Be In the Know!

How do your nursing assistants handle workplace conflict? Do they ignore it and pretend it isn’t happening? Do they give in just to make it go away? Or, do they compromise respectfully with each other? At your next CNA inservice meeting, consider using this case study as a way to open a discussion about conflict management at your organization.

You Can’t Avoid Conflict

It’s true: whenever people spend day after day together, conflict cannot be avoided completely. You may be nodding in agreement or you may be thinking that you’ve never had a dispute with anyone. However, conflict at work happens to everyone at some point in his or her career.

A dispute between people usually begins with a disagreement. When you and a co-worker disagree, you have one opinion and your co-worker has another. Often, it doesn’t really matter to either of you what the other person thinks. You both go on with your lives, each sticking to your own opinion. Usually, disagreements consist of only words and they do not affect how people interact with each other.

For example, Tim and Connie, both CNAs, disagree one day at work about the proper way to give a bath to a bedridden client. They each express their opinion, saying that’s how they were taught in school. They end the discussion by saying, “OK…you do it your way and I’ll do it mine.” Tim and Connie disagree, but they respect each other’s opinion and have no trouble working together.

A full-blown conflict can begin with different opinions, but it grows into something much larger. Generally, it is not what people say, but how they act, that causes a disagreement to escalate into a conflict. In almost all conflicts, the problem is not the initial disagreement, but the way in which it is handled.

Let’s take another look at Tim and Connie’s situation. Imagine that instead of agreeing to disagree about bathing a client, they get into an ongoing struggle about who is right.

Tim starts telling other co-workers that Connie doesn’t know how to give a proper bath. Connie gives Tim hateful looks and refuses to work with him. They have entered into a contest of opposing forces. Having gone past the point of disagreement, Tim and Connie are in a full-blown conflict, which can start causing a disruption among their co-workers and eventually in job performance. Both Tim and Connie are creating a situation where neither will back down; each thinks that they would appear to be wrong by offering a truce. Unless their conflict is resolved, work will remain an unpleasant place for both of them!

Tim and Connie must put an end to their conflict, as it is hurting them both… and is also causing a disruption to the rest of the workplace. Let’s see them fix the problem by going through five simple steps:

1. Connie realizes that they need to stop this fight and asks Tim politely if she can speak to him. Tim agrees and they sit in an empty meeting room together–away from their coworkers.
2. They take turns telling one another their points of view. One speaks while the other actively listens.
3. They see that the problem is they each have a strong personality, are competitive and like to be right. They agree that the problem was never the actual bathing technique—but how they communicated.
4. They discuss the bathing method they each use and decide that both techniques are acceptable. However, Tim and Connie say they will continue using their own method. Neither person wins or loses.
5. Tim and Connie decide that, in the future, they will keep their own techniques to themselves. As long as the job is getting done, they can agree to disagree on the proper method. If either Tim or Connie uses a method that is not getting the job done, they will discuss it politely at that time. In the meantime, they agree that the conflict is over, and they both decide to apologize to their co-workers.

Would Your Nursing Assistants Like to Know More?

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

• The common ways that people approach conflict.
• A step-by-step process for resolving workplace conflict.
• How gossip and workplace bullying promote conflict.
• How to respond to an unprofessional coworker.
• How to handle conflict with a supervisor or a client.

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

Happy Teaching!

There’s a book I’d like to recommend to nursing supervisors and educators everywhere.  It has nothing to do with health care or nursing specifically, but has everything to do with helping us inspire those around us.  The book, Start with Why, emphasizes the importance of uncovering what makes you “tick”.  Its author, Simon Sinek, encourages readers to reach past the “what” and “how” of their jobs and dig deeply for their “why”—the purpose, cause or belief that gets them out of bed every morning.

For example, here’s how I examined myself after reading the book:

WHAT I do:  I run a company that sells continuing education for nursing assistants.

HOW I do it:  Along with a team of writers, I create CNA inservices and sell them to health care organizations around the globe.

WHY I do what I do:  Here’s where it got challenging.  The process of mining my personality for my “why” took some time.  Basically, here’s how it evolved…

• I create inservices for nursing assistants because I’m a nurse. Well, yes, being a nurse is a requisite, but I could have taken my nursing career in many different directions.  So that’s not the answer.

• I create CNA inservices because I like to teach. Sure, that’s true.  But that’s not exactly what makes me eager to come to the office every day.  I had to start thinking beyond the obvious and look for my purpose, my true beliefs.

• So, I began looking around me, examining the company that I had created.  Then it struck me.  I had named my company In the Know.  The website address I established is made up of the words knowing and more.  My employees are all encouraged to continue learning…and even have library time during their workday when they can read up on any subject of interest to them.  Together, we create learning materials.  Everything pointed toward the same thing: knowledge.

• I believe that knowledge is power. Hmm…I felt like I was getting close!  But thinking of knowledge as power paints a static picture.  My “why” felt more dynamic than that.

• I believe that lifelong learning is essential to both personal and professional success. Ah ha!  That’s more like it!  Learning is an ongoing, fluid process.  Learning brings people together—and when two people share what they know, they both come away with more than they had before.  That’s my personal and professional “why” and is what inspires all of us at In the Know to do our very best!

As a nursing supervisor or educator, are you tapping into your “why” when it comes to inservicing your nursing assistants?  For example:

WHAT you do:  Present inservices to your CNAs.

HOW you do it:  By passing out and discussing handouts at monthly one hour meetings.

WHY you do it:  Because it’s required? That’s just the surface.  To share your knowledge with your nursing assistants? Maybe, but author Simon Sinek would have you dig deeper.  To join together with your aides to learn something new? That’s better.  Because you believe that the more your CNAs know, the more they can achieve? Maybe…but only you can figure out your “why” and use it to inspire not only yourself but everyone around you.

If you don’t have time to read Simon’s book, at least take a quick peek at his blog.  You’re sure to find inspiration in his words.  And, have fun pondering your own personal and professional “why”!

Nurses and nursing assistants are all part of the same team and have the same goal: provide quality care to clients in need. So why is it that nurses and CNAs don’t always see eye to eye? Here’s what a few CNAs across the U.S. had to say recently:

Valnecia said: “I respect nurses for their education but they should realize that CNAs are their eyes and ears with the patients.  I feel the nurses at my job do not take me seriously—as if I don’t know what I am talking about.  We need to learn to work together as a team and not against each other.”

Guadalupe said: “Nurses and CNAs should have respect for one another; this would not only help the patients but create a better work environment.”

Heather said:  “I know we don’t have as much schooling as nurses but we’re not dumb and that’s how I feel that we’re treated sometimes.  And, some of my fellow CNAs are terrible, too.  They throw child-like tantrums when you ask them for some help.   I just wish everyone would work together as a team.“

Lori said:  “I love my job and will stick it out but when I’m doing a good job and don’t get any good feedback-just constant criticism instead-that is when the going gets tough. Just a little praise goes a long way.”

Do any of the above statements sound familiar? If so, here are some tips you can share that may help promote respect between the nurses and CNAs at your workplace:

Be kind to everyone on the nursing team. Remember that working with sick and/or aging people can be emotionally exhausting.  It can be very frustrating to work hard every day and see no improvement in your clients—or even see them getting worse.   Support your coworkers…and let them support you!

Put yourself in your co-workers’ shoes. Think about what it must be like to be them—what they may be going through and why they behave as they do.  When you try to understand other people, it’s easier to empathize with them.

Pull your own weight by fulfilling your assigned duties. But, remain flexible, too!  Your assignment may change from week to week, from day to day or even from hour to hour.  And, when someone asks you to help with a task that’s not one of your regular duties, try to avoid saying, “That’s not my job.”

Be passionate about your work. By showing others that you love your work, you become a shining example for others to follow.

Do the right thing. If you approach your work with honesty and integrity—and do your best at all times—you will respect yourself for a job well done.  And self-respect is so important!  Remember the old Spanish proverb, “If you want to be respected, you must first respect yourself.”

Keep on learning. Take every opportunity to learn new things.  Complete extra inservices and then apply what you learn during your daily work with clients.  The more you know, the more valuable you become to yourself, your co-workers and to your workplace.

For more about teamwork between nurses and CNAs, consider our inservice modules: The CNA/Nurse Relationship and Working with a Team.

Until next time!

Linda

Linda Leekley BS, RN

Here’s a true story that says a lot about the perception of quality in the United States:

IBM decided to have some of their computer parts manufactured in Japan. In the contract, IBM stated that they would accept three defective parts out of ten thousand.  When the parts were delivered from Japan, they arrived with a letter.   It said, “In Japan, we have a hard time understanding American business practices.  But, the three defective parts you ordered have been manufactured separately and are included with your regular order.  We hope this pleases you.”

So, how do the CNAs perceive quality at your workplace?  Here are some basics that you might want to cover with them at your next inservice meeting:

What Is Quality?

Quality is doing the right things to the right people at the right time…and doing things right the first time.

Quality saves money. Doing things right the first time requires less money than having to deal with the consequences of poor client care.

Quality means doing the right things right. When each employee strives for 100% quality, everyone benefits.

Quality focuses on the results of your client care—not just on getting the care done.

Quality is everyone’s responsibility.  (It’s possible to measure quality so that every health care worker understands what “good care” means.)

What Are the Benefits of QI?

Have you ever heard the saying, “If it’s not broken, don’t fix it”? So why bother trying to improve when the quality of care may already be good? Health care organizations that focus continuously on quality benefit in many ways:

• The clients receive the best possible care.
• The employees have a clean and safe workplace.
• Problems can be identified and solved before they become serious or widespread.
• Staff members from different departments work together to solve problems.
• The organization avoids wasting resources…including supplies, money and employee’s time.
• Surveys from the state or from JCAHO are less stressful because meeting (or exceeding) standards is a way of life for every employee.
• The workplace gains a positive image in the community.

And Remember…

In health care, quality can’t always be measured by how quickly clients get well. No matter how hard they try, health care workers are never in complete control over their clients’ health status.

For example, hospice employees care for people who are dying.  It would be unfair to measure the quality of hospice care based on how many clients get well and go home!  Instead, there need to be other measurements such as: Is spiritual counseling offered to every hospice client and his family?  How many clients at the hospice die free from pain?

The methods for measuring quality vary somewhat from one health care workplace to another.

Spending a lot of money on client care does not guarantee good quality.  Poor client care can be just as expensive—if not more so—as quality improvement programs.  Think about it.  It can cost up to $30 thousand to heal just one bed sore.  And, if a client falls and breaks a hip, it can cost up to $35 thousand! Preventing these problems would cost much, much less.

Changing the way things are done does not necessarily mean the old way was “wrong”. It could mean that a QI team at your workplace has come up with a better way to do something…or an easier way…or a quicker way…or a cheaper way. There’s always a reason for change. If you’re not sure what that reason is…ask!

Quality improvement is the responsibility of every employee. Even if a workplace has a special QI nurse or a large QI committee, all employees are still responsible for doing their part to improve quality of care.

Get Excited about Quality Improvement

Share the results of any quality improvement studies for your workplace with your nursing assistants.

Suggest that some of your CNAs volunteer for the QI committee at your workplace.

Remind all your CNAs that they are the experts at the tasks they perform every day. If they see ways to make their job—or their client care—better, it is their responsibility to share their ideas.

For more information about quality improvement, please check out our inservice, Understanding Quality Improvement.

Happy Teaching!

Linda

Maintaining a fully staffed team of CNAs can be a challenge.  Let’s say you’re short staffed and rushing to fill those job vacancies.  You take the time to advertise for CNAs, interview prospective employees and complete the entire hiring process.  You’re tempted to get those new CNAs on the schedule as soon as possible.  However, the best thing you can do to make sure that both time and money haven’t been wasted is to orient your new nursing assistants.

Nurse aides have the least amount of pre-employment training of any other clinical employee.  Your CNAs may come to you with only weeks of clinical schooling.  As a result, they require—and deserve—an extensive introduction to their jobs.

A thorough orientation has many benefits—for your workplace, your new employee and you.  These benefits include:

• Reduced anxiety. By providing new employees with specific guidelines, an orientation helps them know what is expected of them from day one.

• Increased job satisfaction. Orientation helps ensure that new employees are well-prepared to perform their assigned duties instead of feeling overwhelmed, stressed out and ready to leave!

• Time savings for supervisors and coworkers. A thorough orientation makes new employees self-sufficient sooner—so they don’t pull you and your other aides away from your own jobs to answer questions or provide constant assistance.

• An improved employee retention rate. Across the nation, turnover of nursing assistants costs healthcare organizations more than $4 billion every year!  However, studies have shown that organizations with a comprehensive orientation can expect to reduce their turnover rate by 50% within two years.

So, what should a CNA orientation program include?  Here are some suggestions that have been shown to get nursing assistants off to a good start:

• Working as a Nursing Assistant. Promote professionalism by providing your aides with the tools they need to be team players.  Review their job description with them, step by step, and discuss workplace policies on chain of command and delegation.

• Supporting Patient Rights. Emphasize the importance of patient rights, especially confidentiality—the cornerstone of the relationship between healthcare workers and their clients.  Help your CNAs understand advance directives and the signs and symptoms of abuse.

• Infection Control. Because nosocomial infections continue to be the most common cause of medical errors, new employees benefit from a review of handwashing protocol, standard precautions and drug-resistant infections.

• Client Care Tips. Nursing assistants, especially those who are “new grads”, can become overwhelmed quickly by the demands of client care.  If you arm them with practical tips that focus on personal care, nutrition and client safety, their on-the-job confidence will soar.

• Self Care. By spending orientation time on employee wellness, you’ll show your new aides that you care about them as people and recognize that they are your greatest resource.  If you ignore this crucial area, you run the risk of developing stressed-out, disgruntled CNAs within a matter of months.

• Providing Quality Care. By focusing on customer service, quality improvement and medical error prevention, you’ll instill a desire for excellence among your new CNAs.

• Writing It All Down. As every nurse knows, when it comes to client care, if you don’t write it down, you didn’t do it.  Devoting time to proper documentation (and/or oral reporting) is essential for every new employee.

Whew…that’s a lot of information.  Who has time to put together an orientation program like that?  The good news is that you don’t have to.  Instead of reinventing the wheel, check around for companies that offer an orientation course for nursing assistants.  For example, take a look at our comprehensive CNA Orientation Program:  Getting Off to a Good Start.  Not only does it provide your new CNAs with a top-notch orientation, it also gives them a whopping six hours of inservice credit!

Remember…by developing and retaining top-notch CNAs, you’ll recoup the money you spend on quality orientation materials in no time.

Quality inservices develop top-notch CNAs!

Is part of your job as a nursing supervisor or nurse educator to develop monthly inservices for your nursing assistants? If so, you know how time consuming that process can be. Perhaps you’ve considered purchasing “ready-made” topics from a company (like In the Know) that sells CNA inservices. You’re really tempted, but are not sure it’s worth the cost. Here are five tips for helping you make that decision:

1.  Tally Your Time.

Next time you need to prepare an inservice, keep track of how much time you spend. Remember to include the time it takes you to think of a topic, come up with learning objectives, research and write the inservice, create some handouts, develop a quiz and produce an evaluation form. Chances are, this will take at least 10 hours of your time. Multiply that by your salary and you’ll probably be shocked at what one inservice is costing your workplace! By purchasing inservices, you avoid “reinventing the wheel” and can bring down your cost per inservice considerably.

2.  Do a Quality Check.

No matter how knowledgeable you are about the nursing field, creating inservices may not come easily to you. It requires a variety of “non-nursing” skills such as knowing how to research quickly and effectively, being a good writer and having some computer savvy. Are the inservices you’re creating capturing the attention of your CNAs? Do they provide an in-depth study of each topic? If not, they may not be having a positive effect on client care. Inservices from a respected inservice company can spark interest for both you and your aides. However, before making a purchase, insist on trying out a sample inservice. You’ll want to see the quality of their product for yourself.

3.  Take a Look at Compliance.

We all get in a rut, causing us to do something a certain way just because that’s how it’s always been done. But, when you look at your current system for providing inservices, is it really working? For example, do your CNAs skip inservice meetings because they are too busy or just aren’t interested? Do you struggle to get all your nursing assistants to meet their inservice hours by the end of the year? If so, there is probably an easier way. A quality inservice provider can give you a flexible, easy-to-institute inservice program that will please you, your CNAs and any surveyors that come your way.

4.  Eye Your Inventory.

Over time, you’ve probably built up a library of inservice topics. Take a peek at what you’ve got to offer your nursing assistants. The basics are probably there: standard precautions, nutrition, Alzheimer’s disease, abuse, confidentiality. And, you might find yourself reusing these topics with each newly hired group of CNAs. But, it’s important to meet the learning needs of your aides by offering a wide variety of inservice topics. Coming up with mandatory topics, disease process inservices, psychosocial issues and basic skill reviews could be a full time job and/or eat into your personal time! A good inservice provider has dozens of topics from which to choose. And, the more your CNAs know, the more they can achieve!

5.  Ask Your CNAs.

To find out if your current inservice offerings are meeting the needs of your nursing assistants, ask them! You might distribute an evaluation form or have an informal group discussion. Ask questions such as: Do our current inservices prepare you to succeed at your job? Do you feel that your skills are enhanced by every inservice you complete? Are the inservices providing you with information that you can apply in your daily client care? If your CNAs answer “no” more often than “yes”, then it may be time to try an inservice provider. Quality inservice education should do more than fulfill state requirements. It should enhance the professionalism of your nurse aides and improve your client care. So, take the time to investigate inservice providers and find the one that helps you develop a team of top-notch CNAs.

If you are looking for more ideas to spice up your 2010 inservice schedule, consider presenting the following topics:

1.  Review the Normal Aging Process

During their short initial training time, nursing assistants learn a few basics about the human body. However, in order to enhance their observational skills, it’s good to provide more details about how humans age. Try presenting the information by body system. Talk about the lifestyle choices that slow aging and those that speed it up—and remind your CNAs how they can help their elderly clients enjoy a good quality of life.

2.  Discuss End of Life Care

To be outstanding, CNAs should be able to handle the full spectrum of life, including the dying process.  Give your aides information on the end of life, such as how to recognize symptoms that signal death is near, how to provide comfort for dying clients and their families and how to care for the body once death has occurred. Consider including information on death and cultural diversity and the stages of grief.

3.  Brush Up on Mouth Care

Top-notch CNAs understand the importance and benefits of good oral hygiene and how it can affect not just the quality of their clients’ lives, but also their overall health. How about presenting an inservice that goes beyond the mouth care protocol for your workplace? Give plenty of tips for performing oral hygiene, dealing with dentures, and observing for oral and dental problems.

4.  Delve into Basic Human Needs

To enhance your nursing assistants’ sense of empathy, give them an overview of Maslow’s Hierarchy of Needs. During the inservice, review the five levels of basic human needs, how the levels relate to each other and how illness affects a person’s place in the Hierarchy. With a greater understanding of what makes people “tick”, your aides will excel at providing holistic, client-centered care.

5.  Talk about Cost-Efficient Care

While cost-efficiency is always important in health care, it’s especially vital in today’s economy. Plan an inservice that provides practical tips for how nursing assistants can save money throughout their daily client care.  Be sure to cover how to minimize waste and how time management, healthcare associated infections and medical errors affect the bottom line. Top-notch CNAs know that saving money today means better working conditions tomorrow!

These are just a few ideas for rounding out your inservice offerings.  At the same time, you’ll keep your nursing assistants interested and be on your way to developing a team of top-notch CNAs!

Happy Teaching,

Linda

Linda Leekley BS, RN

Chances are, you have presented inservices to your CNAs on the typical topics: standard precautions, confidentiality, nutrition, pain management and dementia. Without question, these are all necessary inservices for nursing assistants.

However, to develop a team of top-notch CNAs, it’s important to go beyond what is necessary or mandated. Coming up with pertinent topics can be a challenge when you’re trying to fit inservice education into your already busy schedule. Here are 5 ideas for inservices that will get your nursing assistants thinking outside the box—and, in turn, have a real impact on the quality of their client care.

1.  Teach Your CNAs about Being Assertive

Why?  Because top-notch CNAs are assertive people. They understand the difference between communicating passively, aggressively and assertively. They use their assertiveness skills to deal with difficult people and challenging situations. And, because they respect the rights of others without ignoring their own rights, they are excellent team players. Consider presenting an inservice that includes a “personal assertiveness assessment” so that your nurse aides can gauge their current communication style.

2.  Examine Conflict in the Workplace

On-the-job conflict exists in every health care organization, so how about teaching your CNAs how to deal with it? Provide them with practical tips for resolving conflict. Be sure to cover the dangers of gossip and bullying in the workplace and how they can handle conflicts with supervisors and clients. Armed with this information, your CNAs will focus less on “workplace politics” and more on the needs of their clients.

3.  Discuss Maintaining a Professional Distance

One of the toughest things for anyone in nursing is to provide TLC to clients without overstepping professional boundaries. A top-notch CNA knows the difference between personal and professional relationships and can spot the warning signs that professional distance has been lost. Giving an inservice on this issue will help your nursing assistants be caring without veering from the plan of care.

4.  Promote the CNA/Nurse Relationship

In the same way that the relationship between nurses and physicians continues to evolve, so does the relationship between nurses and nursing assistants. Outstanding CNAs understand the importance of delegation, assertive communication and mutual respect. They know how to give a great report, how to make the most of their performance review and how to work together with nurses as a team. Consider presenting this information to your CNAs and your nurses for a real boost to nursing teamwork.

5.  Practice Time Management Skills

Why are some CNAs better than others at completing their work on time? Nursing assistants who strive for excellence have learned how to avoid time wasters like procrastination, a lack of focus and a negative attitude. Help your CNAs become time savers by teaching them about setting goals and priorities and providing them with practical tips that help them work efficiently—whether they work in a facility or in clients’ homes.

Try incorporating a few of these topics into your current inservice schedule and see what happens.  (If you’d rather not “reinvent the wheel”, give us a call at 877-809-5515 or visit our store.  We have inservices on all of the above topics.)  Remember…when inservice education goes above and beyond the norm, it spurs critical thinking, enhances the quality of client care, and encourages professionalism on the part of your aides.

Happy Teaching!

Linda

Linda Leekley BS, RN