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.

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 CNA Week and that’s a great time to think about how you can help your nursing assistants continue to learn on the job.  Here at In the Know, we’re all about lifelong learning.  And we know that the best learning experiences are often a bit “outside the box”.  So, here are some tips that might spur both critical thinking and learning among your direct care staff:

• Institute a “Learning Award” and present it to the nursing assistant who completes the most hours of continuing education in a specific time period (calendar quarter or year) or on a specific subject pertinent to your workplace (patient rights or workplace safety).

• Encourage and support skills that go beyond client care, such as money management, parenting, career planning, resume writing, etc.

• Have a different nursing assistant lead each inservice meeting with you.

• Consider developing a tuition reimbursement plan and/or a college scholarship program for the nursing assistants at your workplace.

• Ask a CNA or two to join you when a medical equipment representative comes in to demonstrate or promote a new product.  The CNAs may know best if the equipment in question will work at your facility.

• Encourage your nursing assistants to volunteer for committees at work–ethics, quality improvement, safety, etc.  Then, give them the time and support to attend the meetings.

• At home health or hospice client care meetings, ask your aides to present each of their clients.  Don’t let them sit there quietly when they probably have such valuable input to share.

• On your CNAs’ yearly performance evaluations, make sure that at least one of their goals has to do with learning.

• Build a library of books at your workplace on a variety of subjects:  health care, motivation, parenting, physical fitness, healthy eating, etc.  Allow your CNAs to “check out” the books.

• Encourage your CNAs to become computer literate (if they aren’t already).\

• Start each inservice or staff meeting by asking your CNAs to share one thing they have learned since the last meeting.

• Assess the learning needs of your nursing assistants quarterly…or at least annually.

• Teach your CNAs to speak up if they are assigned to a client with an unfamiliar diagnosis.

• Have your nursing assistants lead a book club for the residents in your facility or teach the residents one of their favorite hobbies.

Whew…as you can see, the possibilities are endless!  But the bottom line remains the same:  give your nursing assistants the opportunity to learn and grow and they will be happier, more productive employees.  And, you’ll have a team of top-notch CNAs!

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

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

It’s common for nursing assistants to feel like they are powerless in the workplace. They may think of themselves as the least important employees—unable to make a difference no matter what they do. It’s important to remind your employees that they do have power…and to help them recognize it.

Their personal power comes from their communication skills and their desire for personal achievement.

Their relationship power comes from their ability to work well with others.

Their knowledge power comes from their experiences on the job and from their continuing education efforts. (Remind your employees that knowledge is power and that the more they know about their work, the more valuable they’ll be to your organization–and to their clients.)

Their task power comes from their daily work. Their close contact with clients gives them a unique ability to make suggestions for improving client care. Because nursing assistants perform up to 80% of the client care for your organization, they have the power to make or break the reputation of your company.

The Bottom Line: Encourage your nurse aides to make every decision on the job as if they owned the company! And be sure to acknowledge when you see them demonstrate their importance to your health care team.

Happy Teaching!
Linda