Be In the Know!

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

Chances are, you have presented inservices to your CNAs on the typical topics: standard precautions, confidentiality, nutrition, pain management and dementia. Without question, these are all necessary inservices for nursing assistants.

However, to develop a team of top-notch CNAs, it’s important to go beyond what is necessary or mandated. Coming up with pertinent topics can be a challenge when you’re trying to fit inservice education into your already busy schedule. Here are 5 ideas for inservices that will get your nursing assistants thinking outside the box—and, in turn, have a real impact on the quality of their client care.

1.  Teach Your CNAs about Being Assertive

Why?  Because top-notch CNAs are assertive people. They understand the difference between communicating passively, aggressively and assertively. They use their assertiveness skills to deal with difficult people and challenging situations. And, because they respect the rights of others without ignoring their own rights, they are excellent team players. Consider presenting an inservice that includes a “personal assertiveness assessment” so that your nurse aides can gauge their current communication style.

2.  Examine Conflict in the Workplace

On-the-job conflict exists in every health care organization, so how about teaching your CNAs how to deal with it? Provide them with practical tips for resolving conflict. Be sure to cover the dangers of gossip and bullying in the workplace and how they can handle conflicts with supervisors and clients. Armed with this information, your CNAs will focus less on “workplace politics” and more on the needs of their clients.

3.  Discuss Maintaining a Professional Distance

One of the toughest things for anyone in nursing is to provide TLC to clients without overstepping professional boundaries. A top-notch CNA knows the difference between personal and professional relationships and can spot the warning signs that professional distance has been lost. Giving an inservice on this issue will help your nursing assistants be caring without veering from the plan of care.

4.  Promote the CNA/Nurse Relationship

In the same way that the relationship between nurses and physicians continues to evolve, so does the relationship between nurses and nursing assistants. Outstanding CNAs understand the importance of delegation, assertive communication and mutual respect. They know how to give a great report, how to make the most of their performance review and how to work together with nurses as a team. Consider presenting this information to your CNAs and your nurses for a real boost to nursing teamwork.

5.  Practice Time Management Skills

Why are some CNAs better than others at completing their work on time? Nursing assistants who strive for excellence have learned how to avoid time wasters like procrastination, a lack of focus and a negative attitude. Help your CNAs become time savers by teaching them about setting goals and priorities and providing them with practical tips that help them work efficiently—whether they work in a facility or in clients’ homes.

Try incorporating a few of these topics into your current inservice schedule and see what happens.  (If you’d rather not “reinvent the wheel”, give us a call at 877-809-5515 or visit our store.  We have inservices on all of the above topics.)  Remember…when inservice education goes above and beyond the norm, it spurs critical thinking, enhances the quality of client care, and encourages professionalism on the part of your aides.

Happy Teaching!

Linda

Linda Leekley BS, RN

In August, I had routine surgery in one of the country’s best hospitals, (according to U.S. News and World Report) which just happens to be in the city where I live.  Naturally, I expected the upmost in quality care from the entire medical team, including the nurse aides. I had never had any surgery up to this point and had no idea what to expect.  Did the CNAs deliver top-notch care?

My first experience with a nursing assistant occurred when I was wheeled from the recovery area to my room.  CNA #1 (as I will call her) took my vital signs and made sure I was comfortable.  Unfortunately, she also complained about being tired and let me know she only had thirty minutes until quitting time.  She also mentioned she had the next day off and she could not wait. Not a great impression. Even in my groggy state, I thought she could use some training geared towards professionalism.

CNA #2 was my nurse aide through the night and very early morning.  She came into my room with a huge smile and a great attitude.  Not only did she take my vital signs, she also asked if I needed anything.  She even asked my husband if he was comfortable in his chair as he was staying the evening with me.  Since I was feeling a little better, I decided to ask her why she decided to become a CNA.  She said that she completely switched gears professionally, loved being a CNA and hoped to become a registered nurse one day. Her love for patient care was obvious by her enthusiasm and demeanor.

CNA #3 woke me up bright and early the next day to take my vital signs.  She seemed competent, but very rushed; professional, but a little cold.  She came across as someone who was having a bad day. Did she enjoy being a CNA?  I did not feel comfortable asking her. Our interaction together was the briefest among the ones I had with nursing assistants.

What was most evident to me during my hospital stay is that, along with the rest of the team, CNAs leave a lasting impression on a patient…and this impression can be good or bad.  It can also color how the patient feels about the healthcare organization as a whole.  My experience with CNA #2 was memorable because she seemed to really enjoy her job.  Even though we all look forward to quitting time, no one should express that sentiment to a client or patient, as CNA #1 did.  And, if CNA #3 was feeling hurried or having a bad day, I should not have picked up on it.

Think about your nurse aides. Are they a CNA #1, #2, #3, a combination of all three or completely different?  What do you do to make sure they give exceptional care (and top-notch customer service) to their clients every day, regardless of circumstances? How do you keep them excited about performing their job responsibilities?  We would love to hear from you!

Back to "School" for CNAs

Summer is almost over and thousands of children and adults are headed back to the classroom for another year.  As for many teachers and professors, providing informative and interesting educational materials can be a challenge for nurse supervisors.  Researching topics, creating inservices and handouts…how do nurse supervisors keep learning interesting?  Below is a list of ten of our favorite tips that we believe can enhance your CNA education program:

• Do use the information from your CNA evaluations to determine what topics to cover.
• Do plan ahead!  Map out your inservice topics for the year in advance.
• Do find a local health care professional who would be willing to present on a topic they know.
• Do solicit a different nursing assistant to help teach each inservice.
• Do choose a theme for each inservice, and have goodies that you can give away.
• Don’t choose topics that are not relevant to your nurse aides and their clients.
• Don’t forget your CNAs who do “self study.”  Make sure you follow up with them in person to discuss the inservice.
• Don’t just lecture or read from the inservice material:  imagine if you were in the audience!
• Don’t forget those CNAs who can’t make it to the inservice.  Make sure you review the material with them verbally.
• Don’t talk down to your staff.  They are professionals just like you.  Many of them have decades of health care experience.

We hope the above tips add a zing to your CNA continuing education program so your nursing assistants can start this fall on the right foot…and with renewed energy!

How do you keep your nurse aides engaged in their continuing education? What teaching tips do you have to share?  We would love to hear from you!

Please take ten minutes to check out this short film called Persistence.  It’s a reminder about the most important part of being a nurse:  the patient.

It’s a great piece to show your nursing assistants, too!

Take care,

Linda

P.S.  Be patient.  The “screen” stays black for about 6 seconds before the start of the film.

Did you hear about the study released by the UNC Institute on Aging?  It identified three programs being introduced to nursing homes in North Carolina in hopes of improving client care and reducing the number of sub-standard fines and sanctions placed against the state’s nursing homes.

The study was led by Thomas R. Konrad, PhD, a research professor of health policy and management at the UNC Gillings School of Global Public Health, and a senior scientist at the Institute on Aging.  Here’s what he had to say:  “The study shows North Carolina’s unique partnerships between the state, the university and nursing homes are effectively leveraging federal funds to improve the lives of those who live in, as well as those who work in, nursing homes,”

Konrad’s study was conducted in North Carolina nursing homes between 2004 and 2007.  What’s interesting is that it was funded by civil monetary penalties – funds collected from nursing homes for deficiencies in care.  The goal was to improve client care by redistributing the penalty funds back into the same nursing homes in the form of three initiatives:

1. The Win a Step Up program focused on the nursing assistants by upgrading their knowledge and skills, increasing their job commitment and providing rewards and recognition for a job well done.
2. Quality Improvement Collaboratives, in which groups of nursing homes worked together with the statewide Quality Improvement Organization to improve specific quality care measures, such as reducing pressure sores, reducing resident falls or limiting the use of restraints.
3. Culture Change Initiatives was designed to assist nursing homes with changing their structures or routines to make their environments more “homelike.”  This initiative fell in line with goals that all nursing homes have recently made a priority.

The study found that the participating nursing saw a number of improvements, including:

• Facilities using the Win a Step Up saw a decrease in pressure sores among their residents, and experienced a drop in employee turnover when compared to the previous year.  As you know, having continuity with your staff will go a long way in making sure your facility runs at its full potential.
• Nursing homes participating in the Quality Improvement Collaboratives saw a significant reduction in incontinence and a decrease in the use of restraints.  Most significantly, resident falls were almost cut in half after the study.
• Facilities using the Culture Change Initiatives also saw a reduction in the use of restraints, as safer and more comfortable alternatives were taught and implemented.  In addition, resident satisfaction increased dramatically, especially relating to resident independence and quality of life.

At In the Know, we applaud the idea of putting penalty funds back into nursing homes-especially when the focus is to increase the knowledge base of nursing assistants.  As we always say, when people learn more, they achieve more!

Till next time,

Evan

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!

As you are well aware, a nurse aide’s job can be quite stressful.  Being on the frontlines of client care is tough!  Most nursing assistants are not fully prepared for the challenges that lie ahead on a daily basis.  As a result, job burnout and quick turnaround of CNAs are very real problems being faced by many administrators.

One way to help reduce the stress felt by your nurse aides is to implement a relaxed (but professional) continuing education program.  Here are some ideas for doing just that:

Home Study…Having the flexibility to study the material from the comfort of home is a great option.  With In the Know inservices, you have the freedom to make as many copies as you need (within your single facility) of the inservice topic.  You can send the learning materials home with your aides.  (If you have email addresses for your CNAs, you can also simply email the “learner’s section” of the inservice to each of them.)  All you’ll have to do is grade and file their quizzes!  This method allows your CNAs to complete their necessary continuing education at their own pace.

Grab a Partner…Allow your aides to partner up (or assign them a study partner).  Most of the time, having to work with someone else creates a higher sense of accountability.  Working as partners also fosters teamwork, promotes problem-solving skills and gets your CNAs talking amongst themselves about the learning materials.  They can think out loud, share ideas and learn from one another.

Take It As It Comes…Another idea is to create a library of inservices that is accessible to your CNAs during their work hours.  Develop a “sign up sheet” (or use the one provided by In the Know).  Then, allow your nurse aides to complete the inservices at work “on the clock” as time allows. Not only will you have more time for other aspects of your job, but your aides will feel like they are in control of their own learning.

With a flexible inservice plan, you’ll head off burnout and CNA turnover at your workplace.  For more information, give us a call at 877-809-5515.

Do you have any different methods for inservicing your CNAs that you’d like to share?  We would love to hear them!

The internet offers some terrific options for nursing paraprofessionals who are looking to learn new things. However, it’s easy to get “lost” in cyberspace when searching for relevant information. Here are just a few sites that we feel have a lot to offer CNAs—and anyone who works in health care. You may want to pass them on to your nursing assistants and/or home health aides.

Nursing Assistant Resources on the Web
For ten years, three nursing assistants named Patti, Kim and Heather have worked diligently to create a central location for CNAs to access information on the web. They believe that “the more informed CNAs are, the better quality work they will produce.”

On this site, you’ll find a blog filled with important information for CNAs and anyone who is part of the healthcare system. I regularly read their blog postings! The blog is interactive which means readers can post their comments (the same as here on the In the Know blog).

Nursing Assistant On-line Video Lessons
Your CNAs are bound to find the Nursing Assistant On-line Video Lessons interesting. This site was created by Fox Valley Technical College and Northeast Wisconsin Technical College as a resource for nursing assistant students.

While the videos are copyrighted, you are welcome to watch them online for free. There are 80 different videos to help CNA students reinforce their classroom learning and to give working CNAs a refresher on a variety of topics. The videos alone cannot count as inservices, but they still provide a great learning experience.

Nursing Assistant Central
This is another great site that has great information for both students and working CNAs. This website offers information about becoming a CNA and tips for succeeding as a CNA.

There is also a very active message board which provides an excellent place to ask questions, learn and socialize with others in the field. All are welcome to participate, whether you’re a past, present or prospective CNA.

We recommend taking a long look around Nursing Assistant Central. You’re bound to learn a thing or two. We did!

National Network of Career Nursing Assistants
Have your heard of the National Network of Career Nursing Assistants? It is a non-profit educational organization that promotes recognition, education, research, advocacy and peer support development for nursing assistants in nursing homes and other long term care settings. Genevieve Gipson NA RN MEd RNC is the director. She advocates tirelessly for direct-care workers across the United States.

One of our favorite spots on this site is a page of Frequently Asked Questions. These questions (and answers) relate to transferring CNA certification from one state to another, finding a local CNA training program, and much much more!

Last but not least, you may want your nurse aides to check out our Just for CNAs blog. On it, we strive to provide them with information that will help them in both their careers and their personal lives.

Till next time,
Linda

Linda Leekley BS, RN

It’s great to know that our inservices are helping health care organizations achieve measurable outcomes. Many customers tell us that it’s a “trickle down” effect; they save time and money with our inservices; the nurse aides add to their knowledge and skill set; and the clients benefit from being cared for by well-prepared staff.

Here are some more ways that In the Know customers have benefited from using our inservices:

“When I ordered ‘Understanding Depression’ from In the Know, I was really thinking of my employees. Gas prices were very high and it didn’t look like we would be having a increase in Medicaid reimbursement. However, since presenting the inservice, I have noticed in our aides weekly notes that they are more aware of their clients’ moods.”
Norma B.
American Healthcare Services
Mount Airy, North Carolina

“We love the ‘Importance of Activity for the Elderly’ inservice from In the Know.. We really believe that keeping our residents active, alert and stimulated mentally as well as physically provides a better quality of life. New staff members have a hard time recognizing the importance of this. However, once we have them do this inservice we notice a huge change in their attitude and we see them get more involved with the activities. Some employees even come to us with new activity ideas that they would like to try. This inservice has really made a difference!”
Teri S.
Latter Days Assisted Living
Santaquin, Utah

“To assist our CNAs in stepping up, we cultivated a group of nursing assistant preceptors. We utilized a number of In the Know inservices as their course content. This helped the preceptors become the ‘go to’ people for the other CNAs. The preceptors provide information and are seen as an ‘on unit’ resource. They also take responsibility for insuring that all the nursing assistants also complete the In the Know modules.”
Stephanie W.
Deborah Heart & Lung Center
Browns Mill, New Jersey

Are your CNA inservices helping you overcome challenges with your nursing assistants and/or client care? If not, they should be! Give us a call today at 877-809-5515 and tell us about a current problem you’d like to solve. We’ll help you find the best solution…guaranteed!

Take care,
Linda

Linda Leekley BS, RN
CEO, In the Know, Inc.