Customer Service: It IS Your Job!

itk headerWhether we’re RNs, LPNs or CNAs, most of us got into nursing out of a desire to help people.  But, like it or not, health care is a business…with both external customers (patients) and internal customers (co-workers).  How each of us treats our “customers” has a big impact on our most important outcome:  patient health and well-being.

I was reminded of that today, in a small way, when I went to the drug store to pick up a prescription.  The pharmacist greeted me and asked how she could help.  I told her my name and she brought my prescription to the counter.  She asked if I had any questions…the usual drill.  Then, instead of ringing up my prescription and sending me on my merry way, she said, “My assistant will be with you shortly.”

Unfortunately, her assistant was swamped with people who were dropping off prescriptions.  And, the “drop off” line kept getting longer as I stood at the register.  This meant that people who arrived after me were being served first.  Meanwhile, the pharmacist stood a mere five feet from the register.  I was the only person waiting to pay, so she could have checked me out in less than a minute.  In fact, in the time it took her to tell me the assistant would help me, she could have been halfway through the process!  Instead, I was forced to wait more than ten minutes for the pharmacy assistant.

OK, I get it.  The pharmacist went to school for a lot longer than her assistant.  And, I’m sure the pharmacist had plenty of prescriptions to fill.  But, she did not demonstrate good customer service to me (the “patient”) or to her co-worker.  She was in full-on “it’s not my job” mode!

We’ve probably all been guilty of ignoring the needs of a patient or co-worker with the justification that we had something more important to do or that the task wasn’t in our job description.  In my work with CNAs, I’ve heard stories that make me cringe: the nurse who brushed off the patient who asked for fresh water because that was the aide’s job (so the patient waited 30 minutes for water).  Or the CNA who ignored her co-worker’s plea for help making an occupied bed…because she didn’t like the co-worker.

We all get busy, caught up with fulfilling the responsibilities of our daily assignment.  But who suffers in the above examples? The patient.  Each and every time.

There’s no way around it:  every interaction between two nursing co-workers has an impact, either positive or negative, on patient care. If you think your staff could use a reminder of this fact, consider purchasing our inservice, Customer Service in Health Care.  It focuses on issues like internal and external customers, customer expectations, the price of poor customer service, handling customer complaints…and much more.  Like all our CNA inservices, it provides an hour of inservice credit.

And feel free to share your customer service stories–for example, a story of exceptional customer service by one of your CNAs or a cautionary tale of what not to do!

Happy Teaching,


CNAs on TV!

Shelly Sun, CEO of BrightStar

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.

How Well Do Your CNAs Observe & Report?

shutterstock_17777329As you know, one of the primary roles of the nursing assistant is to collect and communicate information.  The information is collected by observing clients and communicated by reporting to the nurse and/or documenting in the client’s chart.  So, how good are your CNAs at observing and communicating important information about their clients?

For example, do they know the difference between information that is urgent, important or significant?  And do they communicate these three types of information appropriately?  For example, urgent observations are those that are immediately life threatening.  If your aides consider a client going one day without a bowel movement urgent information, you might want to give them a review of this topic.

Do your CNAs distinguish between objective and subjective observations?  When was the last time you reminded them that for information to be objective, they must be able to see, hear, feel or measure it…or have it confirmed by another person?  If the reports from your nursing assistants tend to sound like opinion instead of fact, they may need to brush up on this skill.

In both acute and long term care, things can change fast for your clients.  Your nursing assistants need to be knowledgeable about what is normal so they can recognize what is abnormal.  This applies to vital signs, mental status, elimination, the skin…and so much more.  While most CNAs learned the “norm” in school, it is helpful to give them a refresher on abnormal observations once in a while.

Here are some inservice ideas to help your CNAs hone their observation and reporting skills:

  • Spend an hour giving an overview of the human body.  Review each of the body’s miraculous systems…and discuss how important each one is to a person’s overall health.   Then, your CNAs can use what they learn to help their clients live healthier, longer lives.
  • Present an inservice about basic human needs.  Remind your nursing assistants that they aren’t caring for bodies, they are caring for people.  And, all their clients have very basic needs, including physical and psychological needs–fundamental needs that are the same, regardless of where or how they live. Review the five levels of Maslow’s hierarchy of human needs.
  • Teach them about the normal aging process so they know what to expect when working with elderly clients.  For example, do your aides know that the elderly have fewer sweat glands, so they have trouble keeping their body temperature stable?   Or that the heart muscle becomes less “elastic” so it pumps with less force?  To make up for this, the heart beats more frequently.
  • Give your aides a vital signs update.  While many organizations rely on technology to measure vital signs, your CNAs should never lose the basic skills of taking a client’s temperature, pulse and blood pressure.  And, since pain is considered the fifth vital sign, be sure to provide information about pain management.
  • Review reporting and/or documenting client care information. During this inservice, remind your nursing assistants that if they are providing care for clients without documenting thoroughly and carefully—your organization may not get reimbursed for their work.  Or, if they are documenting care that they did not perform, your organization may not get reimbursed, and could possibly be fined for the false records.  Both situations result in a financial loss.  And, a loss for the organization is a loss for you, your CNAs and your clients!

If you don’t have the time to put together inservices on one or more of the above topics, remember that, at In the Know, we have done it for you.  You can click on the links throughout this article to see what we have to offer.  And, if you have ideas for inservices that you’d like our team of nurses to write, please send an email to  We’d love to hear from you!

Six Teaching Tips for CNA Inservices!

prof 10It’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!

Helping Your CNAs Understand Emotional Loss in the Elderly

CryingIt’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!