Andrea MacDonald, RN, BSN, is the winner of the 16^th Annual Joan Anne McHugh Award for Leadership in Long-Term Services and Supports (LTSS) Nursing. The award will be presented at the LeadingAge Annual Meeting and EXPO, which takes place Oct. 16-19, 2022, in Denver, CO.

MacDonald is the clinical operations manager for Nascentia Health Home Health Aides, a licensed home care service agency in Syracuse, NY. In that role, she oversees a team of 13 registered nurses (RN) and office staff, and more than 120 home health aides.

The McHugh Award recognizes a director of nursing or an assistant director of nursing who creates a supportive and engaged workplace environment by displaying excellent leadership skills while managing nursing staff and direct care professionals. The award was established in 2005 in memory of Joan Anne McHugh, a registered nurse, nurse manager, and nursing consultant who made a lasting impact on the geriatric health care profession.

BEGINNING WITH A LOVE OF PEOPLE

Andrea MacDonald began her healthcare career as a “candy striper,” passing out drinks and magazines to patients in a small, rural hospital in her hometown of Walton, NY. The experience helped her discover a key personality trait: she really likes being with people.

That love of people has become legendary since MacDonald arrived at Nascentia Health in 2015, a few years before the Visiting Nurse Association (VNA) Homecare, VNA Homecare Options, and Home Aides of Central New York were united in the new healthcare system.

Taking over a team that was suffering from low morale, MacDonald felt her first task as a nurse manager was to lighten the atmosphere. She did that by instructing team members to put a note in her “Happy Jar” each time someone on the team did something nice for them. Each week, MacDonald pulled one note out of the jar and invited the “do-gooder” to select a gift card as a reward.

“I had to encourage them to smile,” says MacDonald. “It took three months, but it worked. That first year, I didn’t make any changes other than in the comfort zone. That’s because I believe work has to be a place of comfort. People shouldn’t feel afraid or intimidated.”

The Happy Jar offers a good illustration of McDonald’s management style at Nascentia, where she is known for smiling perpetually; hosting regular celebrations, preferably with food; and writing personal notes to welcome team members to Nascentia, celebrate their birthdays, or acknowledge a death in their families.

PANDEMIC CHALLENGES

Despite MacDonald’s infectious enthusiasm, she faced serious challenges as a nurse leader during the pandemic. After nearly a third of her home health aides left the job due to COVID fears, MacDonald began working with the Nascentia human resources (HR) and marketing teams to bolster recruitment and retention. She couldn’t increase aides’ pay, much to her dismay. Instead, she worked with HR to develop a collection of soft benefits that she hoped would help attract and keep new employees on the job. Those benefits included:

• A sign-on bonus, which increased applications for aide positions.
• A $1,000 bonus for aides referring a friend who is hired.
• Benefits like a 401(k), health insurance, and paid time off.
• Paid mileage from home to the first case, in between cases, and back home.
• Paid travel time in between cases.
• An awards program that gives special recognition to two aides each month.
• An on-site training program for aides, who receive their full wages during the course.

MacDonald also instituted flexible scheduling, which helped the agency make the most of the aides who stayed on the job during the pandemic.

“With the support of the executive team, we started asking aides to let us know what cases could safely be reduced,” she says. “For example, aides on homemaking cases are in the home four hours. We asked, ‘Can you get the work done in three?’ In the end, we were able to give clients what they needed while also spreading out our aides to cover more cases.”

This kind of creative problem-solving is what MacDonald loves most about her job.

“It’s about asking the right questions and it’s about planting lots of seeds,” she says. “I tell my team, ‘This is where I want to go, but I need your help in how to get there. So, think about it. In a day or two, come back to me with your thoughts.’ When we meet, I get feedback and buy-in so we can implement something new, revising as we go. It’s about respecting everybody’s opinions and figuring out how we can come to a consensus.”

PREPARING FOR RETIREMENT

As she nears retirement, the 64-year-old MacDonald recently turned her attention to another task: succession planning. She’s currently mentoring team member Eleanor Greenfield, RN, with the goal of preparing Greenfield to become clinical operations manager one day.

MacDonald says she enjoys her mentoring role and plans to use her McHugh Award to improve her coaching skills. In the meantime, she never tires of practicing those skills on talented aides at Nascentia. With her encouragement, several of those aides have gone on to become LPNs or RNs. One aide is planning a career in medicine.

“If I see an aide with a special skill, I ask them if they’ve ever thought about pursuing other career opportunities,” she says. “I tell them what I see in them and what I hear about them from clients. Things like, ‘You come up with activities that are just amazing. You have kept the sparkle in that client’s eye. You’re doing great things.’”

MacDonald is also focusing on what her legacy will be after she leaves Nascentia.

“I want to leave this agency better than it was when I arrived,” she says. “But I really don’t want to be remembered for what I did. We’re at work more than we’re at home, right? So, I want my team to remember how it felt working with me. I hope they’ll think it was fun and worthwhile.”