Be In the Know!

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!

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!

There’s a book I’d like to recommend to nursing supervisors and educators everywhere.  It has nothing to do with health care or nursing specifically, but has everything to do with helping us inspire those around us.  The book, Start with Why, emphasizes the importance of uncovering what makes you “tick”.  Its author, Simon Sinek, encourages readers to reach past the “what” and “how” of their jobs and dig deeply for their “why”—the purpose, cause or belief that gets them out of bed every morning.

For example, here’s how I examined myself after reading the book:

WHAT I do:  I run a company that sells continuing education for nursing assistants.

HOW I do it:  Along with a team of writers, I create CNA inservices and sell them to health care organizations around the globe.

WHY I do what I do:  Here’s where it got challenging.  The process of mining my personality for my “why” took some time.  Basically, here’s how it evolved…

• I create inservices for nursing assistants because I’m a nurse. Well, yes, being a nurse is a requisite, but I could have taken my nursing career in many different directions.  So that’s not the answer.

• I create CNA inservices because I like to teach. Sure, that’s true.  But that’s not exactly what makes me eager to come to the office every day.  I had to start thinking beyond the obvious and look for my purpose, my true beliefs.

• So, I began looking around me, examining the company that I had created.  Then it struck me.  I had named my company In the Know.  The website address I established is made up of the words knowing and more.  My employees are all encouraged to continue learning…and even have library time during their workday when they can read up on any subject of interest to them.  Together, we create learning materials.  Everything pointed toward the same thing: knowledge.

• I believe that knowledge is power. Hmm…I felt like I was getting close!  But thinking of knowledge as power paints a static picture.  My “why” felt more dynamic than that.

• I believe that lifelong learning is essential to both personal and professional success. Ah ha!  That’s more like it!  Learning is an ongoing, fluid process.  Learning brings people together—and when two people share what they know, they both come away with more than they had before.  That’s my personal and professional “why” and is what inspires all of us at In the Know to do our very best!

As a nursing supervisor or educator, are you tapping into your “why” when it comes to inservicing your nursing assistants?  For example:

WHAT you do:  Present inservices to your CNAs.

HOW you do it:  By passing out and discussing handouts at monthly one hour meetings.

WHY you do it:  Because it’s required? That’s just the surface.  To share your knowledge with your nursing assistants? Maybe, but author Simon Sinek would have you dig deeper.  To join together with your aides to learn something new? That’s better.  Because you believe that the more your CNAs know, the more they can achieve? Maybe…but only you can figure out your “why” and use it to inspire not only yourself but everyone around you.

If you don’t have time to read Simon’s book, at least take a quick peek at his blog.  You’re sure to find inspiration in his words.  And, have fun pondering your own personal and professional “why”!

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

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

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.

If you are looking for more ideas to spice up your 2010 inservice schedule, consider presenting the following topics:

1.  Review the Normal Aging Process

During their short initial training time, nursing assistants learn a few basics about the human body. However, in order to enhance their observational skills, it’s good to provide more details about how humans age. Try presenting the information by body system. Talk about the lifestyle choices that slow aging and those that speed it up—and remind your CNAs how they can help their elderly clients enjoy a good quality of life.

2.  Discuss End of Life Care

To be outstanding, CNAs should be able to handle the full spectrum of life, including the dying process.  Give your aides information on the end of life, such as how to recognize symptoms that signal death is near, how to provide comfort for dying clients and their families and how to care for the body once death has occurred. Consider including information on death and cultural diversity and the stages of grief.

3.  Brush Up on Mouth Care

Top-notch CNAs understand the importance and benefits of good oral hygiene and how it can affect not just the quality of their clients’ lives, but also their overall health. How about presenting an inservice that goes beyond the mouth care protocol for your workplace? Give plenty of tips for performing oral hygiene, dealing with dentures, and observing for oral and dental problems.

4.  Delve into Basic Human Needs

To enhance your nursing assistants’ sense of empathy, give them an overview of Maslow’s Hierarchy of Needs. During the inservice, review the five levels of basic human needs, how the levels relate to each other and how illness affects a person’s place in the Hierarchy. With a greater understanding of what makes people “tick”, your aides will excel at providing holistic, client-centered care.

5.  Talk about Cost-Efficient Care

While cost-efficiency is always important in health care, it’s especially vital in today’s economy. Plan an inservice that provides practical tips for how nursing assistants can save money throughout their daily client care.  Be sure to cover how to minimize waste and how time management, healthcare associated infections and medical errors affect the bottom line. Top-notch CNAs know that saving money today means better working conditions tomorrow!

These are just a few ideas for rounding out your inservice offerings.  At the same time, you’ll keep your nursing assistants interested and be on your way to developing a team of top-notch CNAs!

Happy Teaching,

Linda

Linda Leekley BS, RN

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

Are you constantly trying to think of fun and creative ways to present information to your nursing assistants?  There is a great website called “Puzzlemaker” that will create puzzles and games for you.  And best of all…it’s free!

Puzzlemaker allows you to create and print customized word searches, criss-crosses, math puzzles, and more—using your own word lists.  This is a great tool for spicing up your in-house inservices.  (All of our In the Know inservices include interactive games and activities…and word searches are just one of the fun ways we reinforce learning.)

Visit the Puzzlemaker website and start making your own puzzles for your next inservice training!

Happy Teaching,

Evan

At In the Know, we believe that lifelong learning is the key to both professional and personal success.  But, this isn’t just a meaningless mission statement stuck in a frame and hung on the wall.  Instead, it’s a way of life at our company. As the founder of In the Know, I created an atmosphere that encourages learning for each employee.

For example:  we have an In the Know library, filled with books relating to a variety of subjects—especially (but not limited to) health care.  Every employee has two hours of “library time” each week.  While they are encouraged to select reading material from the company library, they are free to read whatever they like.  The only “rule” is:  If you come across a great idea or are inspired by something you read, please share it with your coworkers.

What’s the result?  My employees and I are always reading, reviewing and researching…on a constant quest to continue learning.   Every day around our offices, you are likely to see a couple of excited employees huddled over a headline or hear someone say, “Wow…listen to what I just found out!”  New ideas are valued and it makes for motivated employees who enjoy coming to work.

How are things at your workplace?  Do you think your CNAs are inspired by you to add to their knowledge base and/or expand their skills?  At inservice time, do they sense your excitement about the topic at hand?  Do your nursing assistants know they can come to you for more information about a specific client care issue?

If you would like to promote lifelong learning among your aides, try sharing a few of these tips:

Instead of a “to do” list, keep a “to learn” list. Encourage your CNAs to jot down any learning needs they have.  For example, do they want to know more about diabetes, pressure sores or time management?  Put them on the list.  Would they like to learn more about quality improvement, patient rights or ethical issues?  They get added to the list, too.

Keep your eyes open! Suggest that your CNAs observe a coworker whom they admire.  A lot can be learned by watching, especially when you observe people who are really good at what they do.  Some of their habits may rub off!

Practice what you learn. Knowledge by itself is great…but it takes on real value when it is applied.  Share with your CNAs how you put new knowledge to work for you on the job and suggest they try the same thing.

Show others how it’s done. A great way to learn is by teaching others!  Ask your aides to help train new employees.  Or, each time you hold an inservice meeting, ask a different CNA to help lead the meeting.

Learn in groups. If your nursing assistants complete their inservices as self-study modules, suggest that they work together in groups of two or three.  They can bounce ideas off each other and, as a result, learn more than they would “going solo.”

Think outside the box. If your CNAs stick to the exact same routine every day, they may go on “autopilot” and stop learning.  Encourage them to switch things up a bit—as long as it doesn’t interfere with a client’s needs or rights.

Make learning a priority. The motivation to keep on learning has to come from within. Show your CNAs that lifelong learning is a daily habit for you and they may decide to make it a priority in their lives, too.

Do you have tips that have helped you create an environment of learning?  Please share them with us…we’re always open to learning new things!

Take care,

Linda

Linda Leekley BS, RN

President, In the Know