Be In the Know!

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!

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.