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Healthcare Training Institute - Quality Education since 1979

Section 16
Gaining Support for Transporting

Table of Contents | NCCAP/NCTRC CE Booklet

(Before reading this section, you need to have read the Introductory Commentary and completed the exercises in Section 1.)   Now let’s start with transporting.  Once again, you notice that Mary is not at Bible Study.  You are in a 200-bed home, and Bible Study is a favorite activity of many residents, many of whom are in wheelchairs and need transporting.  You have two full-time assistants.  However, there is no way you and your staff can transport all of the residents yourselves.  You must have CNA assistance.  Granted, there are more residents than Mary who are not there who could benefit by attending Bible Study.  Also, Mary’s CNA Sara is not the only CNA ignoring the e-mail sent to the nurse’s station as well as the posted list.  But just focus on one resident and one CNA for now.

The answer you gave above depends upon your formal and informal relationships with these staff members.  There is no right or wrong answer.  The person who you write today may be different than the one you would write tomorrow, depending on changing circumstances in your formal and informal relationships with these staff members.

For example, depending on the history of transporting noncompliance in the past, you feel the best person to talk to is your Director of Nursing, Carol.  Regardless of the CMS guidelines, Carol may really feel her CNAs are overworked and underpaid, due to lack of adequate Medicare/Medicaid reimbursement.  The fact is, she oftentimes operates short-staffed due to high turnover.  In short, Carol feels stressed in many areas.  She feels Culture Change guidelines add additional duties to her CNAs’ workload that may cause additional turnover. When Carol gets stressed, she like a lot of people in her situation, gets short-tempered.

Since you know all of this about Carol, you view your meeting concerning transporting residents to Bible Study as being stressful; especially in light of the fact this is going to be your fourth meeting in five months regarding this issue.  So you are feeling not only anxious, but frustrated.

To prepare for this meeting with your Carol, which you view as stressful, and perhaps even provoking negative feelings from Carol, you need to rehearse what you will do and replace negative thinking with positive thinking.

First, keep in mind that finger-pointing doesn’t work very well here, but by using “I” statements, instead of “you” statements, you can reflect your perception and feelings and send a nonblaming message regarding transporting. An “I” statement is a statement about how something affects you, your interactions with the other person, and the relationship. It’s a statement about how you feel rather than being critical or complaining about what Carol or the CNA did wrong. For example, saying, “Your CNAs are not transporting residents” isn’t going to get you very far. But saying, “I’m concerned about CMS compliance regarding transporting” is a clear statement of your feelings, said in a non-blaming way. Do you see the difference between blaming and naming the staff support issue here? Remember, your feelings belong to you and it’s not easy for someone to argue with the fact that you are concerned. Saying things in a non-blaming way gives your DON a chance to be open to hearing what you have to say without becoming defensive regarding how short and busy the staff is.

Step One: Describe the behavior in observable, non-blaming terms. “Yesterday, I noticed that Mary was not transported to Bible Study.  Her CNA at that time was Sara.” (This frames the interaction from your own perception in such a way so that the other person feels less defensive and less likely to argue.)

After you state your perception of the behavior or interaction, you might want to ask, “Am I correct about that?” or “Do you agree that’s what happened?”  “Was Sara provided with Mary’s name at shift change by the charge nurse?”

Step Two: Tactfully describe how you felt about the behavior. “I felt concerned (confused).”  Now in fact, you may have felt angry or frustrated, but Anthony Robbins talks about downgrading your vocabulary when using negative descriptors. 

Step Three: Now let’s shift gears and look at what is going on inside of you as you speak with this staff member.  Describe how you explained the behavior to yourself. For example, “When I noticed Sara once again had not transported Mary to Bible Study, I told myself, ‘I’m not worth listening to.’ This is the same thing I used to tell myself when my mom dozed off as I was talking to her.  I’m just not that important.”

By raising your awareness level of old baggage, this situation may provoke you for yourself to decide to react more rationally or logically to the current circumstances.  In short, Sara is just a CNA who did not transport a resident to Bible Study.  She is not your parent who never gave you the respect or love that you needed.

Step Four: Describe to your DON what you would like to have happen the next time. “Next week I would like Mary transported to Bible Study.”

If the staff member is below you in the organizational structure of your facility, for example your assistant, it’s helpful to add active listening steps to make sure the other staff member understands your meaning: Ask the person to repeat back what she or he heard you say to make sure your meaning was clear.

However, if the unsupportive staff member is above you in the facility hierarchy, you might accomplish active listening by stating, “Let me see if I have this correct.  You are going to do xxx.  And I am going to do xxx.  Do I have that correct?…”   For example you state, “Let me see if I have this correct.  You are going to ask the charge nurse to provide each CNA with a list of residents on their wing to be transported to the Activity that day.  I am going to create an email listing residents in order by wing, that the charge nurse can make a hard copy of, cut apart, and distribute to the appropriate CNAs.  Do I have that correct?”

Empathy goes a long way
Practice being empathic.  Try putting yourself in the shoes of the unsupportive staff member before your meeting. This is an important key to listening to him or her. Sometimes it’s useful to try to hypothesize or guess what might be going on with that staff member. What might she or he be feeling? Remember, hypothesizing or guessing does not mean analyzing or judging another to be right or wrong, good or bad. Putting yourself in someone else’s shoes is different than obsessive thoughts regarding trying to figure another staff member out and putting yourself into someone’s mind.  To see this from Sara, the CNA’s point of view, “Gee, I am too busy to transport Mary.  I’m a single parent and was up all last night with my sick kid.”  To see this from the Carol, the DON’s, point of view, “If I have the charge nurse ask more of Sara, maybe Sara will quit.  Then I will be even more short-staffed for CNAs.”

Also the emphatic statements you hypothesized or guessed about above are a good antidotes for playing the “poor me” game of  “I don’t get any respect.”  Think for a minute.  No, someone else’s actions aren’t always about you.  Don’t take their lack of support personally.  They have other things going on not related to you and your request for transporting.  So make a habit of guessing what could be going on with that other person not related to you that has caused their lack of support; rather than feeling their actions are somehow a reflection on you.  In short, don’t take their lack of support personally, or as some type of evaluation of you and/or your department.  Make sense?

A Reminder about Scheduling your Meeting
If you have had several meetings regarding this same Culture Change issue, for example, three previous meetings regarding transporting; you may find that getting the other staff member to first agree to a discussion may involve some tactfulness on your part. A good approach would be to talk in general terms.  For example, rather than saying, “I would like to schedule a meeting to talk about the fact that Sara did not transport Mary to Bible Study,” you might say, “I have some Culture Change areas I would like to discuss. When is a good time for your schedule?” Also it’s common sense to have some examples of staff compliance with Culture Change that you have noticed and mention these at the beginning and end of your meeting.  For example, “I noticed the CNA, Sally, gave Hazel her yarn winding and Bill his magazine after breakfast.”

Feel Free to Edit or Change
Good communication involves paying attention to your own needs.  This means clearly stating your needs and asking about the other person’s needs.  A way to do this is to state, to gain clarification, “I want to make sure my meaning is clear.” Or if you feel you may have misspoken, state, “I didn’t exactly mean what I said—let me correct it now.”

Index Card Reminder
As you explore ways to tailor the steps to your needs, communication begins to flow more easily. When I first tried it out, I even listed the steps on an index card to help me out. One day I noticed I didn’t need to think it through anymore, it just seemed to flow.

When you check out someone’s meaning, or confront a situation, you are being proactive, if you are proactive, you won’t feel so boxed in, so stuck. You can make choices here. You can choose how you want to check something out. You are the one choosing the course of action. You are taking the initiative, allowing the situation to glide into positive communication patterns. You, too, may come to a realization like one Activity Director, who stated, “When I took the time to plan ahead and use these four steps, I felt more professional, centered—even though sometimes the result is not a perfect resolution, or I don’t get exactly the response I was hoping for from the other staff member. Now I try to hold on to that centered, professional feeling and keep it with me. It’s a good reminder for the next time I want to check something out with another staff member.”

When you learn structuring your facility communication skills your relationships with other staff and department heads will probably go more smoothly. Try asking “What is it that I want from the other person? What can I do to make the situation better?” Then, really listen to the answers the other staff member gives you.  Notice in my example above, the Activity Director divided residents to be transported by wing, making it easier for the charge nurse to cut the hard copy apart and distribute to the appropriate CNA

1. Update the list weekly as residents are discharged and admitted.  Organize the list into the format that parallels the nursing assistant workload.  The sample email below assumes a CAN is assigned a wing.
2. Email a copy of the list to the Charge Nurse, or appropriate nurse in your facility, and copy it to the Director of Nursing, should you deem it appropriate to gain accountability from the Charge Nurse.   If  compliance regarding transporting is a continual problem, consider copying the email to the Administrator.  Or if you feel the Administrator does not want to be bothered, save hard copies of these emails with check marks by the names of the residents that were not transported on that particular day.
3. Format your email grouping residents’ names together in such a way as to facilitate your running a hard copy, cutting it apart, and handing a hard copy to the charge nurse and a second copy to be posted at the Nurses’ Station.  Sample email is below.