Be In the Know!

Shelly Sun, CEO of BrightStar

Did you happen to see Undercover Boss on CBS this past Sunday?  That’s the show where executives from large companies go incognito in their own businesses.  They do it to learn firsthand how their employees really feel about working for them.  It’s always interesting, but this week’s episode revolved around BrightStar, a nationwide company that offers home care, child care and health staffing.

The CEO of BrightStar, Shelly Sun, disguised herself and shadowed several BrightStar Caregivers in different areas of the country.  One was a certified nursing assistant, Arlene, who had been assigned temporarily to a nursing home in California.  Arlene represented CNAs quite well, performing her job with warmth, sensitivity and professionalism.  She was honest with “Linda” (Shelly’s alter ego) about the pros and cons of the job, while always maintaining a positive attitude.

The hour-long show also showcased Caregivers in home health, assisted living and child care.  It was so good to see health care workers on television doing what they do in real life–rather than the fictionalized stereotypes we see so often.  You know what I mean…those shows where all the health care workers forget about their patients and spend their time “making whoopee” in the supply closet!

So, a big thank you to CBS for showcasing health care workers in such a good light.  All of us at In the Know send a heartfelt congratulations and shout out (Woo Hoo!) to Arlene for her dedicated work as a nursing assistant.  And, we are proud to be the CNA inservice provider chosen by BrightStar to serve all of their locations nationwide.

If you missed Undercover Boss with BrightStar, you can watch it on the CBS website.  You can also see more of Shelly’s thoughts about her experience here.

Twenty years ago, when I worked at Duke University Medical Center, I remember clearly how some of my co-workers viewed their colleagues in home care.  I was precepting a newly hired nurse to our oncology unit.  A number of the “old timers” on the unit whispered to me, “Good luck training her!  She doesn’t have any skills…she’s been working as a home health nurse!” The general consensus seemed to be that home care was the “red-headed stepchild” of the health care industry.

Things have definitely changed!  Home care has now taken the lead as the fastest growing sector of the health care industry.  Here are some statistics to prove it:

• According to the Agency for Healthcare Research and Quality (AHRQ), the number of patients needing home care after hospitalization is up by a whopping 70 percent!

• The U.S. Bureau of Labor Statistics projects a 22 percent employment growth through 2018 for health care in general, but home health jobs are expected to increase by more than 46 percent.

Many of those job openings will be for home health aides.  As home care agencies struggle to fill positions, it will be more challenging than ever to develop and maintain a team of top-notch HHAs.  That’s where In the Know can help.  With more than 140 topics, we’ve got an inservice that addresses nearly any issue that might arise for your home health aides.  If you would like assistance in putting together either an orientation program for newly hired aides or a continuing education program, please give us a call.

Oh…and my colleagues at Duke were wrong.  That former home health nurse did just fine on the unit!  And, a couple of years later, I moved on from the hospital to work in home care myself.

Congratulations to home health for finally being recognized in the media as such an important part of our health care system.  And, a big thank you to all you home health nurses and aides out there for the vital work you do!

Picture an average health care facility.  Think about all the supplies, paper, equipment and food that get thrown out every day.  Can you guess how much trash all of us health care providers are generating every year?  While the exact number is impossible to determine, researchers estimate that hospitals add nearly 6 million tons of trash to our landfills every year.  And that’s just hospitals! Add nursing homes, clinics, home health agencies, public health departments and so on…and that number gets even scarier.  We may be tasked with doing no harm to our patients, but what about the environment?

There is good news.  Across the nation, healthcare workers are leading a revolution in waste management!  While some waste is unavoidable, much of it can be eliminated.  And, American healthcare workers are making changes.  Even “small” ideas can lead to reduced waste—and huge savings.

Here are examples of what is working:

• Switching from disposable to reusable sharps containers saves a medium-sized facility as much as $175,000 a year.
• Eliminating plastic trash bag liners in administrative areas saves $20,000 a year.
• Replacing paper towels with air dryers saves $45,000 a year.
• Switching from disposable to reusable food service items saves $500,000 and prevents 400,000 pounds of waste.
• A Health System in Portland, Oregon switched from disposable coffee cups to an all-plastic recyclable cup. Employees were also encouraged to bring their own mug to the cafeteria for a discount. This resulted in a savings of $24,000 and waste reduction of 28,333 pounds per year!

And then there’s paper.  Anyone who’s worked in health care knows that we kill a lot of trees.  In fact, researchers estimate that nearly half of those annual 6 million tons consist of paper and cardboard.  As more health care facilities move to computer-based charting, this figure may drop.   In the meantime, does your organization recycle paper and cardboard?  If not, how about asking the powers-that-be to get with the program?  Then, rally your nursing assistants and other co-workers to make recycling at work a habit.

Even if you or your nursing assistants are not into “being green,” there’s a more personal reason for providing cost-efficient care.  For the average health care workplace, supplies take up 20% of the budget.  Inefficient use of those supplies “steals” money from the budget that might go to employee raises and benefits!

So, remind your nursing assistants to use supplies wisely and pay attention to waste.  Every time they throw away an unused item, they are costing the consumer money, adding garbage to our nation’s landfills and possibly denying themselves a raise!  And be sure to ask them for their ideas on minimizing waste–and doing no harm to the environment.

Have your heard about the study of 780 Medicare patients that was released today?  The study focused on adverse events during hospitalizations.  As reported by USA Today, the study found that:

• Of the 780 patients, twelve died as a result of hospital care.  Five were related to blood-thinning medication.
• Two other medication-related deaths involved inadequate insulin management (causing hypoglycemic coma) and over-sedation (causing respiratory failure).
• About one in seven Medicare hospital patients were harmed by their medical care.
• Another one in seven experienced temporary harm because the problem was caught in time and reversed.

Patients in the study suffered adverse effects such as bed sores, infections and excessive bleeding from blood-thinners.  Overall, the researchers estimate that 15,000 Medicare patients die each month in part because of care they receive while hospitalized.  Some of the adverse events were medical errors; some were unforeseen complications.  Still, the federal Agency for Healthcare Research and Quality called the results “alarming.”

Peter Pronovost, co-author of the book Safe Patients, Smart Hospitals, declared medical mistakes to be “an enormous public- health problem.” That should come as no surprise to anyone who works in nursing!  Mr. Pronovost also said, “We spend two pennies trying to deliver safe health care for every dollar we spend trying to develop new genes and new drugs.” That’s pretty shocking, right?  Especially since adverse events are so costly…to health care facilities and, most importantly, to patients.

Whether you work in acute or long term care, you can arm your nursing assistants with the knowledge they need to prevent adverse events.  The pennies you spend educating your aides may well save your organization thousands of dollars…and maybe even save a patient’s life!

Some ideas for inservice topics to promote patient safety include:

Preventing Medical Errors.  Teach your nursing assistants about the types of medical errors, the factors that contribute to mistakes and how they can take an active role in reducing medical errors at your workplace.

Understanding Drug Resistant Bacteria.  Review common drug- resistant bacteria (such as MRSA and VRE) with your CNAs and give them tips for how they can protect themselves and their clients from these deadly bugs.

Understanding Fall Risk Factors.  Remind your nurse aides about the factors that put clients at risk for falls including age-related factors, medical factors and environmental factors.  Be sure to include ways that your employees can help keep high-risk clients safe.

Preventing Pressure Ulcers.  Consider conducting an inservice on the causes of pressure ulcers and tips for preventing them.  As with other adverse events, make sure your CNAs understand how much easier it is to prevent a pressure ulcer than to cure one!

Providing Cost Efficient Care.  Preventing adverse events and saving money go hand in hand.  For example, how about reviewing the relationship between nosocomial infections and wasted dollars?  Give your CNAs practical tips for how nursing assistants can save money throughout their daily client care.

Client Safety Tips.  Give your nursing assistants an overview of client safety–whether their workplace is a facility or a client’s home.  Be sure to include information on fall prevention, nosocomial infections, faulty equipment, pressure ulcer prevention, medication and food safety.

By taking the time to educate your CNAs, you can help prevent adverse events such as the ones outlined in today’s new Medicare study.   Your relatively small investment now may save countless dollars later!

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

Please take ten minutes to check out this short film called Persistence.  It’s a reminder about the most important part of being a nurse:  the patient.

It’s a great piece to show your nursing assistants, too!

Take care,

Linda

P.S.  Be patient.  The “screen” stays black for about 6 seconds before the start of the film.

Did you hear about the study released by the UNC Institute on Aging?  It identified three programs being introduced to nursing homes in North Carolina in hopes of improving client care and reducing the number of sub-standard fines and sanctions placed against the state’s nursing homes.

The study was led by Thomas R. Konrad, PhD, a research professor of health policy and management at the UNC Gillings School of Global Public Health, and a senior scientist at the Institute on Aging.  Here’s what he had to say:  “The study shows North Carolina’s unique partnerships between the state, the university and nursing homes are effectively leveraging federal funds to improve the lives of those who live in, as well as those who work in, nursing homes,”

Konrad’s study was conducted in North Carolina nursing homes between 2004 and 2007.  What’s interesting is that it was funded by civil monetary penalties – funds collected from nursing homes for deficiencies in care.  The goal was to improve client care by redistributing the penalty funds back into the same nursing homes in the form of three initiatives:

1. The Win a Step Up program focused on the nursing assistants by upgrading their knowledge and skills, increasing their job commitment and providing rewards and recognition for a job well done.
2. Quality Improvement Collaboratives, in which groups of nursing homes worked together with the statewide Quality Improvement Organization to improve specific quality care measures, such as reducing pressure sores, reducing resident falls or limiting the use of restraints.
3. Culture Change Initiatives was designed to assist nursing homes with changing their structures or routines to make their environments more “homelike.”  This initiative fell in line with goals that all nursing homes have recently made a priority.

The study found that the participating nursing saw a number of improvements, including:

• Facilities using the Win a Step Up saw a decrease in pressure sores among their residents, and experienced a drop in employee turnover when compared to the previous year.  As you know, having continuity with your staff will go a long way in making sure your facility runs at its full potential.
• Nursing homes participating in the Quality Improvement Collaboratives saw a significant reduction in incontinence and a decrease in the use of restraints.  Most significantly, resident falls were almost cut in half after the study.
• Facilities using the Culture Change Initiatives also saw a reduction in the use of restraints, as safer and more comfortable alternatives were taught and implemented.  In addition, resident satisfaction increased dramatically, especially relating to resident independence and quality of life.

At In the Know, we applaud the idea of putting penalty funds back into nursing homes-especially when the focus is to increase the knowledge base of nursing assistants.  As we always say, when people learn more, they achieve more!

Till next time,

Evan