Be In the Know!

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!

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

It’s a new year…and time for a fresh look at how you present your CNA inservices.  Are you making the most out of your inservice meetings?  Do your nursing assistants come away from your inservices knowing more about their clients and excited to put that new knowledge to use?  If not, here are a few quick tips to help you develop a top-notch team of CNAs in 2010:

Convey your passion for nursing during inservice presentations. If your nursing assistants sense that you are excited about client care, they are more likely to be enthusiastic, too.  On the flip side, if you seem bored while presenting inservice materials, your CNAs are likely to be bored by you and the inservice!

Help your CNAs bridge the gap between learning and doing. It’s great to present an inservice full of important facts, but how does that information translate to the “real world” at your workplace?  For example, you can teach your nurse aides that they should observe for the signs and symptoms of depression, especially in older clients.  But, what do you want them to do with their observations?  Go beyond the facts and have your CNAs practice documenting and/or reporting their observations.  Get a discussion going about what resources are available if a client is depressed.  By thinking outside the box, you’ll do more than teach; you’ll develop CNAs who think critically and follow thoughts with actions.

Listen when your CNAs voice their opinions. Some of your nursing assistants may have worked in health care longer than you have!  Show them that you respect their experience by encouraging them to voice their opinions about client care.  For example, you may feel like “tuning out” when an aide says, “In my previous workplace, we did it this way.” Instead, take notice.  Ask the CNA what makes the “old way” better.  This opens a discussion and creates an atmosphere where you both might learn something.

During your inservices, make use of real-life situations—with the names concealed or changed to protect client confidentiality. For example, when teaching about diabetes, prepare an example of a current or former diabetic client.  Give a scenario that calls for action from a CNA and ask for suggestions as to how they would handle it.  As you discuss each response, relate it directly to the information in the inservice.

Have a system for following up. To ensure that your aides retain what they learn during your inservice meetings, come up with a simple way to “test” them on what they know.  For example, at each inservice meeting, start out by asking three or four key questions about last month’s topic.  Offer a small prize or treat for the right answers.  This will ensure that your CNAs come prepared to answer your questions!

How do you make the most of your inservice meetings?  Do you have some tips to share with fellow educators?  We’d love to hear from you.  You may make a comment below or email me at lindaleekley@knowingmore.com.  Thanks!

As a nursing supervisor, you know that your nursing assistants must meet their annual inservice requirement.  In most states, this is a minimum of twelve hours of inservices per year—although that number jumps to 24 in some states.  But, how do you make the most of the time you spend on CNA continuing education?  How do you ensure that your inservices are helping to develop top-notch nursing assistants?  And, what do surveyors look for when they review inservice records?  Here are four basic guidelines that will keep you on track:

• Any inservice you give should contain “portable” information.  This means that the knowledge your nurse aides gain must serve them in any job—not just at your workplace.  For example, if you review how to take blood pressures and instruct your CNAs on the importance of documenting vital signs, that’s an inservice.  Your nursing assistants can put that knowledge to use no matter where they might work in the future.  But, if you pass out a new vital signs flow sheet and teach your aides how to fill it out, that knowledge is workplace-specific and would not count as an inservice.

• Inservices should consider the learning needs of your CNAs.  Have you asked your aides lately what topics they would like to learn more about?  Have your quality improvement studies uncovered a “weak area” that needs attention?  What about annual performance reviews?  Are there specific issues on which you should focus to ensure quality client care?  It’s not enough to pick twelve topics each year that sound interesting.  Surveyors want to see that your education plan targets specific, identified learning needs.

• When planning your inservices for the year, you also need to take your clients into consideration.  Do your aides have the knowledge they need to care for their clients?  For example, if your CNAs work with a large number of diabetic clients, they should be well-educated about how diabetes can affect their daily work.  They need to know the signs of hypo- and hyperglycemia; what a diabetic client should be eating; how exercise affects blood sugar levels…and so on.  Because Alzheimer’s disease and other dementias are on the rise, many states require an annual inservice on how to work with cognitively impaired clients.  Be sure to analyze your client population and take their needs into account as you create next year’s inservice calendar.

• Make sure that a registered nurse oversees all CNA inservice training.  You may enlist the help of office staff, therapists, LPNs, CNA preceptors or guest speakers, but the overall responsibility for inservicing your aides must fall on an RN.  To satisfy state surveyors, your CNAs must be made aware of which registered nurse they can go to if they have questions about what they are learning.  And, that nurse has to be available, either by phone or in person.

Your nursing assistants play a vital role within your nursing team. Let’s face it…they probably deliver up to 80% of the hands-on client care! When you consider that aides have the least amount of pre-employment education of any clinical employees, it’s clear that their ongoing on-the-job training is crucial.  By following these four guidelines, you will be on your way to giving your CNAs the continuing education that they deserve.  When you make each inservice count, your team, your clients and your organization all reap the benefits!

If you’d like assistance in planning your 2010 CNA inservice calendar, feel free to contact me at lindaleekley@knowingmore.com or by calling our In the Know offices at 877-809-5515.

Happy Teaching,

Linda

Linda Leekley BS, RN

We all know that ongoing education leads to reduced turnover and greater job satisfaction. Not to mention that

Do your CNAs retain knowledge from inservices?

continuing education is a yearly requirement for nurse aides! But, how do you know the information you provide to your nurse aides “sticks?”  Here are some staggering statistics regarding adult learning retention. Over a period of three days:

• Adults retain 10% of information that is read
• Adults retain 30% of information that is seen
• Adults retain 50% of information that is seen and heard
• Adults retain 90% of information that is said and done (applying learning to real life situations)

Many factors affect adult learning retention including age, level of prior education and motivation.  In some of our previous posts, we have given you ideas on how to motivate your nurse aides by keeping education fresh and interesting.  Below are some additional strategies your organization can take with continuing education to ensure that your nurse aides actually retain the information you are giving them.

• Touch upon a medley of learning styles – As you know, our inservices may be used in a group setting or as self-study modules.  If you choose self-study, perhaps get the group in a few times a year to interact in team activities.
• Encourage nurse aide participation – If using the self-study option, set aside time to address any questions your nursing assistants may have regarding the inservice material. If using group participation, use real-life situations, etc. to stimulate discussion.
• Use variety – Adding visual aides to reading material, such as PowerPoints, greatly enhances learning retention.
• Use active learning – Group discussions and activities, problem solving activities that involve critical thinking skills, games, etc. all lead to greater learning retention.
• Review job performance – Check for retention by making sure your caregivers are applying what they have learned to their responsibilities.  Give continuous feedback and address any issues as they arise.

What do you do to make sure your nurse aides retain the information you share with them? Please share any tips and suggestions with us.  We would love to hear from you!

Give your CNAs a "thumbs up"!

There is nothing more uplifting for a CNA (or any employee for that matter) than when they are recognized for a job well done.  Many employees feel that their boss is quick to point out any deficiency or mistake, but feel that getting positive reinforcement is difficult and infrequent.  If your nursing assistants are deserving of recognition, here are a few ways to show them that you appreciate it…without spending a dime!

1. Send them a handwritten note. A CEO of a Fortune 500 company frequently handwrites “thank you” notes on $2 bills.  In more than 3 years of doing this, only one employee has asked if the bill could be spent.  This tells us that instead of spending the $2, the employees prefer to keep it as a positive memento
2. Share the love. Ask each employee to write something down about an exemplary aide who has earned their respect and admiration.  Put all of their comments into a small picture frame and give it to the aide.
3. Up-front parking. Create a sign for the best parking space at your office or facility.  The sign should read: “Employee of the Month,” or something similar.  Make the right to this parking space competitive, and you won’t believe what lengths your aides will go to in order to win the competition, and the parking space.
4. TGIF. Allow a deserving CNA to take off early on a Friday afternoon.  This may not be possible due to client care responsibilities, but if you feel that you can get along without the aide for the afternoon, offer him or her the rest of the day off.  Naturally, you’ll want to treat these few hours off as time “on the clock” as a reward for this employee.
5. Well days. Many people can relate to this:  You need a day off.  You may have something really important to do, or you may not.  So you decide to call in “sick.”  Most of the time this makes you feel guilty about missing work, right? Reward a job well done by allowing your employees to earn “well days.”  These are days off when an employee can do whatever they need or want to do, but does not have to fib about feeling ill.
6. Rank and Title. It may or may not come with a raise in pay, but if outstanding aides continue to show that they are responsible and accountable, offer to add “Senior” or “Shift Leader” to their title.  It is amazing how much pride your new leaders will take in this small gesture.
7. Go public. Create and distribute a company-wide newsletter detailing an employee’s exemplary performance.  This will honor that particular nursing assistant, while creating motivation for the rest of your staff.A quick “thank you.”  The most cost effective way of acknowledging hardworking employees is to simply thank them…and it only takes a second.  Everyone appreciates being appreciated.

If one or more of these rewarding gestures appeals to you, give them a try with your staff.  Then, come back to this blog and let everyone know what the response was to your show of appreciation.  We would love to hear from you!

Thanks for reading,

Evan

Evan Leekley

evanleekley@knowingmore.com

Have you ever hired nursing assistants and, after HR paperwork and a quick tour of your facility or agency, sent them off to a full day’s work? Does orientation seem like a waste of time with CNAs? After all, many of them don’t stick around long, so why bother? Well, here’s a tale from my past that spells out the problem with that theory:

When I started my first job as a new nursing graduate, it was on a busy hematology/oncology unit at a big teaching hospital. I was green, intimidated and in need of a good orientation. Did I receive it? Nope…instead I was thrown into a full patient assignment. (There was a preceptor assigned to me, but she was busy with her own caseload.) When I expressed my concerns to my preceptor, she said to me, “Look, we know an orientation would be nice. But, you’re a warm body to fill a spot on this shift. Just do the best you can because none of us have time to help you.”

What happened? Well, thankfully, I avoided causing any harm to my patients! But, my stress level went sky high; I felt alienated from my co-workers; and I spent my days off worrying about work. Before long, I developed strep throat and walking pneumonia. After a month, I transferred to another oncology unit where the staff was willing to orient me.

So, guess what? Once again, the heme/onc unit was short staffed! Their neglect of my learning needs was shortsighted and cost them another “warm body”. And, as time went on, I found out that the cycle continued; very few nurses wanted to work on that unit. Their attitude about orientation harmed everyone: the supervisor, the staff and the patients!

It’s the same with nursing assistants. If they are not oriented properly to their role within your workplace, they are likely to become stressed, overwhelmed and anxious to move on to another job. This vicious cycle is part of why CNA turnover is so high across the United States.

There is good news. Studies have shown that, on average, when an organization institutes a high quality orientation, their turnover rate decreases by 50% within two years! That’s one reason why we developed a complete CNA Orientation Program entitled, “Getting Off to a Good Start”. We wanted to help you with your aide retention rates AND provide the tools and support that nursing assistants need when they begin a new job.

“Getting Off to a Good Start” includes information on professionalism, communication, teamwork, patient rights, infection control, time management, stress management, personal wellness, customer service, cultural diversity, quality improvement, documentation and LOTS of practical client care tips. And, the program gives the learner SIX hours of inservice credit…right off the bat!

If you want more information on our CNA Orientation Program, please feel free to give us a call at 877-809-5515. We’re happy to answer any questions you have and/or email you a preview of the program.

Happy Hiring!
Linda

Linda Leekley BS, RN
www.knowingmore.com

Today, you can read about our final group of nursing assistants who were selected by their supervisors and all of us at In the Know to be honored for being outstanding on the job:

Miranda M., who is a real team player at Dependable Home Healthcare in Martinsville, Virginia

Linda L., a top-notch CNA at Carolinas Medical Center-Union in Monroe, North Carolina

Josephine A., a real star at Good Samaritan Lutheran Health Care Center in Delmar, New York

Nita W., who believes in the mission of the Area Agency on Aging of West Central Arkansas in Hot Springs, Arkansas

Marie S., who excels at her job at the Jerome Home in New Britain, Connecticut

Supervisor, Fiana P., told us that she is so glad to have Miranda on her team. She has been able to please some of their most challenging clients. The agency stands by its name, Dependable Home Healthcare, and Miranda is ALWAYS dependable! Miranda has chosen a career as a nursing assistant, but it’s obvious that nursing is in her heart.

At CMC-Union, Kathleen R. reported that Linda is an extraordinary person. She is always so friendly and courteous to both patients and staff. Linda is always willing to help. She has been working for the hospital for a long time and knows everyone. You can always expect a lift in your spirits when you see her in the hall. Linda’s patient care is outstanding!

Supervisor, Marjorie H., told us that Josephine is always doing all the little extra things that make a resident’s day. The residents confide in her; if they are grieving, she cries right along with them. And, if they need a “lift”, all she has to do is show them her beautiful smile. Josephine’s co-workers are all glad that she is part of their team!

Missy M., Director of Health Services, reported that Nita has been working with their Agency for many years. Even though she has since earned her LPN degree, Nita continues to work full-time as a CNA because she believes in the mission of the Agency to help seniors lead independent, meaningful and dignified lives. Nita sees clients in their homes on a daily basis and always goes above and beyond to see their needs are met. She is the eyes and ears of the Agency and they feel so lucky to have her. The quality of their clients’ lives is so much better because Nita is looking after them!

At the Jerome Home, Kathy F. told us that Marie is an outstanding CNA. She works the 3-11 shift on their dementia unit. Marie is faced with challenging behaviors every day. She has learned to respond with a caring tone–which is sometimes all that is needed. Marie is always striving to improve her education and skills by participating in many of the classes offered at her facility. Recently, she was selected to take part in a phlebotomy training class so that she can draw blood as needed for her residents. Marie is a star employee!

We also send special recognition to all the CNAs at Washington County Hospital in Nashville, Illinois. Your supervisor, Clara S., told us that she is fortunate enough to have outstanding CNAs on every shift…and there was no way she could nominate just one. So, congratulations to all of you!

WOW! Such amazing stories of personal and professional growth! We send a big thank you…to Miranda, Linda, Josephine, Nita, Marie and all the thousands and thousands of other hardworking CNAs who bring so much of themselves to their jobs!

CONGRATULATIONS from the Team at In the Know!