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Healthcare Training Institute - Quality Education since 1979

Section 4
Track #4: Priorities & Strategies for Your Wish List

Table of Contents | NCCAP/NCTRC CE Booklet

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Note-Taking Exercise

What are the three steps in attaining staff support that have been covered so far?
1.

2.

3.

What are three criteria you might use to set priorities for your wish list?
1.

2.

3.

What are your priority goals?
1.

2.

3.

Sample Format for a Listing of Residents to be Transported

How might you acquire the names of the charge nurses?

Record the names of the charge nurses below:

Transcript of Track 4

On the last track we discussed Conflict Avoidance and how to use the “Two-Screen” technique.
So the purpose of the previous track was to provide you with a means to dissipate your anxiety towards talking to your administrator, Director of Nursing, etc, regarding federal guidelines.

Let's summarize the 3 steps proposed so far.  First, you have had your administrator, Mr. Smith, clarify his ideas with you concerning compliance regarding CNA’s transporting residents, activities not being limited to being provided only by staff, and re-arranging medication and treatment schedules to accommodate residents who prefer to attend activities. Second, you have acquired a hard copy of these guidelines from your administrator, your corporate activity consultant, downloaded them from the internet, or used the outline provided in the note-taking booklet that accompanies this course.  Third, you have met with your director of nursing, and have provided her with a copy of these regulations.

So now what?  In the meeting with your director of nursing, or perhaps in a separate second meeting, you need to discuss in very specific terms what you would like to have happen.  It's great to say, "CNAs will transport residents to activities”, and everything sounds peachy-keen, so to speak.  However, the next step is to provide the specifics that need to be outlined regarding who will do what, when, and how it will happen. 

You, of course, don't want your director of nursing to feel overwhelmed in this meeting.  Plus, she is a busy person, and probably if a meeting lasts over 10 minutes, your Cindy may be getting antsy.  So, you might suggest that you schedule another meeting to talk about specifics as to how this will happen.

At this point, you need to decide exactly what you want to have happen, and how you define getting department head and staff support.  I'm going to ask you to turn the CD player off shortly to design your wish list based on your priorities.

Let's talk about how to set your priorities for your staff support wish list.  It could be based on a specific resident who appears the most needy, or even a resident's family who has been pressuring you for their family member to attend an activity.  Or, it might be based on your own observation that a resident is becoming more disoriented due to lack of stimulation.  Another criterion for setting your priority item on your wish list for staff support is to choose your easiest victory first.  In other words, a resident whose room is located the closest to an activity, and/or a CNA on that wing who seems to be the most cooperative.  Your strategy here is to choose to build support with the easiest, most compliant goal first.  Or, you might choose the opposite strategy and request the most obstinate CNA to transport a resident.  When you hear the musical tone, turn the CD player off, or perhaps replay this portion of the CD and think about what are the criteria for setting certain priority goals to gain staff support prior to talking to your Director of Nursing and establishing a game plan with her.

Of the 3 areas mentioned at in previous tracks, transporting, starting activities, and scheduling, you can see that the transporting and doing activities is at the CNA level, and the scheduling of medications and showers is at the charge nurse level. Clearly, scheduling of treatments is at the therapy level.

Just to have a starting point, let's create a strategy for transporting residents. In this second meeting with your director of nursing, or perhaps in the first where you talk about regulatory guidelines in your meeting with your administrator, providing your Director of Nursing won't feel overwhelmed, come prepared with a neat, legible, listing of residents, grouped by wing, listing the day, the name and the time they are to be transported.  A sample format is in your note-taking booklet.  It's extremely important that you group your residents by wing, because nursing assistants are usually assigned a wing.  Make this listing in a format that can easily be posted by the charge at the nurse's station.  The next step is to get the buy-in or support of the charge nurses. Do you know their names?  Do you know anything about them personally? 

How can you get someone to care about follow-through regarding something you want to have done if you don't care enough about them to even know his or her name?  When you hear the musical tone, turn the CD player off, and think about a strategy for acquiring the names of the charge nurses. Next time you are charting behind the nurse's station, make it a point to make casual conversation specifically with the charge nurse.  Now envision how this will happen.

At shift change, many homes have a meeting they call "Report," where information about residents from the preceding shift is provided to the shift that is coming on.  The charge nurse, or director of nursing, may conduct this meeting.  Wouldn't it be great if the person conducting this meeting had your list in his or her hand, and stated to Susie, the CNA on A wing at about 1:45, Effie needs to be transported to the sing-along today in the lounge?  Sound good?

I have just given you a general outline how you can proceed from a meeting with your administrator, to a meeting, and possibly a follow-up meeting with your D.O.N. in which you discuss regulations. During these meetings, you provide your D.O.N. with a listing of residents to be transported to activities.  I also suggested that you establish informal lines of communication between yourself and the charge nurses.  In the meeting with your director of nursing, you need to get a commitment to developing a system of communication between yourself and nursing regarding which residents are to be transported.  The specifics of this system are unique to your home, However, the meeting with your director of nursing will be a waste of time if YOU have not figured out ahead of time an effective way for this agreement made in the director of nursing's office to trickle down to that CNA so that he or she ACTUALLY transports Effie at 1:45 to the lounge. Make sense?

Let's leave the topic of transporting residents.  Now, let’s talk about CNAs doing activities with residents. Now the guidelines actually state, "all staff can do activities with residents.  This would include housekeeping, but let's just focus on nursing.  So what kind of activities can a CNA do with a resident?  If you have not purchased our 5 courses in our Alzheimer's series, you might consider doing so.  Hundreds of one-to-one and small group activities are not only explained in detail in those courses, but specifics are given exactly how to implement them with physically and mentally impaired residents ranging from semi-comatose to mid-stage Alzheimer's.  A system is proposed in those courses of putting a Success Therapy® Bag in residents' rooms, which contains a project you have started with the resident.  Since these projects are from discarded items like gallon milk bottle caps and butter dishes, they have been specifically designed to be left in residents' rooms.  Some examples of these projects are yarn-winding, pillow maze, geometric puzzle, color pattern cards, etc. If you are not able to purchase all 5 courses, the first course contains key implementation concepts and several simple activities that will work with many of your mid to later stage Alzheimer's residents.  I felt I needed to add this information in case you were wondering what or how to have CNAs involve a resident in an activity after they have assisted your Hester or Effie in dressing.

So, let's say you have yarn-winding in a plastic bag, taped to the night stand in Lillian's room.  What is going to motivate Susie, her CNA, to actually give Lillian the yarn-winding?  The problem is… if CNA Susie is not giving the yarn-winding to Lillian, activities really cannot cross department lines, and reprimand the CNA.  Agreed?  The delicate situation you are in is that if you go to the charge nurse or director of nursing, and report the CNA, you may feel uncomfortable for having gotten the CNA in trouble with her superiors.

The next track will provide you with specific actions to take if you are experiencing difficulty getting other staff to follow through.