Be In the Know!

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.

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.

It’s a fact: adult learners enjoy lively continuing education sessions.  But, coming up with ways to spice up your CNA inservice meetings can be challenging.  Here are six tips that may help:

1.  Every month, insert a crisp new $1.00 bill in a couple of the inservice handout packets.  If you conduct your inservices in a group setting, ask the lucky recipients to read part of the inservice out loud or to “volunteer” for the participatory activities.
2.  To promote participation during the inservice, pick a “secret word” or “secret phrase” prior to the inservice.  It should be a word or phrase that is likely to be said by a participant during the learning session.  Write it down on a piece of paper and seal it in an envelope.  When someone says the secret word or phrase, make a big fuss and give that person a prize.  You can even have two or three secret words prepared to keep the group alert and active throughout the entire inservice.
3.  During an inservice–especially one that’s on a serious topic–take a few minutes to get rid of stress.  Pass out some “stress-reducers” such as squeeze balls, bubble gum or rubber bands.  Make paper airplanes and race them.  Or inflate balloons and let them loose.
4.  Reward participation during inservice meetings.  using “Monopoly money”, give out a bill for each contribution to the topic at hand.  Allow your CNAs to redeem the play money for little prizes (candy, magazines, pretty pens, etc.) that “cost” a certain amount of play money each.
5.  Put a disposable tablecloth on the table during your inservices.  Let your nurse aides draw or write on it (before and after the inservice and during a two minute break in the middle of the meeting).
6.  To encourage group discussion or to make it easier to break into teams, copy each inservice onto two or more different colors of pastel paper.  Group the participants together based on the color of their inservice.  Or, ask for a member of each group to comment on a discussion question.

Using one or more of these simple strategies is bound to enliven your educational sessions and enhance learning…so, happy teaching!

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 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!

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!

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.