Be In the Know!

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

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

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

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

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

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

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

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

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

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

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

Happy Memorial Day!

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.

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

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

1.      Awareness of Self and Others.

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

2.      Managing Their Moods.

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

3.      Motivating Themselves.

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

4.      Empathy.

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

5.      Managing relationships.

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

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

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

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

The CNA/Nurse Relationship

Building Trust & Confidence with Clients

Working with a Team

Stress Management Skills

The Caring Qualities of a CNA

Conflict in the Workplace

Dealing with Difficult & Combative People

Being Assertive

Professionalism & Work Ethic

Happy Teaching!

Linda

Picture an average health care facility.  Think about all the supplies, paper, equipment and food that get thrown out every day.  Can you guess how much trash all of us health care providers are generating every year?  While the exact number is impossible to determine, researchers estimate that hospitals add nearly 6 million tons of trash to our landfills every year.  And that’s just hospitals! Add nursing homes, clinics, home health agencies, public health departments and so on…and that number gets even scarier.  We may be tasked with doing no harm to our patients, but what about the environment?

There is good news.  Across the nation, healthcare workers are leading a revolution in waste management!  While some waste is unavoidable, much of it can be eliminated.  And, American healthcare workers are making changes.  Even “small” ideas can lead to reduced waste—and huge savings.

Here are examples of what is working:

• Switching from disposable to reusable sharps containers saves a medium-sized facility as much as $175,000 a year.
• Eliminating plastic trash bag liners in administrative areas saves $20,000 a year.
• Replacing paper towels with air dryers saves $45,000 a year.
• Switching from disposable to reusable food service items saves $500,000 and prevents 400,000 pounds of waste.
• A Health System in Portland, Oregon switched from disposable coffee cups to an all-plastic recyclable cup. Employees were also encouraged to bring their own mug to the cafeteria for a discount. This resulted in a savings of $24,000 and waste reduction of 28,333 pounds per year!

And then there’s paper.  Anyone who’s worked in health care knows that we kill a lot of trees.  In fact, researchers estimate that nearly half of those annual 6 million tons consist of paper and cardboard.  As more health care facilities move to computer-based charting, this figure may drop.   In the meantime, does your organization recycle paper and cardboard?  If not, how about asking the powers-that-be to get with the program?  Then, rally your nursing assistants and other co-workers to make recycling at work a habit.

Even if you or your nursing assistants are not into “being green,” there’s a more personal reason for providing cost-efficient care.  For the average health care workplace, supplies take up 20% of the budget.  Inefficient use of those supplies “steals” money from the budget that might go to employee raises and benefits!

So, remind your nursing assistants to use supplies wisely and pay attention to waste.  Every time they throw away an unused item, they are costing the consumer money, adding garbage to our nation’s landfills and possibly denying themselves a raise!  And be sure to ask them for their ideas on minimizing waste–and doing no harm to the environment.

Have you seen the latest online newsletter from the Joint Commission?  It details a number of the “most challenging requirements” for the first half of 2010…in other words, the requirements for which organizations are getting cited.  This is great information, especially if you expect a Joint Commission survey any time soon.

Here are some examples:

• 31% of home care agencies surveyed this year were found non-compliant in following physician’s orders!
• 23% of home care staff were found to be less than competent to perform their jobs.
• Home care staff failed to reduce the risk of client falls 21% of the time.
• A whopping 24% of Medicare-certified nursing homes were deficient in hand hygiene!
• In skilled nursing facilities, residents were not assessed or reassessed properly 17% of the time.
• 16% of skilled nursing facilities had an ineffective emergency plan.
• Hospitals didn’t fare any better.  47% of them were cited for improper fire safety equipment.  And, 27% of them did not maintain a safe environment for patients.

Armed with the above knowledge, you can take steps now to prepare your nursing assistants for future Joint Commission (or other) surveys.  And, we can help!  In the Know has inservices covering all of the above topics…and much, much more.  If you have pressing issues that you feel might come up during a survey, give us a call.  We can help you put together a pre-survey inservice plan that will help your CNAs sail through with no deficiencies!

And, if you’d like to see the Joint Commission statistics for yourself, check them out here.

Last week, the results of a Penn State study on occupational injuries were revealed.  It should come as no surprise that nursing assistants and home health aides were high on the “injured list”.  However, the researchers found that on-the-job injuries caused a lot more than just a few aches and pains.  They also led to increased CNA turnover and, potentially, a bad reputation in the community!  Here’s what Deirdre McCaughey, assistant professor of health policy and administration had to say:

“In our research, we saw a cascading effect.  Employees who had no training or did not believe their training prepared them well had more injuries.  Those employees were also much less likely than non-injured employees to recommend their organization as a place at which to work or seek services.”

Here are some other findings of the study:

• Employees who felt ill-prepared were three times more likely to be injured than employees who were well-trained.
• Employees who felt poorly supervised were also more likely to be injured–not just once, but multiple times.
• Cutting back on training to shave the budget increased employees’ injury risk and turnover rates.  In the long run, this boosted costs rather than saving money!

You’ve probably experienced it firsthand.  When money gets tight, education is one of the first things to go…especially at the nursing assistant level.  But are you really saving money?  What are the injury and turnover rates at your workplace?  If asked, do you think your CNAs would consider themselves both well-trained and well-supervised? Would they recommend your organization as a place to work or as a place to receive care?

At In the Know, we strive to provide quality CNA continuing education to meet every budget.  If you’d like to discuss how you can maintain a top-notch team of (healthy) nursing assistants please give us a call at 877-809-5515.  With more than 130 inservice topics, including modules on safe transfers, back care, the CNA/Nurse relationship and personal wellness, we can meet your CNAs’ learning needs.

Happy Teaching!

Linda

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 CNA Week and that’s a great time to think about how you can help your nursing assistants continue to learn on the job.  Here at In the Know, we’re all about lifelong learning.  And we know that the best learning experiences are often a bit “outside the box”.  So, here are some tips that might spur both critical thinking and learning among your direct care staff:

• Institute a “Learning Award” and present it to the nursing assistant who completes the most hours of continuing education in a specific time period (calendar quarter or year) or on a specific subject pertinent to your workplace (patient rights or workplace safety).

• Encourage and support skills that go beyond client care, such as money management, parenting, career planning, resume writing, etc.

• Have a different nursing assistant lead each inservice meeting with you.

• Consider developing a tuition reimbursement plan and/or a college scholarship program for the nursing assistants at your workplace.

• Ask a CNA or two to join you when a medical equipment representative comes in to demonstrate or promote a new product.  The CNAs may know best if the equipment in question will work at your facility.

• Encourage your nursing assistants to volunteer for committees at work–ethics, quality improvement, safety, etc.  Then, give them the time and support to attend the meetings.

• At home health or hospice client care meetings, ask your aides to present each of their clients.  Don’t let them sit there quietly when they probably have such valuable input to share.

• On your CNAs’ yearly performance evaluations, make sure that at least one of their goals has to do with learning.

• Build a library of books at your workplace on a variety of subjects:  health care, motivation, parenting, physical fitness, healthy eating, etc.  Allow your CNAs to “check out” the books.

• Encourage your CNAs to become computer literate (if they aren’t already).\

• Start each inservice or staff meeting by asking your CNAs to share one thing they have learned since the last meeting.

• Assess the learning needs of your nursing assistants quarterly…or at least annually.

• Teach your CNAs to speak up if they are assigned to a client with an unfamiliar diagnosis.

• Have your nursing assistants lead a book club for the residents in your facility or teach the residents one of their favorite hobbies.

Whew…as you can see, the possibilities are endless!  But the bottom line remains the same:  give your nursing assistants the opportunity to learn and grow and they will be happier, more productive employees.  And, you’ll have a team of top-notch CNAs!

How do your nursing assistants handle workplace conflict? Do they ignore it and pretend it isn’t happening? Do they give in just to make it go away? Or, do they compromise respectfully with each other? At your next CNA inservice meeting, consider using this case study as a way to open a discussion about conflict management at your organization.

You Can’t Avoid Conflict

It’s true: whenever people spend day after day together, conflict cannot be avoided completely. You may be nodding in agreement or you may be thinking that you’ve never had a dispute with anyone. However, conflict at work happens to everyone at some point in his or her career.

A dispute between people usually begins with a disagreement. When you and a co-worker disagree, you have one opinion and your co-worker has another. Often, it doesn’t really matter to either of you what the other person thinks. You both go on with your lives, each sticking to your own opinion. Usually, disagreements consist of only words and they do not affect how people interact with each other.

For example, Tim and Connie, both CNAs, disagree one day at work about the proper way to give a bath to a bedridden client. They each express their opinion, saying that’s how they were taught in school. They end the discussion by saying, “OK…you do it your way and I’ll do it mine.” Tim and Connie disagree, but they respect each other’s opinion and have no trouble working together.

A full-blown conflict can begin with different opinions, but it grows into something much larger. Generally, it is not what people say, but how they act, that causes a disagreement to escalate into a conflict. In almost all conflicts, the problem is not the initial disagreement, but the way in which it is handled.

Let’s take another look at Tim and Connie’s situation. Imagine that instead of agreeing to disagree about bathing a client, they get into an ongoing struggle about who is right.

Tim starts telling other co-workers that Connie doesn’t know how to give a proper bath. Connie gives Tim hateful looks and refuses to work with him. They have entered into a contest of opposing forces. Having gone past the point of disagreement, Tim and Connie are in a full-blown conflict, which can start causing a disruption among their co-workers and eventually in job performance. Both Tim and Connie are creating a situation where neither will back down; each thinks that they would appear to be wrong by offering a truce. Unless their conflict is resolved, work will remain an unpleasant place for both of them!

Tim and Connie must put an end to their conflict, as it is hurting them both… and is also causing a disruption to the rest of the workplace. Let’s see them fix the problem by going through five simple steps:

1. Connie realizes that they need to stop this fight and asks Tim politely if she can speak to him. Tim agrees and they sit in an empty meeting room together–away from their coworkers.
2. They take turns telling one another their points of view. One speaks while the other actively listens.
3. They see that the problem is they each have a strong personality, are competitive and like to be right. They agree that the problem was never the actual bathing technique—but how they communicated.
4. They discuss the bathing method they each use and decide that both techniques are acceptable. However, Tim and Connie say they will continue using their own method. Neither person wins or loses.
5. Tim and Connie decide that, in the future, they will keep their own techniques to themselves. As long as the job is getting done, they can agree to disagree on the proper method. If either Tim or Connie uses a method that is not getting the job done, they will discuss it politely at that time. In the meantime, they agree that the conflict is over, and they both decide to apologize to their co-workers.

Would Your Nursing Assistants Like to Know More?

If you’d like to give your CNAs more information about workplace conflict, consider presenting an inservice on conflict resolution that includes:

• The common ways that people approach conflict.
• A step-by-step process for resolving workplace conflict.
• How gossip and workplace bullying promote conflict.
• How to respond to an unprofessional coworker.
• How to handle conflict with a supervisor or a client.

Don’t have time to put together your own inservice?  Then, please check out our inservice called Conflict in the Workplace.  It covers all of the above information…and more.

Happy Teaching!