communicate during the plan of care? A huge part of clinical management is truly managing the care plan. You need to make sure that the best clinical person is also able to coordinate the care plan effectively. Changes to visit frequencies and visit plans are something that will need to be discussed by the clinical manager with the clinical disciplines providing the hands-on care on a routine basis. Gone are the times of this process just being about a one-sided report from the clinician to the manager.
- How well does the clinician understand the money? Clinicians don't like talking about clinical care and money together, but the reality is that some of your nurses and therapists are really good at understanding the finance end of things. Yes, you can afford to lose money on certain cases, but some of the best clinical staff are better in the field as opposed worrying about the dollars behind the cases they manage.
- What do your clinician candidate's care plans look like? This is also key as we live in a PDGM world. If you don't see how frequencies are based upon the most effective way to provide care to the patient in a cost-effective manner, then there are probably other things missing. Are care plans really long? If you pull 5 patients with the same diagnosis, does that clinician create the exact same care plan each time? Is the aide always added throughout the entire length of the care plan? Does it show forethought of progression of the patient to independence as the agency prepares for DC? Are the care plans updated along the way? These are all things to consider about your potential candidate. It will show you if the care plans are patient centered. It will show if the clinician clearly stays in their own swim lane and doesn't attempt to integrate a care plan. You need a clinician who promotes all disciplines working within full scope of practice for patients where they are the primary nurse. Rehab goals should be addressed with all disciplines every visit. Nursing goals can be achieved with the help of the home health aide and the rehab staff. Does your nurse have the have the aide or therapist report if there are days in the medi-box where the patient didn't take meds? Or, is this something potentially just held to assess once the nurse goes back into the home? These are simple examples of where our disciplines should overlap in advancing the care plan goals.
- How are they with confrontation? Your best clinicians may not be the ones who can address issues with other clinicians as they arise. The fact is that there absolutely will be times when your clinical manager will have to provide coaching or initiate a performance improvement plan. I recall once a manager who could not look clinical staff in the eye for these types of issues. It was a problem and the staff never took any type of performance improvement plan seriously because of it.
These are important things to consider for such an important position within your agency. It holds both clinical and financial ramifications as well potential compliance landmines if the wrong person is in charge of your clinical program. If you see good clinical staff who may not fit the role of clinical manager, then consider other ways to reward the clinician for being so good in homes with your patients.
At Kenyon Homecare Consulting, we focus on high quality care while helping agencies to do it in a cost-effective way that promotes financial success as well. Call us today at 206-721-5091 or contact us online
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In an era of rising healthcare costs and widespread clinician burnout, healthcare organizations are facing a critical challenge: how to deliver superior patient care while maintaining a stable, motivated workforce and a thriving business model.
When a patient returns home after a stroke, the clinical landscape changes instantly. Survival is just the first hurdle; the real challenge lies in navigating the complex, often unpredictable journey of rehabilitation and long-term care. For home health and home care agencies and senior care facilities, caring for a stroke survivor requires more than help with Activities of Daily Living (ADLs). Stroke can affect a patient’s neurological, physical, and emotional functioning simultaneously. That’s why specialized, stroke-specific clinical training for caregivers is essential to improving patient outcomes, supporting staff retention, and strengthening the agency’s overall performance. The Multidimensional Complexity of Post-Stroke Care A stroke is not a singular event with a linear recovery path. Depending on the location and severity of the brain injury, caregivers may confront a baffling array of concurrent deficits: Physical and Motor Deficits: Hemiparesis (one-sided weakness) or hemiplegia (one-sided paralysis) completely alters transfer techniques. Improperly moving a patient can cause severe shoulder subluxation or skin tears. Cognitive and Communication Barriers: Aphasia (difficulty speaking or understanding speech) and dysphagia (swallowing difficulties) require immense patience and highly specific intervention techniques to prevent profound frustration or life-threatening aspiration pneumonia. Neurobehavioral Changes: Sudden emotional lability, post-stroke depression, or structural personality changes can easily overwhelm an untrained caregiver, leading to burnout or adversarial dynamics in the home. Without structured education, caregivers are left to rely on intuition. In complex neurological care, intuition is rarely enough to prevent adverse events. 4 Strategic Benefits of Specialized Stroke Education Investing in robust stroke-specific training programs transforms an agency's frontline staff from general monitors into clinical assets. 1. Drastic Reduction in Hospital Readmissions The first 30 to 90 days post-discharge are high-risk windows for stroke survivors. Educated caregivers act as the eyes and ears of the clinical team. They are trained to look past basic symptoms and identify subtle warning signs early: Recognizing micro-signs of silent aspiration during meals. Monitoring for deep vein thrombosis (DVT) in affected limbs. Identifying skin breakdown early on the hemiplegic side. Spotting the warning signs of a secondary stroke using the B.E. F.A.S.T. protocol (Balance, Eyes, Face, Arms, Speech, Time). Early identification allows for timely home health or physician interventions, keeping the patient safe at home and protecting the agency's rehospitalization metrics. 2. Safeguarding Staff and Patients (Risk Mitigation) The process of transferring a patient with dense hemiparesis requires precise biomechanical knowledge. Specialized education teaches caregivers how to support the affected side without pulling on weakened joints, how to properly utilize assistive devices (gait belts, sit-to-stand lifts), and how to manage one-sided neglect (where a patient completely forgets one side of their body exists). Proper training mitigates the risk of catastrophic falls and shields caregivers from debilitating musculoskeletal injuries, directly lowering workers' compensation claims and liability exposure. 3. Boosting Staff Retention and Professional Empowerment High turnover in caregiving is often caused by burnout and feeling unprepared for challenging cases. When an agency provides specialized clinical training, helping staff understand stroke-related behaviors and advanced transfer methods, it strengthens the caregiver’s role. Staff members feel empowered, confident, and valued as professionals rather than viewed as standard domestic labor. This professional dignity translates directly into higher job satisfaction and improved staff retention. 4. A Powerful Market Differentiator In a crowded marketplace, families and hospital discharge planners look for specialized expertise. An agency that can explicitly state, "Our caregiving staff undergoes advanced, competency-verified training in post-stroke neurological care, dysphagia management, and transfer safety," holds a massive competitive advantage. It builds immediate trust with families and establishes preferred provider relationships with local health systems and stroke centers. Building a Competency-Based Training Framework Effective stroke education cannot be a passive, check-the-box exercise. To truly impact care quality, an agency's training framework should combine foundational knowledge with hands-on validation: Neurological Fundamentals Core Focus Areas: Types of strokes, one-sided neglect, emotional lability, and aphasia communication strategies. Competency Verification: Written scenario analysis and communication roleplay. Mobility & Safety Core Focus Areas: Safe transfers (bed to chair), handling the flaccid or spastic limb, fall prevention, and skin integrity. Competency Verification: Hands-on return demonstration with a mechanical lift/gait belt. Nutritional Security Core Focus Areas: Dysphagia precautions, recognizing pocketed food, fluid thickening consistency, and aspiration prevention. Competency Verification: Direct observation of meal prep and feeding techniques. Conclusion: An Investment in Excellence The care of a stroke survivor is inherently complex, demanding, and volatile. Expecting caregivers to navigate these intricacies without targeted clinical education places an unfair burden on the employee and exposes the patient and the agency to significant risk. By prioritizing advanced stroke education, agencies and facilities do more than just improve compliance; they foster a culture of clinical excellence. The results are undeniable: safer patients, more confident and loyal caregivers, and a highly respected agency brand that stands out as a leader in complex home-based care. For in-depth education on caring for a person with a stroke, contact Kenyon HomeCare Consulting, which offers an 8-hour DSHS-certified continuing education course . Each chronic disease course includes a certification with a red-and-yellow flag guide that can be laminated for caregiving staff. To learn more, call 206-721-5091 or email gkenyon@kenyonhcc.com .
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