Be In the Know!

Did you know that people are talking about your CNAs?  It’s true!  People from all over the U.S. are speaking their minds about nursing assistants.  They are sharing their thoughts about the dedication and compassion shown by CNAs across the country and beyond.

Who’s doing all this talking?  Your co-workers…nurses and other nursing assistants.  Politicians…governors and senators.  And, celebrities…a diverse group including Mary Murphy (from So You Think You Can Dance), Dr. Patch Adams and actress Jane Fonda.

Where can you read their comments?  Visit Just for Nursing Assistants.  While you’re there, please consider leaving some comments of your own.  For example, what would you say to a CNA who feels discouraged?  Or, what would you say to someone who is thinking about becoming a CNA?  You may add your thoughts here.

Soon, it will be CNA Week (June 10-17).  That’s a great time to put the focus on your CNAs and give something back to this hardworking group.  At In the Know, we send our thanks to CNAs everywhere…and we hope you will spread the word about our new site, Just for Nursing Assistants, which was created just for them!

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!

There’s a book I’d like to recommend to nursing supervisors and educators everywhere.  It has nothing to do with health care or nursing specifically, but has everything to do with helping us inspire those around us.  The book, Start with Why, emphasizes the importance of uncovering what makes you “tick”.  Its author, Simon Sinek, encourages readers to reach past the “what” and “how” of their jobs and dig deeply for their “why”—the purpose, cause or belief that gets them out of bed every morning.

For example, here’s how I examined myself after reading the book:

WHAT I do:  I run a company that sells continuing education for nursing assistants.

HOW I do it:  Along with a team of writers, I create CNA inservices and sell them to health care organizations around the globe.

WHY I do what I do:  Here’s where it got challenging.  The process of mining my personality for my “why” took some time.  Basically, here’s how it evolved…

• I create inservices for nursing assistants because I’m a nurse. Well, yes, being a nurse is a requisite, but I could have taken my nursing career in many different directions.  So that’s not the answer.

• I create CNA inservices because I like to teach. Sure, that’s true.  But that’s not exactly what makes me eager to come to the office every day.  I had to start thinking beyond the obvious and look for my purpose, my true beliefs.

• So, I began looking around me, examining the company that I had created.  Then it struck me.  I had named my company In the Know.  The website address I established is made up of the words knowing and more.  My employees are all encouraged to continue learning…and even have library time during their workday when they can read up on any subject of interest to them.  Together, we create learning materials.  Everything pointed toward the same thing: knowledge.

• I believe that knowledge is power. Hmm…I felt like I was getting close!  But thinking of knowledge as power paints a static picture.  My “why” felt more dynamic than that.

• I believe that lifelong learning is essential to both personal and professional success. Ah ha!  That’s more like it!  Learning is an ongoing, fluid process.  Learning brings people together—and when two people share what they know, they both come away with more than they had before.  That’s my personal and professional “why” and is what inspires all of us at In the Know to do our very best!

As a nursing supervisor or educator, are you tapping into your “why” when it comes to inservicing your nursing assistants?  For example:

WHAT you do:  Present inservices to your CNAs.

HOW you do it:  By passing out and discussing handouts at monthly one hour meetings.

WHY you do it:  Because it’s required? That’s just the surface.  To share your knowledge with your nursing assistants? Maybe, but author Simon Sinek would have you dig deeper.  To join together with your aides to learn something new? That’s better.  Because you believe that the more your CNAs know, the more they can achieve? Maybe…but only you can figure out your “why” and use it to inspire not only yourself but everyone around you.

If you don’t have time to read Simon’s book, at least take a quick peek at his blog.  You’re sure to find inspiration in his words.  And, have fun pondering your own personal and professional “why”!

Maintaining a fully staffed team of CNAs can be a challenge.  Let’s say you’re short staffed and rushing to fill those job vacancies.  You take the time to advertise for CNAs, interview prospective employees and complete the entire hiring process.  You’re tempted to get those new CNAs on the schedule as soon as possible.  However, the best thing you can do to make sure that both time and money haven’t been wasted is to orient your new nursing assistants.

Nurse aides have the least amount of pre-employment training of any other clinical employee.  Your CNAs may come to you with only weeks of clinical schooling.  As a result, they require—and deserve—an extensive introduction to their jobs.

A thorough orientation has many benefits—for your workplace, your new employee and you.  These benefits include:

• Reduced anxiety. By providing new employees with specific guidelines, an orientation helps them know what is expected of them from day one.

• Increased job satisfaction. Orientation helps ensure that new employees are well-prepared to perform their assigned duties instead of feeling overwhelmed, stressed out and ready to leave!

• Time savings for supervisors and coworkers. A thorough orientation makes new employees self-sufficient sooner—so they don’t pull you and your other aides away from your own jobs to answer questions or provide constant assistance.

• An improved employee retention rate. Across the nation, turnover of nursing assistants costs healthcare organizations more than $4 billion every year!  However, studies have shown that organizations with a comprehensive orientation can expect to reduce their turnover rate by 50% within two years.

So, what should a CNA orientation program include?  Here are some suggestions that have been shown to get nursing assistants off to a good start:

• Working as a Nursing Assistant. Promote professionalism by providing your aides with the tools they need to be team players.  Review their job description with them, step by step, and discuss workplace policies on chain of command and delegation.

• Supporting Patient Rights. Emphasize the importance of patient rights, especially confidentiality—the cornerstone of the relationship between healthcare workers and their clients.  Help your CNAs understand advance directives and the signs and symptoms of abuse.

• Infection Control. Because nosocomial infections continue to be the most common cause of medical errors, new employees benefit from a review of handwashing protocol, standard precautions and drug-resistant infections.

• Client Care Tips. Nursing assistants, especially those who are “new grads”, can become overwhelmed quickly by the demands of client care.  If you arm them with practical tips that focus on personal care, nutrition and client safety, their on-the-job confidence will soar.

• Self Care. By spending orientation time on employee wellness, you’ll show your new aides that you care about them as people and recognize that they are your greatest resource.  If you ignore this crucial area, you run the risk of developing stressed-out, disgruntled CNAs within a matter of months.

• Providing Quality Care. By focusing on customer service, quality improvement and medical error prevention, you’ll instill a desire for excellence among your new CNAs.

• Writing It All Down. As every nurse knows, when it comes to client care, if you don’t write it down, you didn’t do it.  Devoting time to proper documentation (and/or oral reporting) is essential for every new employee.

Whew…that’s a lot of information.  Who has time to put together an orientation program like that?  The good news is that you don’t have to.  Instead of reinventing the wheel, check around for companies that offer an orientation course for nursing assistants.  For example, take a look at our comprehensive CNA Orientation Program:  Getting Off to a Good Start.  Not only does it provide your new CNAs with a top-notch orientation, it also gives them a whopping six hours of inservice credit!

Remember…by developing and retaining top-notch CNAs, you’ll recoup the money you spend on quality orientation materials in no time.

Quality inservices develop top-notch CNAs!

Is part of your job as a nursing supervisor or nurse educator to develop monthly inservices for your nursing assistants? If so, you know how time consuming that process can be. Perhaps you’ve considered purchasing “ready-made” topics from a company (like In the Know) that sells CNA inservices. You’re really tempted, but are not sure it’s worth the cost. Here are five tips for helping you make that decision:

1.  Tally Your Time.

Next time you need to prepare an inservice, keep track of how much time you spend. Remember to include the time it takes you to think of a topic, come up with learning objectives, research and write the inservice, create some handouts, develop a quiz and produce an evaluation form. Chances are, this will take at least 10 hours of your time. Multiply that by your salary and you’ll probably be shocked at what one inservice is costing your workplace! By purchasing inservices, you avoid “reinventing the wheel” and can bring down your cost per inservice considerably.

2.  Do a Quality Check.

No matter how knowledgeable you are about the nursing field, creating inservices may not come easily to you. It requires a variety of “non-nursing” skills such as knowing how to research quickly and effectively, being a good writer and having some computer savvy. Are the inservices you’re creating capturing the attention of your CNAs? Do they provide an in-depth study of each topic? If not, they may not be having a positive effect on client care. Inservices from a respected inservice company can spark interest for both you and your aides. However, before making a purchase, insist on trying out a sample inservice. You’ll want to see the quality of their product for yourself.

3.  Take a Look at Compliance.

We all get in a rut, causing us to do something a certain way just because that’s how it’s always been done. But, when you look at your current system for providing inservices, is it really working? For example, do your CNAs skip inservice meetings because they are too busy or just aren’t interested? Do you struggle to get all your nursing assistants to meet their inservice hours by the end of the year? If so, there is probably an easier way. A quality inservice provider can give you a flexible, easy-to-institute inservice program that will please you, your CNAs and any surveyors that come your way.

4.  Eye Your Inventory.

Over time, you’ve probably built up a library of inservice topics. Take a peek at what you’ve got to offer your nursing assistants. The basics are probably there: standard precautions, nutrition, Alzheimer’s disease, abuse, confidentiality. And, you might find yourself reusing these topics with each newly hired group of CNAs. But, it’s important to meet the learning needs of your aides by offering a wide variety of inservice topics. Coming up with mandatory topics, disease process inservices, psychosocial issues and basic skill reviews could be a full time job and/or eat into your personal time! A good inservice provider has dozens of topics from which to choose. And, the more your CNAs know, the more they can achieve!

5.  Ask Your CNAs.

To find out if your current inservice offerings are meeting the needs of your nursing assistants, ask them! You might distribute an evaluation form or have an informal group discussion. Ask questions such as: Do our current inservices prepare you to succeed at your job? Do you feel that your skills are enhanced by every inservice you complete? Are the inservices providing you with information that you can apply in your daily client care? If your CNAs answer “no” more often than “yes”, then it may be time to try an inservice provider. Quality inservice education should do more than fulfill state requirements. It should enhance the professionalism of your nurse aides and improve your client care. So, take the time to investigate inservice providers and find the one that helps you develop a team of top-notch CNAs.

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