Be In the Know!

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!

As you know, nursing assistants provide up to 90% of hands-on care for our sick and elderly.  Yet, even after all of their hard work, many CNAs feel unappreciated.  Throughout the U.S., we are losing many dedicated nursing assistants who can’t handle putting their “all” into a job for which they do not feel respected.  (It’s not unlike the way it was for nurses in the past, right?)

Has your organization been affected by the CNA shortage? Unfortunately, the problem is only going to get worse.  In the United States alone, there are more than 3 million direct care workers, but we will need one million more by 2016!  And, over the next ten years, it is estimated that we’ll need 30% more home health aides.  This rate of growth is much faster than the average for all occupations.

Our mission at In the Know has always been to enhance the professionalism of nursing assistants everywhere. So, to do just that, we have created a website where the general public can gain a better understanding of the important work done by CNAs.  And, at Just for Nursing Assistants, people are free to let nursing assistants know they care by offering words of support, a personal experience or simply expressions of gratitude.

Some of you have already submitted your thoughts to us.  If so, your comments will be published on Just for Nursing Assistants in the coming weeks.  If you have not expressed your feelings, please consider doing so now…and help us spread the word about the dedication and compassion of CNAs.  And, feel free to share the website address (www.justfornursingassistants.com) with all your direct care staff.

Take care,

Linda

Linda Leekley BS, RN

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!

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

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

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