Tag Archives: AGE-u-cate Training Institute

Retention Culture: Antidote to C.N.A Turnover in LTC

Shaping organizational culture and respect for Certified Nursing Assistants can impact retention.

Kathy Dreyer penned a terrific post last week about Long Term Care Certified Nursing Assistants and turnover. This issue has been identified as a crisis. I submit that it is also a tragedy, because, we have ignored the problem with the lack of a national strategy.

Certified Nursing Assistants are the backbone of care in long term care. They provide care for those that nobody else can, or will.

Our nation’s 1.3 million nursing home residents depend on C.N.As  365 days of the year for personal care of all types and levels. This is not an easy job. But those that continue to do this work know that it is also soul-filling and rewarding. But, what else makes some stick with it?

Retention Through Culture and Respect

A 2009 study found that an organizational culture that respects and invests in their workers inspires retention. To that end, I submit that Certified Nursing Assistants in Long Term Care do not receive the recognition they deserve.

Nationally, nothing has been done to advance the vocation. Additionally, at the state level, dismal Medicaid reimbursement has a disastrous effect on wages. Consequently, all we can directly control is our organizational culture.

If we truly value our seniors, we should vigorously value the people who are taking care of them, day in and day out.  An article in Provider Magazine speaks to the importance of respecting certified nursing assistants as individuals to retention.

Concrete Steps

  • Invest in training and education. Help C.N.As grow,  and acquire new skills (refer to previous blog for more ideas).
  • Tell their wonderful stories. Profile C.N.As who live the values of your organization and contribute to a high quality of life and care.
  • Lift them to your residents, family members, and the larger community.
  • Arrange for regular scheduled time off the floor with coverage to participate in QAPI initiatives.
  • Ask for their opinions, ideas, and find ways they can contribute to decision making.
  • Intentionally incorporate into their schedule time for relationship building. In addition, allow them to spend time with elders outside of their job as a caregiver- as a human being that enriches life.
  • Find ways that your C.N.As can share their gifts and talents with co-workers, residents and family members.

Ponder whether your organizational culture truly respects not just the work, but the personhood of your Certified Nursing Assistants. In doing so, you may realize improved retention, the antidote to turnover.

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Education First in Dementia Care

Foundational Education is critical for inexperienced caregivers of persons with Dementia. Don’t rely on understanding through experience alone.

Working in senior care for over 30 years, it takes digging deep to recall my early experiences interacting with the elderly and those with dementia.  I was a volunteer and an intern during college when my first encounters occurred.

My experiences were mostly pleasant and fun. The people were just older versions of my grandparents. I enjoyed visiting with the independent seniors. They showed me around their cute apartments and told me stories.  However, encountering people with dementia was another story.

It puzzled me when one lady repeatedly said, “I want to go home,” when she was at home. I didn’t know what to say. One lady forgot that I was picking her up for a concert, even though I reminded her the day before. I thought maybe she didn’t want to go after all.

Little did I know that these people had Alzheimer’s Disease.  Learning that their memory was impaired, I assumed they had NO memory.  Therefore, I thought it was my job to remind them of everything.  I thought their brains could be fixed. I was wrong about a lot of things, albeit well-intentioned.

Learning Through Education and Experience

Over-time, I “got it” and became more comfortable being around people with dementia.  My confidence grew as time went on.  I learned that the things they said and their behaviors didn’t define their personhood. Consequently, I came to enjoy being with them.

Looking back, I can see how extraordinarily helpful training like Dementia Live would have been. I genuinely think it would have propelled my understanding and improved my interactions ten-fold.  Webinars and lectures barely scratch the surface to learn what it takes to promote quality of life for persons with dementia.

Time and experience alone should not be our only path to understanding.  The valuable lessons that the  Dementia Live experience teaches learners include:

  • persons with dementia experience feelings, even with impaired memory
  • their behaviors are a form of communication
  • the environment makes a big difference in their ability to connect
  • purpose in life is still essential for their well-being
  • our communication approaches can make or break an interaction

Learning does comes with time and experience.  However, I submit that ground zero isn’t the best place to start.  People with dementia deserve better than to be surrounded by uninformed, clueless people, such as I was years ago.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  Julie provides training and educational programs on elder caregiving for family and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Infection Control and Expressive Touch: We Can Have Both

The healing benefit of expressive touch is lacking in the lives of older adults.

The topic of infection control almost always enters the conversation when I deliver Compassionate Touch training.  This training teaches caregivers the skill of expressive touch.

Hand, back, and foot rubs used to be a part of the care process.  Seasoned nurses consistently confirm this fact.  In contrast,  newer nurses and nursing assistants report that expressive touch was not a part of their training.

This lays the foundation to discuss the reasons why older, frail adults lack expressive touch in their lives.

Glove Culture and Expressive Touch

Infection control is consistently cited by skilled nursing employees as a reason for the lack of expressive touch in the lives of older adults.    Furthermore, employees fear citations from surveyors for not using gloves.

Megan J. DiGiorgio, MSN, RN, CIC, FAPIC  coins the phrase “glove culture”.  In addition to the wasteful use of resources, the over-use of gloves increases disconnection and a lack of trust in caregivers, among other negative outcomes.

Burdsall, Deborah Patterson, MSN, Ph.D.,  identified situations that require the use of gloves.  Touching intact, non-infectious skin of older adults in healthcare settings does not require gloves.

Skilled nursing caregivers do expressively touch their residents.  Indeed, holding a hand or giving a hug communicates how much we care and provides comfort.  We can incorporate more of this excellent medicine of expressive touch in our caregiving practices and still uphold infection prevention standards.

Gloves are not used with Compassionate Touch techniques. I urge those I am teaching to resist the temptation. The benefits of touch would be lost for both the resident and care provider.

Consider evaluating the extent to which gloves are used in your community and understand the unintended consequences.  Even more, it seems like this would be a worthwhile QAPI project.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  she provides training and educational programs on elder caregiving to private and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.

Elevating the Vocation of Aging Services Certified Nursing Assistants

The shortage of Certified Nursing Assistants in Aging Services is reaching a critical point.  Piled on top of the current shortage is the projected need.  However, systemic and sustainable solutions have evaded the industry.

The U.S Bureau of Labor Statistics projects the demand for personal care aides to grow by an astounding 38%  to the year 2026.  Consequently,  this leaves many aging services providers panicked and scrambling to attract and retain qualified and caring nursing assistants.

More importantly, we need a new generation of dedicated persons who have a calling and see this work as their vocation.

Expecting a high level of dedication from nursing assistants in an industry that does very little to advance the vocation seems unrealistic. Therefore, creating a vision for a new role of the C.N.A needs attention from a national, state and organizational strategic level.

Possibilities for a New Role

Recently, I had the pleasure to meet with Karen Messer, CEO, and President of LeadingAge Illinois.  Karen and her team are responding to challenges facing association members by developing workforce solutions and resources.

Karen and I discussed ways to elevate the esteem and professional standards of the certified nursing assistant.  As a result, we started running down the list of potential skills-building opportunities.  Noteworthy ideas include fall prevention expert, medication aide, dementia care coach.  Also consider life enrichment facilitator, mechanical lift trainer, oral care technician, infection prevention certified.

Adding on specialties and certifications to the vocation of a certified nursing assistant will elevate the esteem of the position.  In addition, it will create a needed career path.

Cash strapped Chief Financial Officers will be concerned about paying more.  Therefore, I encourage organizations to consider the positive impact of reduced hiring and turnover activity, increased census,  and improved job satisfaction and morale of their staff.

Begin with starting a conversation in your community about how you can nurture the potential of your C.N.As.  As a result,  build a sustainable workforce solution to propel your organization into the future.

 

Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare,  she provides training and educational programs on elder caregiving to private and professional caregivers.  She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.