Be In the Know!

As you know, one of the primary roles of the nursing assistant is to collect and communicate information.  The information is collected by observing clients and communicated by reporting to the nurse and/or documenting in the client’s chart.  So, how good are your CNAs at observing and communicating important information about their clients?

For example, do they know the difference between information that is urgent, important or significant?  And do they communicate these three types of information appropriately?  For example, urgent observations are those that are immediately life threatening.  If your aides consider a client going one day without a bowel movement urgent information, you might want to give them a review of this topic.

Do your CNAs distinguish between objective and subjective observations?  When was the last time you reminded them that for information to be objective, they must be able to see, hear, feel or measure it…or have it confirmed by another person?  If the reports from your nursing assistants tend to sound like opinion instead of fact, they may need to brush up on this skill.

In both acute and long term care, things can change fast for your clients.  Your nursing assistants need to be knowledgeable about what is normal so they can recognize what is abnormal.  This applies to vital signs, mental status, elimination, the skin…and so much more.  While most CNAs learned the “norm” in school, it is helpful to give them a refresher on abnormal observations once in a while.

Here are some inservice ideas to help your CNAs hone their observation and reporting skills:

• Spend an hour giving an overview of the human body.  Review each of the body’s miraculous systems…and discuss how important each one is to a person’s overall health.   Then, your CNAs can use what they learn to help their clients live healthier, longer lives.

• Present an inservice about basic human needs.  Remind your nursing assistants that they aren’t caring for bodies, they are caring for people.  And, all their clients have very basic needs, including physical and psychological needs–fundamental needs that are the same, regardless of where or how they live. Review the five levels of Maslow’s hierarchy of human needs.

• Teach them about the normal aging process so they know what to expect when working with elderly clients.  For example, do your aides know that the elderly have fewer sweat glands, so they have trouble keeping their body temperature stable?   Or that the heart muscle becomes less “elastic” so it pumps with less force?  To make up for this, the heart beats more frequently.

• Give your aides a vital signs update.  While many organizations rely on technology to measure vital signs, your CNAs should never lose the basic skills of taking a client’s temperature, pulse and blood pressure.  And, since pain is considered the fifth vital sign, be sure to provide information about pain management.

• Review reporting and/or documenting client care information. During this inservice, remind your nursing assistants that if they are providing care for clients without documenting thoroughly and carefully—your organization may not get reimbursed for their work.  Or, if they are documenting care that they did not perform, your organization may not get reimbursed, and could possibly be fined for the false records.  Both situations result in a financial loss.  And, a loss for the organization is a loss for you, your CNAs and your clients!

If you don’t have the time to put together inservices on one or more of the above topics, remember that, at In the Know, we have done it for you.  You can click on the links throughout this article to see what we have to offer.  And, if you have ideas for inservices that you’d like our team of nurses to write, please send an email to info@knowingmore.com.  We’d love to hear from you!

Has your budget for continuing education been cut or put on hold during this economic downturn?  When money is tight, it’s typical for many organizations to look at staff training as “non-essential”.  But, consider these results from a recent study of nearly 1200 companies, comparing the impact of recruiting externally with that of developing current employees.

• 75% of the 1,189 companies involved in the study felt that training their own staff was more beneficial to their business than recruiting people from outside.
• 50% of the companies discovered that training staff made them more likely to stay.
• 33% found that continuing education increased staff motivation, and
• Almost 50% saved money in the process.

In an article about the study, senior researcher, Emma Parry, said: “With training budgets often the first to go in a recession, this research demonstrates that ‘growing your own’ is an effective way for organizations to obtain the skills that they need while saving money.”

“I wasn’t surprised by the findings, but it is nice to have the evidence,” she said, adding that it makes sense that money spent on advertising, interviews and orientation programs can often be better spent on existing staff.

“It also helps staff retention because employees are more likely to stay if they are being developed. They are more committed and are more likely to go the extra mile if they feel the company is helping them to expand their skills,” she said.

Parry added that the problem was that companies often didn’t see the value of investing in training until it was too late. “Sometimes training is seen as nonessential, and when budgets get tight, companies start to look at what they can save money on. But to be honest, cutting training is a false economy.”

What’s the bottom line?  Organizations must focus on nurturing the employees they have if they are to survive, grow and succeed.  This is especially true for certified nursing assistants due to the increasing demand for their services. As the above study shows, effective training reduces staff turnover and absenteeism, improves motivation, increases productivity and helps boost customer satisfaction.

Don’t let a tight budget diminish the quality of your continuing education program.  For starters, be sure to download our free inservice, Customer Service in Health Care.  And, if you’d like help creating a cost-efficient CNA inservice plan, give us a call at 877-809-5515.  We offer options suitable for every education budget!

Have you seen the latest online newsletter from the Joint Commission?  It details a number of the “most challenging requirements” for the first half of 2010…in other words, the requirements for which organizations are getting cited.  This is great information, especially if you expect a Joint Commission survey any time soon.

Here are some examples:

• 31% of home care agencies surveyed this year were found non-compliant in following physician’s orders!
• 23% of home care staff were found to be less than competent to perform their jobs.
• Home care staff failed to reduce the risk of client falls 21% of the time.
• A whopping 24% of Medicare-certified nursing homes were deficient in hand hygiene!
• In skilled nursing facilities, residents were not assessed or reassessed properly 17% of the time.
• 16% of skilled nursing facilities had an ineffective emergency plan.
• Hospitals didn’t fare any better.  47% of them were cited for improper fire safety equipment.  And, 27% of them did not maintain a safe environment for patients.

Armed with the above knowledge, you can take steps now to prepare your nursing assistants for future Joint Commission (or other) surveys.  And, we can help!  In the Know has inservices covering all of the above topics…and much, much more.  If you have pressing issues that you feel might come up during a survey, give us a call.  We can help you put together a pre-survey inservice plan that will help your CNAs sail through with no deficiencies!

And, if you’d like to see the Joint Commission statistics for yourself, check them out here.

Last week, the results of a Penn State study on occupational injuries were revealed.  It should come as no surprise that nursing assistants and home health aides were high on the “injured list”.  However, the researchers found that on-the-job injuries caused a lot more than just a few aches and pains.  They also led to increased CNA turnover and, potentially, a bad reputation in the community!  Here’s what Deirdre McCaughey, assistant professor of health policy and administration had to say:

“In our research, we saw a cascading effect.  Employees who had no training or did not believe their training prepared them well had more injuries.  Those employees were also much less likely than non-injured employees to recommend their organization as a place at which to work or seek services.”

Here are some other findings of the study:

• Employees who felt ill-prepared were three times more likely to be injured than employees who were well-trained.
• Employees who felt poorly supervised were also more likely to be injured–not just once, but multiple times.
• Cutting back on training to shave the budget increased employees’ injury risk and turnover rates.  In the long run, this boosted costs rather than saving money!

You’ve probably experienced it firsthand.  When money gets tight, education is one of the first things to go…especially at the nursing assistant level.  But are you really saving money?  What are the injury and turnover rates at your workplace?  If asked, do you think your CNAs would consider themselves both well-trained and well-supervised? Would they recommend your organization as a place to work or as a place to receive care?

At In the Know, we strive to provide quality CNA continuing education to meet every budget.  If you’d like to discuss how you can maintain a top-notch team of (healthy) nursing assistants please give us a call at 877-809-5515.  With more than 130 inservice topics, including modules on safe transfers, back care, the CNA/Nurse relationship and personal wellness, we can meet your CNAs’ learning needs.

Happy Teaching!

Linda

The dictionary defines compassion as “a deep awareness of the suffering of another, coupled with the wish to relieve that suffering.” So, for someone to be compassionate, he or she must be able to put themselves in someone else’s shoes, AND act on his or her desire to lessen that person’s suffering or unhappiness.

It can be hard to always know whether or not your nurse aides act in a compassionate manner while on the job.  That’s why it’s so important to encourage compassionate behavior.  By studying our newly added inservice called “The Caring Qualities of a CNA,” your nurse aides will learn everything they can do to have more empathy, compassion, patience, dedication and respect for their clients.

A Peek Inside the Inservice:

Whether or not you can TEACH compassion is a question that is hard to answer.  However, as a nurse educator, you can ENCOURAGE your nurse aides to be more compassionate.  Try sharing the following tips with your CNAs:

• Remember to put your clients’ needs before your own.
• Treat people fairly and with respect and dignity.
• Show kindness without expecting rewards.
• Get to know your clients.
• Comfort your client’s family members who may be stressed and/or grieving.
• Be sensitive and allow people to vent their frustrations.
• Listen when people confide in you.
• Be friendly to any new co-workers who seem to be overwhelmed.
• Help a co-worker without being asked.
• Try to understand someone you don’t like or with whom you disagree.
• Accept people for who they are–faults and all!

Click here to see a sample page of “The Caring Qualities of a CNA.”

If your client population is comprised mostly of seniors, the National Mental Health Information Center has some terrific (and free) resources for you.  As you probably know, mental health is a big issue for seniors.  In fact, people over age 65 have one of the highest suicide rates of any age group in the United States!

At the National Mental Health Information Center, you can download (at no charge) toolkits, fact sheets and staff workshops all aimed at preventing suicide and promoting optimal mental health among senior citizens.  All you need to take advantage of these materials is Acrobat Reader.

As your nurse aides provide personal care and assist with ADLs, it’s vital that they also pay attention to their clients’ mental health status.  If you are looking for additional mental health resources, don’t forget In the Know inservices.  We offer the following related topics:

• Understanding Depression
• Working with the Mentally Ill
• Understanding Schizophrenia
• Understanding Common Phobias
• Understanding Suicide

Because your CNAs spend so much time with your clients, they are in a good position to notice changes in mental health.  So, be sure to arm your nursing assistants with the knowledge they need to make (and report) appropriate observations about their clients’ mental health.

Your CNAs make observations about their clients all day long.  Therefore, it’s incredibly important that each of your CNAs know what, when and how to report what they see.  Not only should your nurse aides know the procedure for reporting and documenting client care, they should also be aware of what observations are considered abnormal.  After completing our new inservice topic, “Recognizing and Reporting Abnormal Observations”, your nurse aides will be able to:

• Distinguish between normal and abnormal observations in their clients.
• Identify the specific course of action to take with each abnormal observation they may encounter.
• List at least three abnormal observations they might make in regards to:  vital signs, mental status, nutrition and pain.
• Distinguish between objective and subjective observations.
• Demonstrate the ability to recognize and properly report abnormal observations in their daily work.

Would you like to see a sample page from the inservice? Click here to view the PDF file.

Interested in ordering this topic? Click here to visit our website.  If you would prefer to order over the phone, call us toll-free at 877.809.5515 and one of our helpful associates will be happy to assist you!

It’s officially summer when the pace of every day life is supposed to be slower and more laid back.  Hmm…how’s that going for you? These days, it seems like we’re all running at full speed throughout the year!  However, at In the Know, we work hard to make your life easier…at least when it comes to inservicing your CNAs.  Our customers report that implementation of our inservice program is simple.  And, many of them have offered their own tips for sailing through annual inservice requirements.  Here are just a few of those tips:

“I add information and questions to my In the Know inservices that are facility-specific.  And, on each unit, I maintain a self-study folder box so that the CNAs always have access.”

“I utilize members of our team to present different inservices.  For example, an African American assistant administrator presented the ‘Understanding Cultural Diversity’ inservice to help CNAs understand that it is so much more than race.  Medical social workers presented the ‘Understanding & Supporting Advance Directives’ inservice.  And, a corporate compliance officer presented the ‘Maintaining Confidentiality’ inservice.”

“When I do a training, I copy the learner’s section of the inservice, the quiz and any puzzles or games–and distribute them to the aides.  The aides are very involved in the training.  Usually, we split up in groups during the inservice meeting and I assign a group leader.  We do some problem solving.  This allows the aides to practice critical thinking.  Then, we get together and discuss each other’s ideas.

“I develop a workbook for each In the Know topic which includes several copies of the learner’s section and a separate instructor workbook.  This has been especially helpful for the night shift.”

“To save paper, we try to recycle copies of each In the Know inservice throughout the year.  However, aides are welcome to keep their own copies if they wish.”

“We mail In the Know inservices to employees with their paychecks once a month.  It works great!”

“I print out the Certificate of Completion from my In the Know Supervisor Toolkit.  I make one copy for the company file and one for the employee to take home.”

“To let our employees know when and what the monthly inservice is, I ‘advertise’ it by writing a short article in our company newsletter.  (The newsletter comes out one week before the inservice meeting.)”

“I allow my home care aides to do their inservices on a self-study basis.  I pay them for an hour and provide them with a due date.  When I grade their quizzes, I let them know how they did and hand out certificates.  They really enjoy receiving that pat on the back.  Also, if a number of aides miss the same quiz question, I use that as an opportunity for further education.  It lets me know what they don’t understand.”

“Sometimes, I give the nursing assistants material from the inservice to preview.  Then, on the day of the meeting, they present their section of the inservice.”

“I’ll pull some interesting facts or statistics from each inservice and write them on separate slips of paper which are distributed to each participant.  Throughout the inservice, I have each person read his/her fact to the group.  This promotes participation, even among shy employees.

We hope these tips give you some ideas for streamlining your own inservice program, whether or not you use In the Know modules.  And, from all of us at In the Know, Happy Summer!

Did you know that people are talking about your CNAs?  It’s true!  People from all over the U.S. are speaking their minds about nursing assistants.  They are sharing their thoughts about the dedication and compassion shown by CNAs across the country and beyond.

Who’s doing all this talking?  Your co-workers…nurses and other nursing assistants.  Politicians…governors and senators.  And, celebrities…a diverse group including Mary Murphy (from So You Think You Can Dance), Dr. Patch Adams and actress Jane Fonda.

Where can you read their comments?  Visit Just for Nursing Assistants.  While you’re there, please consider leaving some comments of your own.  For example, what would you say to a CNA who feels discouraged?  Or, what would you say to someone who is thinking about becoming a CNA?  You may add your thoughts here.

Soon, it will be CNA Week (June 10-17).  That’s a great time to put the focus on your CNAs and give something back to this hardworking group.  At In the Know, we send our thanks to CNAs everywhere…and we hope you will spread the word about our new site, Just for Nursing Assistants, which was created just for them!

It’s part of life. As we age, we are forced to deal with a greater number of serious emotional losses.  Most elderly people must face a variety of different losses.  Do your CNAs know how to help their elderly clients deal with those losses?  At your next CNA inservice meeting, consider using the following scenario as a way to open a discussion about loss among the elderly.

Emotional Losses of the Elderly

“In youth, we run into difficulties.  In old age, difficulties run into us.”

~Josh Billings

There’s no way around it. Losses are painful and often sad. They represent an end to something—and this ending creates an emotional wound. This is especially true for the elderly who must endure a number of different emotional losses. For example:

• At age 65, Sarah Smith retires from her job. Even though this gives her more free time, she misses the daily contact with her former coworkers. A year later, Sarah’s husband dies. His sudden death leaves her devastated…and in some financial trouble.

• During that same time, Sarah is diagnosed with both diabetes and hypertension. She also develops chronic back pain.

• On her 67th birthday, Sarah receives word that her sister has passed away. Three months later, Sarah’s best friend dies from cancer.

• Six months later, her son decides that she should no longer live alone. He helps Sarah sell her house and moves her into an assisted living facility.

• To the staff at the facility, Sarah seems like a grumpy, forgetful woman who keeps to herself and seems impossible to please. No one is very fond of her. But look at things from Sarah’s point of view. Within two short years, she has lost her work, her friends, her health, her husband and her home. Is it any wonder that she tends to be grumpy and withdrawn?

Just like physical injuries need time to heal…so do emotional wounds. People who spend time grieving are doing what they need to heal their emotional wounds. The only “cure” for grief is to go through the grieving process. People must do this in their own way and at their own pace.

Grieving is hard work and can leave people physically and emotionally exhausted. In the end, the process of grieving encourages people to take charge of their own lives and to move forward.

Would Your Nursing Assistants Like to Know More?

If you’d like to give your CNAs more information about emotional losses, consider presenting an inservice that includes information on:

• The three stages of grief.
• The physical and emotional symptoms of grief.
• The loss of youth.
• The loss of family and friends.
• The loss of work.
• The loss of a spouse.
• The loss of health.
• The loss of independence.
• What your CNAs can do to help clients through these losses.

Don’t have time to put together your own inservice?  Then, please check out our inservice called Emotional Losses in the Elderly.  It covers all of the above information…and more.

Happy Teaching!