Community Connections for Health Care

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NURSING - Gateway to the Big Wide World

by Joan Bachman

My 55 year career afforded many exciting adventures; life was blessed by so many people, places, and opportunities. This written remembering is intended to encourage you to consciously learn to recognize and respond to opportunity, to use the gifts God has given you, and to know that the pain of forging through new territory results in fulfilment and satisfaction for you and your “customer”. Know that failures often lead to good steps forward. We are fortunate to live in a country with boundless resources, opportunities, and freedoms. We must take advantage of these blessings.

Although I loved bedside nursing for the first years, the status quo and inability to make a difference were somehow not satisfying, though certainly not boring. A typical shift for a rural hospital nurse included responsibility for med-surg, emergency room, and delivery room patients; there may also be a call to assist in surgery. We knew our patients as whole people with families in those days before technology and corporate business created major changes.

When offered the opportunity to become Director of Nursing (DON) for our 20-bed rural hospital, I jumped at the chance. Most of you will have trouble believing we had no written policy/procedure manual; Marie was available to answer every question. To initially qualify for Medicare Certification in 1965, we had to produce a written policy and procedure manual. My first 6 months as DON were spent typing - on a manual typewriter. During 9 years as DON, I developed and presented patient education for diabetes and prenatal care, and became otherwise involved in caring for community members. While a new attached nursing facility was being built, I borrowed a mannequin from JC Penney’s and conducted classes for new nurse aides.

When the hospital/nursing home Administrator left, I was hired to replace him and stayed for another 8 years. In 1973, most female health facility Administrators were Catholic Sisters. During those years, we constructed a replacement hospital. The project was time-intensive and I became familiar with the planning, design, and equipping of a facility that would suit changing patient care needs for the ‘70s. We discovered that staff members contribute wonderful ideas to make a building efficient and effective. They just need to be asked!

During subsequent administrative employment in other rural communities, lessons learned included staffing challenges, facility and community politics (not always pleasant), financial reality, and risk-taking. In one hospital, the ER treated an unusually large number of Code Blues. Investigation revealed the local nursing homes didn’t want any resident to die on their premises, so sent dying residents to the hospital in an ambulance. After we met with the nursing home managers, there was a decrease in the number of futile ER visits, and acknowledgement of the need for end-of-life planning – a need not yet filled. That was a valuable lesson in fostering cooperative working relationships between facilities for the good of patients and their families rather than the interest of providers.

Best job ever was my 10 years as Administrator of the SD Office of Health Facility Licensure & Certification (OLC). The 42 health care professionals in OLC were strong-minded regulators but we worked through professional biases to be a strong team. It was good to gain understanding of how government works – and to be instrumental in that arena. I was active in the national organization and made presentations to state and federal leadership for less punitive nursing home regulation - unsuccessfully. This position was my most satisfying and fulfilling, working with health facilities and agencies in the State, and contributing to the protection and promotion of health services for rural areas. The Distinguished State Official award, given by The South Dakota Association of Healthcare Organizations, is one of my most prized possessions.

Because of the growth in assisted living centers and the difficulties new operators had with regulations, I wrote the Guidebook for Assisted Living Centers and registered a private consulting business. My son edited and arranged copying of the books; I assembled them in 3-ring binders on the living room floor. Salesman I am not, but the timing was right to sell many copies across the country. I did get said what I needed to.

An initial consulting job with a Native American tribe to develop a nursing facility and assisted living center on an Indian Reservation resulted in more learning – about culture and about politics. Another interesting job was to study the feasibility of assisted living services for retired Catholic Sisters. Here, it was apparent that Sisters are more fun-loving than I remembered from my days as a student nurse. Other jobs included review and suggested revision of facility staffing practice and organization, and serving as interim administrator for nursing facilities. I was fortunate to be asked to help Somalis, Liberians, and Burundis in new healthcare businesses. A surprise was finding so many frail elderly New Americans tucked away in apartments, unable to fend for themselves. As a volunteer, I’ve been able to apply past experience as a grant writer and organizing member with nonprofit organizations. I offered workshops for continuing education credits for nurses and nursing home administrators, and presented at association conventions. Each of these varied contacts expanded my understanding of similarities and differences between people and organizations and the vital role of listening, often leading to new ventures.

My nursing background was a basic element of each undertaking related here. There are more tales to tell that will end up in The Book by Joan at some future date. Many thanks again to Mercy Hospital School of Nursing for building skills and courage I have used over these many years.

About the Author

Joan Bachman

Joan Bachman is a Registered Nurse, Licensed Nursing Home Administrator, Registered Health Information Technician, and Faith Community Nurse. She earned a Bachelor of Science degree in Business Administration. Joan has experience as a Nurse, Administrator, Developer, Trainer, Grant Writer, and served as Administrator of SD State Survey Agency. She has consulted with health care facilities and nonprofit organizations and presented leadership training. Joan is the author of Guidebook for Assisted Living Facilities and Senior Service Providers and Guidebook for Physician Services in the Nursing Facility, and she has published in professional journals.


Karen Kooren

This is great reading, Joan. You have accomplished so many great things. Thanks for sending it out!

Barbara Keyes

I loved the history lesson of nursing and really loved the insight from an administrative angle, but seen through the eyes of a servant that only desires that the hospital under her watch can be given the potential of being the best hospital/care giver it can be.

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