Be In the Know!

As we celebrate Memorial Day, 2011, all of us at In the Know send our deep gratitude to every past and current member of our Armed Forces.  In addition, we would like to honor the 77,000 nursing personnel who work with Veterans in the VA health care system—including the more than 11,000 certified nursing assistants! Thank you for all you do to promote the health of Veterans across the United States.

Here are a few things you may not know about the VA health care system:  (Thanks to the VA’s website, www.va.gov, for these facts.)

• The VA was a leader in the development of home care.  During the early 1930s, a special category of VA “follow‑up” nurses visited Veteran patients at their homes in rural, isolated areas.

• Until 1976, nursing assistants outnumbered RNs.  Today, there is approximately 1 CNA for every 4 RNs.

• In the early 1990s, some 2,300 VA nurses were in the ready reserve of the armed forces at the time of the Persian Gulf crisis.  More than 600 were called to active duty and another 300 were put on alert status. Approximately 3,200 VA nurses are Veterans themselves.

• In 2005-06, VA nursing staff responded heroically to hurricanes Katrina and Rita by assisting with evacuation and continuing care of hundreds of VA hospital patients.

• The VA is working hard to address the nursing shortage by instituting several scholarship and tuition reimbursement programs that support nurses in continuing their education. Examples of such programs include: Education Debt Reduction Program (EDRP); National Nursing Education Initiative (NNEI); Employee Incentive Support Program; and Tuition Support Program.

• Every year, nearly 30,000 student nurses gain clinical experience in a VA setting.

• Three years ago, the 4000^th VA nurse graduated with the help of the Employee Incentive Scholarship Program.  The awards from this program cover tuition and related expenses such as registration, fees and books.

To do our small part to honor the hardworking VA nursing staff, we are offering any VA health care facility three free inservices. Each facility may choose their three topics from among our vast library of CNA inservices.

There is no gimmick associated with this offer, no strings attached and no deadline. If you work at a VA facility, simply email us at info@knowingmore.com or call us at 877-809-5515.  If needed, we will assist you in selecting the best topics for your facility.  Your order will be filled promptly—and include our sincere gratitude for the work you do every day.

Happy Memorial Day!

Much of the day-to-day work of a nursing assistant has to do with competencies.  For example, does the CNA know how to make an occupied bed, transfer a person safely from a bed to a wheelchair or take an accurate blood pressure reading?  But are task-based competencies enough to ensure quality client care?

If you ask Daniel Goleman, the answer would be no.  In the 1990s, he researched and wrote the book, Emotional Intelligence.  His theory was that people could enhance their personal and professional success by mastering five key emotional competencies.  How do you think your nursing assistants rank when it comes to emotional intelligence?

1.      Awareness of Self and Others.

People with a high “emotional IQ,” also called “EQ,” should be able to identify their feelings accurately.  Imagine your CNAs are working with a difficult client.  Can they tell if they are feeling irritated, hurt or angry when the client is unfriendly?  Can they look past their own emotions and realize that their actions affect how other people feel?

2.      Managing Their Moods.

Emotional intelligence includes controlling impulses and handling anger constructively.  Let’s revisit that scenario with the combative client.  If your nurse aides feel angry when caring for a disruptive client, can they manage that anger without taking it out on the client—even in subtle, non-verbal ways?

3.      Motivating Themselves.

Having a high emotional IQ helps people set goals and work towards them with a positive attitude—even when faced with setbacks.  Do your nursing assistants have an inner drive that keeps them inspired and determined to do their best, no matter what the challenge?

4.      Empathy.

Can your nurse aides put themselves in someone else’s shoes—to see and feel the perspective of a client or a co-worker?  For example, when it comes to a grouchy client, can they see past the angry surface to understand the fear and loneliness that is fueling the client’s hostility?

5.      Managing relationships.

Working as a CNA is all about relationships—with clients, family members, co-workers and supervisors.  How skilled are your nursing assistants at resolving conflict?  Do they cooperate with their clinical team members?  Can you count on experienced aides to share what they know with new employees?

According to author Daniel Goleman, the mastery of these five competencies results in enhanced emotional intelligence. You might be thinking, “So what?” Well, studies show that emotionally intelligent employees communicate more effectively, manage change better and have higher levels of productivity—all great qualities for anyone who works in health care.

In an ideal world, it would be great to have a system in place at every workplace to assess for emotional intelligence during the hiring process.  However, it’s never too late to develop and improve the emotional intelligence of your current employees. You can find a number of resources—both in print and online—to assist you with EQ training.  Or, you can avoid reinventing the wheel by sharing some of the following In the Know inservices with your nurse aides.  Each one offers knowledge and skills that promote a high “EQ.”

Customer Service in Health Care (It’s free! Just fill out the registration form.)

The CNA/Nurse Relationship

Building Trust & Confidence with Clients

Working with a Team

Stress Management Skills

The Caring Qualities of a CNA

Conflict in the Workplace

Dealing with Difficult & Combative People

Being Assertive

Professionalism & Work Ethic

Happy Teaching!

Linda

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!

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

The dictionary defines compassion as “a deep awareness of the suffering of another, coupled with the wish to relieve that suffering.” So, for someone to be compassionate, he or she must be able to put themselves in someone else’s shoes, AND act on his or her desire to lessen that person’s suffering or unhappiness.

It can be hard to always know whether or not your nurse aides act in a compassionate manner while on the job.  That’s why it’s so important to encourage compassionate behavior.  By studying our newly added inservice called “The Caring Qualities of a CNA,” your nurse aides will learn everything they can do to have more empathy, compassion, patience, dedication and respect for their clients.

A Peek Inside the Inservice:

Whether or not you can TEACH compassion is a question that is hard to answer.  However, as a nurse educator, you can ENCOURAGE your nurse aides to be more compassionate.  Try sharing the following tips with your CNAs:

• Remember to put your clients’ needs before your own.
• Treat people fairly and with respect and dignity.
• Show kindness without expecting rewards.
• Get to know your clients.
• Comfort your client’s family members who may be stressed and/or grieving.
• Be sensitive and allow people to vent their frustrations.
• Listen when people confide in you.
• Be friendly to any new co-workers who seem to be overwhelmed.
• Help a co-worker without being asked.
• Try to understand someone you don’t like or with whom you disagree.
• Accept people for who they are–faults and all!

Click here to see a sample page of “The Caring Qualities of a CNA.”

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!

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!

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!