Dr. Sally Francisco stepped in as Acting Nurse Leader in CLC after the CLC Long Term Care Ascellon Survey. That survey left the CLC with many findings. Dr. Sally took on the daunting task of overhauling the unit, led the team together, and started our corrective action plans right away. She started by getting the whole team involved since the front-line staff deals with our veterans day in and day out. She created a Lounge Room or Break Room for the staff, and furnished it with a microwave, refrigerator and coffee machine.

She also made sure that staff took their breaks. Staff breaks were reinforced, as well as coverage during breaks, which is documented in the assignment sheet. This helps with the morale of staff and makes them feel that all of them matter. The 8:15 Morning Huddles, 3:30 Afternoon Huddles for on-call, and 7:30 Evening Huddles were established for better communication of issues or concerns with all staff. As part of HRO, she established the RN Checklist for use during Daily Huddles and Watchlist Huddles. She invited staff from the medical center to reinforce I-CARE values and Whole Health initiatives during huddles. Bereavement support was also offered to staff since 1 CLC RN and 1 HBPC RN passed away during FY 24. Staff were recognized during huddles by distribution of certificates and giving them the VA Gratitude. She also coordinated the educational needs of the CLC staff. She met with each and every one of the staff to reinforce their important role in the organization, and evaluated their responsibilities and tasks. A specific orientation roadmap was established for different positions in the CLC. She mentored the Assistant Nurse Managers and Wound Care Champions in the creation of audit tools in MS Teams.

She hardwired the process of using the Nursing Transport support services so the nurses do not have to stop their nursing care to pick-up their patients from dialysis or outpatient clinics for their scheduled appointments. This also helped with patient satisfaction since the patients used to wait a lot because they were relying on CLC nursing staff to pick them up. She also established Phlebotomy services from 4:00 am to 12:30 pm for routine and non-urgent blood draws in the CLC. Staff are now able to focus on providing care to their respective residents.

She also spearheaded Team Building for CLC Nurses, Nurse Practitioners and the Nursing Leadership Team. SharePoint was established for standardized hand-off between charge nurses. Vocera was implemented in CLC for bidirectional communication between CLC staff, including Tele-Sitter, those on 1:1, and all frontline staff. She educated the nurses on placing work orders and following up every week to close the loop. She solved the unit's WOW issues. She provided guidance and data sharing, which focused on the number of infection-free days in the CLC.

She encouraged the nurses to get involved in projects to improve the unit, and for their own personal and professional growth. She participated in International Day for staff during Nursing Home Week in May 2024, as well as Staff Barbecue in August 2024. She encouraged staff to avail of the Zen Den in the Nursing Office for respite and relaxation. She educated staff regarding the different reporting systems, for example, JPSR and DBRS, and provided feedback. Staff always complain that they are verbally abused by their patients and nothing is being done. She collaborated with the DBRS Coordinator for staff support at all levels. She has an open-door policy, and staff is highly engaged in asking leaders for support. Under her leadership, the CLC has maintained four stars in Quality measures.