Category: Motivating staff
Posted by Dr. El - January 29, 2020 - McKnight's Long-Term Care News, Motivating staff
The Oscars kind of bug me. In the gloom of winter, it can be hard not to notice that the extravaganza is filled with self-congratulatory workers wearing clothes that cost more than the yearly salary of several nursing aides.
Rather than stew, however, about the puzzling priorities of the world, I’ve decided to award my own Oscars.
Drum roll, please…
The award for best Costume Design goes to those workers who rock their uniforms. Holiday-themed ensembles, crisply starched tops, well-groomed hair and a kind attitude all speak volumes about the people who wear them, the pride they take in their work and their willingness to help elders.
Best Production Design goes to the maintenance departments, who manage to keep facilities functioning on an essential level and ensure that the surroundings look top-notch. From repairing air conditioners to fixing dresser drawers to rectifying all the many behind-the-scenes glitches, the maintenance crews renew well-worn buildings, creating inviting, trustworthy foundations for care.
Best Foreign Language Film goes to CMS for their efforts to provide guidance to long-term care operators and staff.
Best Original Score goes to the recreation staff who tirelessly provide musical entertainment, engaging activities and meaningful pursuits in a setting more focused on the health of bodies than on that of minds and hearts. Therapeutic recreation is the soundtrack in the lives of residents.
Best Makeup and Hairstyling goes to the aides who thoughtfully tend to the appearance of their charges, helping residents feel worthy of personal attention and more like their best selves in a frequently impersonal environment. A shout-out to the barbers and hairdressers who come into facilities and work their magic for modest fees for people in need.
Best Documentary Feature goes to the geropsychologists who spend their days talking with seniors about their lives, their loves and their losses, assisting them in navigating medical problems, end of life issues, family concerns and institutional living.
Best Visual Effects goes to the housekeeping staff who transform trashed rooms into sparkling accommodations, keeping residents, families and staff free from contagion and healthcare-associated infections.
Posted by Dr. El - March 28, 2019 - McKnight's Long-Term Care News, Motivating staff
Here’s my latest article on McKnight’s Long-Term Care News:
The Five-Star Quality Rating System reports the results of health inspections, staffing and quality measures. I suggest we replace the current staffing measure with one tracking staff retention.
Here’s my logic:
The existing staffing score is the ratio of nursing staff to residents, taking care needs into account. In allowing for self-reporting of the data, some nursing homes overstated their resident/staff ratio. It therefore hasn’t been a particularly accurate measure of staffing.
It also misses the fact that while some residents have low-acuity physical health needs, they — or their family members — may have high-acuity emotional or mental health needs that require a great deal of staff time and attention. In such situations there are enough workers for the facility to be compliant technically but understaffed in reality.
If we shift to a system that measures staff retention rather than staff ratio, however the whole picture changes.
Staff turnover is a strong signal that something is wrong with a nursing home.
As I noted in an earlier post here, “Reducing Turnover in LTC,” employees tend to leave facilities not just because the pay and benefits are low, but also because of a high workload, poor staffing, unsatisfactory work conditions and a lack of appreciation. Unless they’re older, invested in the facility and perhaps looking forward to retirement benefits, employees depart when a facility isn’t a good place to work.
If a nursing home isn’t a good place to work, it’s an even worse place to live.
Residents and their families want clean, safe environments with quality care and reasonable food — and they especially want workers who know and respect them. High turnover makes meeting these expectations virtually impossible.
For the entire article, visit:
Posted by Dr. El - January 29, 2019 - Inspiration, McKnight's Long-Term Care News, Motivating staff, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
“How’s it going?” I asked Larry, one of the maintenance workers I chatted with from time to time. He didn’t have his usual smile and his wrist was in a brace from a repetitive stress injury.
“I’m tired,” he replied. “I’m real tired. I was supposed to be off today but Jules called in sick and we were already short one guy. Tomorrow will make seven days of work in a row.”
“You’ve got to take care of yourself,” I encouraged him.
“I know,” he said, “but they needed me.”
A few months after my encounter with Larry, I noticed that an excellent nurse had “lost her shine.” I stopped by her med cart to see why.
“My sister’s very sick,” Shirley told me, becoming tearful. “She lives in Haiti and I’m worried about her.”
“Oh no! Do you have any vacation time? Can you go see her?”
“I do, but I don’t know if the director of nursing will sign off on it. I guess I could try.”
I followed up with her the next week as if she’d been one of my patients.
“No,” Shirley said as I approached the nursing station, “I didn’t put in for the vacation time.”
She’d lost weight since the prior week and her expression had become grim. I regularly observed her completing paperwork and tending to the residents an hour after her shift was over.
“Let’s do it now,” I insisted. I stood at the desk while Shirley filled in the form requesting time off the following month. That weekend she had a heart attack.
I’ve met many Larrys and Shirleys over the years. If asked, they’ll work the extra shift because they’re the type of people who don’t like to say no. While it’s tempting for organizations to meet staffing needs with someone who always says yes, good managers recognize that such requests can push employees to the brink. Encouraging employees to engage in ongoing self-care and to recognize when they need to “refill the well” can reduce their chances of burnout and illness, leading to better workers, improved care and fewer missed shifts overall.
Self-care for healthcare workers is, according to one research paper, “a proactive and holistic approach to promoting personal health and well-being to support professional care of others.” Team-care — a concept I learned while researching this article — refers to coworkers supporting and encouraging the self-care efforts of their teammates.
When I asked after the well-being of Larry and Shirley, I was engaging in team-care. While I often informally check in with my coworkers, team-care is much more effective if it’s a consistent, leader-supported element of workplace culture.
There are many ways in which individuals can engage in self-care and be supported by facilities and coworkers in their efforts.
Posted by Dr. El - November 12, 2018 - Business Strategies, Dementia, McKnight's Long-Term Care News, Motivating staff, Personal Reflections, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
I headed to the 2018 LeadingAge convention last week looking for a fix of long-term care enthusiasm and that’s exactly what I got.
I met up with old colleagues, put faces to voices I’d spoken to for years and wandered through the expo hall catching snippets of conversations that might be exciting only to long-term care professionals.
PDPM
Armed with a large cup of black coffee, I attended an early morning seminar on the Patient-Directed Payment Model (PDPM), mostly so I’d know what everyone was freaking out about at work. “Are there any payment adjustments for residents with behavioral health problems?” I inquired of the speakers. “No,” came the reply.
Facilities will continue to have to manage residents with anxiety, substance abuse and other difficult and time-consuming behaviors without financial remuneration through PDPM. For those looking for immediate answers, consulting psychologists can be a good resource for staff training and local associations may be able to offer educational sessions on specific topics across facilities.
Team building
I participated in a session offered by Christopher Ridenhour, GFN entitled, “The Other Voice: Race, Class, Culture and the Other ‘Isms’ in Aging Services.”
“And you wonder why we have a staffing crisis,” he said, pointing out, for example, that attendees walking briskly through the conference hall without acknowledging one another were likely to be doing the same thing with their staff members back at home.
Ridenhour emphasized that all workers, regardless of their race, age or any other characteristic, want to be recognized and appreciated.
The session included practice exercises that highlighted commonalities between participants. I left with a new friend with whom I “LinkedIn” the next day. We were born in different countries, work in different LTC roles and have almost a decade between us, but given the directive to “tell each other your life story in thirty seconds,” we found the kind of common ground that any employer would want for their team members.
Montessori for staff
The theme of connection was echoed in a session offered by psychologist Cameron Camp, Ph.D., and his colleagues at the Center for Applied Research in Dementia on teaching Montessori techniques to staff members.
Posted by Dr. El - September 19, 2018 - Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Motivating staff, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
As a consulting psychologist, my official job is to provide psychological services to the residents of the nursing homes in which I work. Occasionally, though, I’m asked by a department head to informally assist a staff member in distress and, more frequently, a teammate comes to me for a referral for herself or a family member.
And then there are the times that I reach out to a coworker whom I see needs a hug, an acknowledgement or a few words of encouragement.
Based on a study reported in BMJ Open last month, it turns out that I’m not just being of service to my coworkers. I’m also helping to keep them on the job.
The study examined the way managers handle feelings of depression in their team members across 15 different countries. They looked at whether their reactions influenced absenteeism or presenteeism, which refers to attending work but with reduced productivity.
The researchers found that managers who acknowledged depression and actively offered help fostered greater presenteeism and less absenteeism.
The authors recommended that, given the prevalence and substantial costs of depression in the workplace1, attention be paid to developing policies and training that allow managers to better support employees who are experiencing depression. Training managers to recognize and attend to depressed workers makes it more likely that they’ll intervene before symptoms and productivity costs worsen.
Of particular interest given long-term care’s typical workforce is that the results of the study suggest that, “female individuals with low education and those in the middle age group (25–44) might need more support in the workplace.”
Interventions
Clearly, it’s not a good idea for managers to spontaneously hug all the coworkers they think might be depressed. (For the record, I approach only people I know relatively well and I always ask the person if they’d like a hug before hugging!)
Instead, consider these other ideas:
- At a minimum, add a section on recognizing employee depression to in-service trainings already in place for addressing depression in residents. Distribute an up-to-date list of local mental health providers at the end of the program for attendees who might want to access services on their own.
For the entire article, visit:
Posted by Dr. El - August 28, 2018 - Business Strategies, Communication, Customer service, Engaging with families, Inspiration, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
The Nursing Home Compare star rating system assesses quality of care based on health inspections, staffing and quality of resident care measures. It examines important factors such as emergency preparedness, resident/staff ratios, re-hospitalization rates, falls and antipsychotic use.
After writing about turnover in my last column, I wondered what might happen if high marks were also awarded to facilities for strong staff retention, which has been positively correlated with better care (in this research, for example). From there, I began to imagine an entire rating system based on my view of long-term care.
I think of nursing homes holistically, as microcosms that thrive when each group of participants is thriving. The three groups in each long-term care world are the residents, staff and families. If these contingents are happy, it’s more likely that there will be filled beds, fewer lawsuits and reduced turnover expenses, consequently making CEOs happy.
The supplemental rating system would be based on quality of life rather than on quality of care and it would examine the quality of life of all the participants.
The ratings would review:
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Staff turnover — To improve retention, facilities would invest in their staff members not just by reviewing their salaries (because nobody goes into direct care for the money), but also by investing in training, onboarding, teamwork, educational reimbursement and other initiatives (such as offering onsite childcare) that make the organization a good place to work over the long haul.
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Resident independence and uniqueness — This facet focuses on how well residents are encouraged and assisted to maintain their interests and connections, reducing depression and creating a more lively, joyful environment. Greater opportunity for resident autonomy would result in decreased “behaviors,” reduced use of medications, improved staff retention, fewer empty beds and positive public relations when skillfully publicized. To accomplish this, therapeutic recreation would be elevated to its proper position as a crucial department charged with designing programs that enhance life for all within the home. A director of volunteers would be hired and supported, psychology services would be well-utilized and the social work department would be staffed in a way that allows social workers to exercise the skills they were trained for rather than being limited to charting admissions and facilitating discharges.
For the entire article, visit:
Posted by Dr. El - July 31, 2018 - Business Strategies, McKnight's Long-Term Care News, Motivating staff, Resident care
Here’s my latest article on McKnight’s Long-Term Care News:
I once rode down a crowded afternoon elevator with the CEO of a managed care company. “It must be 5:01,” he commented wryly. I heard a measure of scorn for his employees’ lack of dedication to the job. What I saw was a group of people fleeing from utterly uninspiring and unappreciated work.
Similarly, in long-term care facilities with high staff turnover, some may see an absence of commitment on the part of workers, while others recognize that there’s something wrong with the job and the way employees are being treated. If workers are fleeing for the private sector, it’s not because they have an intense desire to work at Burger King.
Managers are no doubt familiar with many ramifications of turnover, such as the time and expense of finding and training new hires, the overtime costs for filling in shifts and the need to engage expensive agency workers. It’s also recognized that staff become demoralized in a high-turnover environment and that the quality of care can suffer — two points worth considering in more depth.
When key employees depart — such as nursing supervisors, department heads and nurses — direct care staff may be hesitant to bring problems to new workers just settling in to their jobs. Without the ease that develops between team members over time, important information may not be relayed, glitches in the system aren’t identified and resolved, and problems can fester and multiply.
When staff retention is low, workers become burned out on meeting new team members. They don’t want to put in energy toward welcoming newbies because they know the likelihood is that the individual isn’t going to stick around. This exacerbates the problem because a new worker who doesn’t feel welcomed is less likely to remain with the job.
The impact on residents is profound. Residents are in a vulnerable position, reliant on others for their most personal needs. It’s difficult for them to adjust to being assisted with toileting and bathing by a familiar person, but an unpredictable rotation of strangers who are new to the work adds another level of stress to their lives. For residents with dementia, expect an increase in distress — and the kinds of behaviors that make new hires less likely to remain on the job.
Turnover begets more turnover.
Posted by Dr. El - June 20, 2018 - Business Strategies, Depression/Mental illness/Substance Abuse, McKnight's Long-Term Care News, Motivating staff, Stress/Crisis management
Here’s my latest article on McKnight’s Long-Term Care News:
With the high-profile deaths this month of designer Kate Spade and chef Anthony Bourdain, the crisis of suicide has been thrust into the spotlight. Suicide deaths in the United States have increased 25% between 1999 and 2016, with an estimated 45,000 occurring per year.
I’ve written about suicide prevention in older adults and protocols for managing suicidal residents before. This column focuses on what organizations can do to address employee suicide.
As I prepared for this article, I realized that we don’t hear much in the industry news outlets about suicide among our staff members. But that doesn’t mean it isn’t happening.
Research has shown that physicians are twice as likely to commit suicide as the general population, and while there is a notable lack of information about the suicide rates for nurses in the US, a report from the UK finds that “for females, the risk of suicide among health professionals was 24% higher than the female national average; this is largely explained by high suicide risk among female nurses.”
A suicide death in the small-town atmosphere of a nursing home can have a devastating ripple effect, deeply affecting other staff members, as well as residents and their families. It can be particularly difficult to absorb a suicide death in an environment where others are struggling to live, despite age and disability and where the job of workers is to keep people alive.
A death by suicide leaves those around the deceased wondering how they might have failed their coworkers and teammates. This feeling can be particularly acute among individuals who pride themselves as excellent caregivers — the kind of people who work in long-term care.
How employers can help
The Suicide Prevention Resource Center (SPRC) points out that it is not only more humane to create an organizational culture of physical and mental health, but it also leads to more productive employees. They suggest a comprehensive approach based on the following three elements to make workplaces more supportive to those who are struggling with depression.
For the entire article, visit:
Posted by Dr. El - June 13, 2018 - Business Strategies, Communication, McKnight's Long-Term Care News, Motivating staff
Here’s my latest article on McKnight’s Long-Term Care News:
McKnight’s Long-Term Care News frequently notes stories about rogue employees engaging in illegal and disturbing behavior and then trying to cover it up after the fact.
There are regular reports about intra-organizational systems that fail, leading to wrongful death lawsuits and other problems, such as this one about a resident who died from scabies.
Occasionally there’s an article about a whistleblower alerting the authorities about a questionable practice, resulting in repercussions for the company.
It’s very likely that there were employees who noticed that things were going awry before these stories became stories.
I know I’m not the only one who has observed that in some facilities, staff reports of potential problems are met with appreciation for the alert before rectifying the situation, while in other nursing homes, information is so often ignored that it is no longer reported. These vast differences in the culture and communication style of organizations directly impact health outcomes.
In a New York Times article last week, “A More Egalitarian Hospital Culture Is Better for Everyone,” author Pauline W. Chen, M.D. detailed efforts to alter interactions between hospital staff members, moving from an authoritarian style to a more egalitarian approach.
In authoritarian hospital cultures — those with a “do as I say” management strategy — nurses feel powerless to affect change. Patients fare worse in authoritarian environments than in egalitarian hospitals where nurses are regularly asked for input and senior management staff meet consistently with clinicians.
The article describes a program called Leadership Saves Lives, which created significant cultural changes in a relatively short time frame and improved clinical outcomes. The effort involved “guiding coalitions,” with the more successful coalitions having more diverse membership, including participants across departments as well as frontline, mid-level and top leadership and administrative staff.
Effective groups were able to elicit authentic contributions from members, who felt that their perspective was welcomed and valuable, and they found ways to handle conflict, fatigue and motivation over time.
While this particular study focused on hospitals, long-term care — with its similar interdisciplinary team approach and fragile population — might take note. Authoritarian, top-down communication makes it less likely that workers will notify supervisors about practices that could negatively affect the health of residents and could potentially lead to litigation and unfavorable press.
Teachable moments
While there’s a temptation to blame rogue workers for their mishandling of an event (and to feel relief that the situation happened elsewhere), we’d be better off viewing these events as teachable moments for any organization.
For the entire article, visit:
Discussion forum of multicolored wooden toy figures on white background
Posted by Dr. El - March 3, 2018 - Business Strategies, Communication, McKnight's Long-Term Care News, Motivating staff
Here’s my latest article on McKnight’s Long-Term Care News:
When we think of teamwork in long-term care, we envision a group of dedicated specialists working together to provide the best care for our residents. They read notes from other disciplines, bounce ideas off colleagues at the nursing station and convene care plan meetings.
In reality, teamwork in long-term care is much more complex.
Teamwork basics
Team members include not just clinical staff, residents and family members, but other workers who frequently have an influence on care, including housekeepers, laundry workers, maintenance staff and security guards. To enhance teamwork, these employees should be included in in-service trainings that might initially appear beyond their purview, such as customer service training and education about the medical and behavioral information they may need to relay to the nurses.
Teamwork is strengthened when team members understand the work of their colleagues and when it can best be utilized. For example, a lack of understanding of the difference between psychology and psychiatry services can cause delays in the receipt of needed treatment. Consider monthly training lunches that can boost morale, increase interdepartmental understanding and improve team functioning.
Team members also include those outside the facility, such as medical specialists, dialysis centers and hospitals, as well as consultants who provide onsite care such as psychiatrists, dentists, respiratory therapists and others.
Unifying all these team members requires uncomplicated and reliable conversation and correspondence. Communication can be enhanced in a variety of ways, including computerized records that eliminate paper consults and indecipherable handwriting, enhanced change of shift reports that include behavioral as well as physical information and a management commitment to staff retention to create the stability necessary for a solid team.
Taking it further
Once teamwork basics of role understanding, stable staffing and communication are covered, teams can begin to address teamwork at a deeper level.
Deep teamwork involves observing how the floor, unit or neighborhood is functioning as a whole over different shifts.
A team is not functioning well if a disruptive resident is keeping others awake at night or frightened during the day. Nor is it a high functioning team if two staff members are in a personal argument that’s obvious to all who walk onto the floor.
Deep teamwork calls for observing the interactions of the team and intervening as necessary to guide them back on track.
For the entire article, visit:
