Page 3 - One Nursing Home's Journey

hold caregivers, staff is cross-trained on a voluntary basis. Non-nursing staff mem- bers including managers are encouraged to become CNAs. They retain their pri- mary jobs, but help with CNA-related tasks as the need arises. The various degrees of cross-training have given rise to new staff positions:
• Homemakers are trained in dietary, housekeeping and laundry. Many originally were dietary staff assigned to the main kitchen. Now they work in the households (following the placement there of automatic dishwashers) and report to the Household Coordinator.
• Resident Service Aides (RSAs)
are CNAs schooled in activities.
• Shower Aides are CNAs taught
“Bathing Without a Battle” techniques to provide a more soothing bathing experi- ence for residents with dementia. If an elder doesn’t want a shower, she may opt for a bed bath or whirlpool. With more choices and a personalized approach provided by shower aides, residents who formerly became agitated during bathing are now much calmer, notes Aube. (For Bathing Without A Battle training video, see www.culturechangenow.com/videos.html).
The biggest challenge to staffing “was getting everybody to realize they could work together and do each other’s job,” says Aube. “Now they’ve become really good at problem solving and helping each other.”
The biggest challenge to staffing “was getting everybody to realize they could work together and do each other’s job,” says Aube. “Now they’ve become really good at problem-solving and helping each other.”
As one CNA told Heath: “I didn’t know what you were thinking when you put me with my partner in our household, but I just love working with her...we did a double shift together last weekend.”
This from a woman who had never worked overtime during the previous three years Heath has been at Lenawee.
“But now she likes her partner and household and she feels committed, so she stays over,” notes the DON. “They’re building relationships not just with resi- dents but with each other...that’s never happened before.”
Harder, But Better for Everyone
That’s not to suggest the journey to households has been a tiptoe through the tulips. Change is tough, especially when following a road few have traveled.
“This process is harder than the tra- ditional,” says Aube. “It’s so new we don’t have a lot of research to tell us how to do things...you work it out yourself.”
Different staff positions become stressful at different phases in the transi- tion, and then calm down as staff become accustomed to their responsibilities in the new environment, she says.
“People who were committed six months ago may go through a period where they wonder if they’re in the right
area, and then they become totally com- mitted again,” she adds.
In the next section we examine the struggles and rewards arising for Lenawee caregivers during the first three years of transition to households. The informa- tion is gleaned from over 40 interviews conducted by Action Pact, Inc. separately with the Administrator, DON, Clinical Dietitian, an LPN, a housekeeper, an activities worker and three CNAs.
Three years after moving to house- holds, seven of these nine staff members remain at Lenawee. All agree they prefer the new model to the old.
“Even though it is harder, it’s just
better for everyone,” says Aube.
CCNOW!
More Trust Prompts DON to Give Up Dictatorship
Deborah Heath says she rel- ished her role as DON—“Dictator of Nursing”—at Lenawee Medical Care Facility in Adrian, MI.
“I like being in charge...telling people what to do,” says this 30-year veteran of nursing care.
So naturally it was difficult for her to delegate responsibility to teams of nurses and CNAs when Lenawee moved to a Household Model. Her main hurdle was a lack of mutual trust. She describes the incident that got her over the hump:
“We were getting ready for the move and the licensed nurses had given us a list of things they thought would hinder our moving forward... we put teams together (to address those issues) and I didn’t go on any of them. I didn’t go to a meeting unless I was invited.”
Thus she learned to trust that nurses and CNAs could resolve important issues like scheduling, stocking, documentation, communi- cations and oversight.
“They thought of things I would never have thought of. That was like the ‘ah-ha’ moment for me,” she recalls.
Now she merely sets param- eters for the teams to decide what they need to do, and they monitor themselves to ensure it gets done.
Instead of micromanaging, she gives more time to seeing the Big Picture by researching the new and innovative, “questioning everything” to weed out unnecessary procedures, and planning for the future. She’s more Clinical Mentor than DON, and it’s way better.
“I used to spend 14 hours here. Now I can do an eight-hour day and leave with a good conscience,” she says.
She credits Action Pact and Administrator Kathy Aube, among others, for helping her change the “me-way” of leadership.
“She’s grown to appreciate the fact that if you make a decision with a lot of input (from others), you get a better decision,” says Aube.
Heath’s advice to DONs: “Give staff parameters and the tools to enable them to make decisions. Don’t set people up to fail, but let the team actually make the decision... that’s hard for DONs.”
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