Are Your CNAs In the Know about Sexual Harassment?

Regardless of your political leanings, there is no denying that the current presidential election has brought the issue of sexual harassment to the forefront.  As healthcare professionals, we know that sexual harassment is an important topic, mandated as part of every employee’s training by the Joint Commission, OSHA and state regulations.

Still, it seems as if most women (and some men) have at least one story to tell about a time they were sexually harassed.  Mine occurred many years ago, when, as a 22-year-old college senior, I landed an internship at a well-regarded children’s hospital.  Back then, parents weren’t allowed in the pre-operative area, so my role was to stay with the children and tend to their physical and emotional needs prior to surgery.

One day, as I was comforting a seven-year-old boy who was frightened about his imminent operation, the anesthesiologist assigned to his case came up to the boy’s stretcher.  Loudly enough for the patient to hear, he said to me, “I sure wish you’d hold my hand, lean over me, and talk softly like that…but I’d want you to loosen another button or two on your blouse.”  His words shocked me; I blushed, feeling both embarrassed and angry, but kept my attention on my young patient.

Later that day, I told my supervisor what had happened.  In turn, she relayed the episode to the Chief of Surgery, who asked to meet with me.  He apologized on behalf of the department and said that the offending anesthesiologist would also apologize.  I was told that he had been reprimanded both verbally and in writing in his personnel file.  Soon after, the anesthesiologist did apologize.  He kept his distance for the remainder of my internship and I suffered no repercussions from reporting the harassment.

Looking back, I can’t help but wonder if I would have been so quick to report the incident had I been an employee at the hospital (instead of an unpaid intern).  Would I have potentially jeopardized my job and/or risked escalating the problem by reporting a man with whom I would have to work, day after day, month after month?  I’d like to think the answer is “yes,” especially because the physician’s offending behavior happened in front of a scared child whose life was soon to be in his hands.  But, of course, I’ll never know for sure.

Do your nurse aides understand what constitutes sexual harassment and how to respond if it happens to them?  Is “locker room talk” okay because it’s just words?  What types of actions are considered sexual harassment?  What if the offender is a person of power in your workplace?  What if the offender is a patient?

If your nurse aides could benefit from a better understanding of this important issue, consider our inservice, Sexual Harassment in the Workplace.  It answers all of these questions, and more.  And, because it is such a critical topic these days, we are offering it at a 25% discount now through November 11th.

Sexual Harassment in the WorkplacePlease note that while the inservice was written for nursing assistants and provides them with one hour of inservice credit, the information in the module would be useful for any and all of your employees.

Best wishes,


Linda H. Leekley BS, RN, President, In the Know


An Easy Way to Thank Your Nurse Aides!

tycard-300x214Did you know that, for many nursing assistants, their number one complaint about work is that they don’t feel appreciated? There’s an easy fix for that. On our sister blog, Embracing Civility, we’re offering a simple template for some cute “thank you” cards that you can download. Try printing them on thick paper or card stock. Then, on the back, jot down some words of appreciation for each of your nursing assistants. Here are a couple of ideas:

  • Praise a CNA for his or her outstanding patient care.
  • Give kudos to an aide who embodies the spirit of teamwork.
  • Let a nursing assistant know that you recognize improvement, especially if it’s an issue for which you had to counsel the person.
  • Acknowledge loyalty for those CNAs who are longtime employees.

Once you’ve readied your cards, think of creative ways to give them out, such as:

  • Hide the thank you card between pages of inservice handouts.
  • Slip it in with the person’s paycheck.
  • Put the card on the employee’s clipboard when his or her back is turned.
  • Tape a card to a piece of equipment that you know that person will be using soon.

Of course, you can also simply hand it to the employee! The important thing is to show your appreciation. By taking the time to show your gratitude, you’ll help to combat one of the main “gripes” of all nursing paraprofessionals–regardless of their work setting.

While you’re visiting Embracing Civility, feel free to poke around the site. You’ll find interesting blog posts and more free downloads that may prove useful at your workplace.

What Joint Commission Says about Incivility


Workplace incivility. Adult bullying. Lateral harassment. These terms make the news nearly every day, headlining another story about employees who are dealing with a toxic work environment.

Jana Raver is an organizational expert and professor at Queen’s University School of Business. She has done research proving that sixty percent of employees are exposed to workplace incivility—and that the “bullies” are often women. That’s bad news for an industry like ours which continues to be dominated by females.

And there is more bad news. While six of every ten employees are victims of workplace incivility, you can bet that the other four are affected by it indirectly. Harassing behaviors are distracting—especially for healthcare employees who must work as a team to meet the needs of their patients.

Ms. Raver says, “They start saying ‘this is not the place for me; I’m going to start looking for work elsewhere.’ And once you psychologically disengage from the organization then you’re not terribly motivated toward helping that organization to succeed, and you’ve always got one step out the door. Turnover is of course a logical consequence.”

This spells trouble, particularly for certified nursing assistants. As you know all too well, the annual turnover rate for CNAs can exceed 90%. If your organization has a “revolving door” when it comes to your nursing assistant staff, a culture of incivility only compounds the problem.

“Imagine how much more productive companies could be if they were to treat people with inclusion and respect and make sure that (workplace anti-harassment) policies are actually enforced,” Raver states.

This is exactly what the Joint Commission has in mind with their zero tolerance of disruptive or intimidating behaviors. Have you seen their statement on this issue?

Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.  Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.

The Joint Commission standards require that each organization institute “a code of conduct that defines acceptable and disruptive and inappropriate behaviors.” They also require that the institution “create and implement a process for managing disruptive and inappropriate behaviors.”

Creating policies that meet these Joint Commission standards are an important step. However, if your workplace has been infected with incivility, it’s going to take more than rubber stamping new policies. Every employee, from administration to the “front lines,” needs to partake in civility training. They need to understand the importance of civility—especially in a high stress environment like healthcare. The training should cover ethical behavior, professional relationships, teamwork and conflict resolution. And, it should emphasize this indisputable key point: that the power—and the responsibility—to overcome a culture of incivility rests within each of us.


If you would like to learn more about how embracing civility can inspire your employees to do their best work, check out The Real Healthcare Reform. (The book is also available from Amazon.) If you need assistance developing a civility training program for your organization, please give us a call at 877-809-5515. We’d be happy to discuss your options.

CNA Educators: Spend Pennies & Save Dollars!

shutterstock_17761315Have your heard about the study of 780 Medicare patients that was released today?  The study focused on adverse events during hospitalizations.  As reported by USA Today, the study found that:

  • Of the 780 patients, twelve died as a result of hospital care.  Five were related to blood-thinning medication.
  • Two other medication-related deaths involved inadequate insulin management (causing hypoglycemic coma) and over-sedation (causing respiratory failure).
  • About one in seven Medicare hospital patients were harmed by their medical care.
  • Another one in seven experienced temporary harm because the problem was caught in time and reversed.

Patients in the study suffered adverse effects such as bed sores, infections and excessive bleeding from blood-thinners.  Overall, the researchers estimate that 15,000 Medicare patients die each month in part because of care they receive while hospitalized.  Some of the adverse events were medical errors; some were unforeseen complications.  Still, the federal Agency for Healthcare Research and Quality called the results “alarming.”

Peter Pronovost, co-author of the book Safe Patients, Smart Hospitals, declared medical mistakes to be “an enormous public- health problem.” That should come as no surprise to anyone who works in nursing!  Mr. Pronovost also said, “We spend two pennies trying to deliver safe health care for every dollar we spend trying to develop new genes and new drugs.” That’s pretty shocking, right?  Especially since adverse events are so costly…to health care facilities and, most importantly, to patients.

Whether you work in acute or long term care, you can arm your nursing assistants with the knowledge they need to prevent adverse events.  The pennies you spend educating your aides may well save your organization thousands of dollars…and maybe even save a patient’s life!

Some ideas for inservice topics to promote patient safety include:

Preventing Medical Errors.  Teach your nursing assistants about the types of medical errors, the factors that contribute to mistakes and how they can take an active role in reducing medical errors at your workplace.

Understanding Drug Resistant Bacteria.  Review common drug- resistant bacteria (such as MRSA and VRE) with your CNAs and give them tips for how they can protect themselves and their clients from these deadly bugs.

Understanding Fall Risk Factors.  Remind your nurse aides about the factors that put clients at risk for falls including age-related factors, medical factors and environmental factors.  Be sure to include ways that your employees can help keep high-risk clients safe.

Preventing Pressure Ulcers.  Consider conducting an inservice on the causes of pressure ulcers and tips for preventing them.  As with other adverse events, make sure your CNAs understand how much easier it is to prevent a pressure ulcer than to cure one!

Providing Cost Efficient Care.  Preventing adverse events and saving money go hand in hand.  For example, how about reviewing the relationship between nosocomial infections and wasted dollars?  Give your CNAs practical tips for how nursing assistants can save money throughout their daily client care.

Client Safety Tips.  Give your nursing assistants an overview of client safety–whether their workplace is a facility or a client’s home.  Be sure to include information on fall prevention, nosocomial infections, faulty equipment, pressure ulcer prevention, medication and food safety.

By taking the time to educate your CNAs, you can help prevent adverse events such as the ones outlined in today’s new Medicare study.   Your relatively small investment now may save countless dollars later!

How Well Do Your CNAs Observe & Report?

shutterstock_17777329As you know, one of the primary roles of the nursing assistant is to collect and communicate information.  The information is collected by observing clients and communicated by reporting to the nurse and/or documenting in the client’s chart.  So, how good are your CNAs at observing and communicating important information about their clients?

For example, do they know the difference between information that is urgent, important or significant?  And do they communicate these three types of information appropriately?  For example, urgent observations are those that are immediately life threatening.  If your aides consider a client going one day without a bowel movement urgent information, you might want to give them a review of this topic.

Do your CNAs distinguish between objective and subjective observations?  When was the last time you reminded them that for information to be objective, they must be able to see, hear, feel or measure it…or have it confirmed by another person?  If the reports from your nursing assistants tend to sound like opinion instead of fact, they may need to brush up on this skill.

In both acute and long term care, things can change fast for your clients.  Your nursing assistants need to be knowledgeable about what is normal so they can recognize what is abnormal.  This applies to vital signs, mental status, elimination, the skin…and so much more.  While most CNAs learned the “norm” in school, it is helpful to give them a refresher on abnormal observations once in a while.

Here are some inservice ideas to help your CNAs hone their observation and reporting skills:

  • Spend an hour giving an overview of the human body.  Review each of the body’s miraculous systems…and discuss how important each one is to a person’s overall health.   Then, your CNAs can use what they learn to help their clients live healthier, longer lives.
  • Present an inservice about basic human needs.  Remind your nursing assistants that they aren’t caring for bodies, they are caring for people.  And, all their clients have very basic needs, including physical and psychological needs–fundamental needs that are the same, regardless of where or how they live. Review the five levels of Maslow’s hierarchy of human needs.
  • Teach them about the normal aging process so they know what to expect when working with elderly clients.  For example, do your aides know that the elderly have fewer sweat glands, so they have trouble keeping their body temperature stable?   Or that the heart muscle becomes less “elastic” so it pumps with less force?  To make up for this, the heart beats more frequently.
  • Give your aides a vital signs update.  While many organizations rely on technology to measure vital signs, your CNAs should never lose the basic skills of taking a client’s temperature, pulse and blood pressure.  And, since pain is considered the fifth vital sign, be sure to provide information about pain management.
  • Review reporting and/or documenting client care information. During this inservice, remind your nursing assistants that if they are providing care for clients without documenting thoroughly and carefully—your organization may not get reimbursed for their work.  Or, if they are documenting care that they did not perform, your organization may not get reimbursed, and could possibly be fined for the false records.  Both situations result in a financial loss.  And, a loss for the organization is a loss for you, your CNAs and your clients!

If you don’t have the time to put together inservices on one or more of the above topics, remember that, at In the Know, we have done it for you.  You can click on the links throughout this article to see what we have to offer.  And, if you have ideas for inservices that you’d like our team of nurses to write, please send an email to  We’d love to hear from you!