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What is the first criterion to think about when considering a department head's or staff's positive or negative reaction to your requests for change?

Think of a specific staff member. How might your requests regarding optimizing a resident's ability to participate in an activity of choice look to that staff member, if not presented in light of regulatory guidelines?

On the last track, we talked about the speech therapist who refused to change Mabel's scheduled appointment which conflicted with her attendance at Bible Study conducted by her church.

On this track, we will discuss why and in what four subtle, or perhaps not so subtle, ways a department head or staff member may react negatively to your tactful attempts at gaining staff support and cooperation for compliance with federal regulations. These four unsupportive reactions are grumbling; attempts at guilt; over-apologizing; and revenge,

What if the other department head responds to your request for a therapy appointment, shower schedule change, or medication change with the comment “Well!! You never minded before!!!”? If so, you may want to be preparing for similar, hopefully perhaps less mild, reactions when you start attempting to gain staff support and cooperation in your facility. Although in not every case, of course, will other staff members respond negatively to your request for compliance with federal regulations, this preparation still has good reason. There is a chance that some people at your facility, and you may have an idea who, will have a negative reaction to your tactful attempts at gaining staff support and cooperation.

#1 How it Looks to Others
When thinking about a department head's or staff's positive or negative reaction to your requests for change, consider how your request appears to them. Let me repeat that. The first criterion to think about when considering a department head's or staff's positive or negative reaction to your requests for change is how it appears to them.

So, how will the speech therapist, your administrator, director of nursing, etc. view your request that these changes be made? If they feel you are making unreasonable demands, your request may lead them to think something terrible has happened to push you “over the edge.” If you don't take time to do your homework first, and start with your administrator; you may come across as demanding, uppity, or high handed for suggesting that the busy overworked, short handed CNAs give the yarn winding project to Frieda that has been left in her room after she has been dressed, for example!

When you hear the musical tone, turn the CD player off and think about specific individuals and how your requests regarding optimizing a resident's ability to participate in an activity of choice may look to that staff member, if not presented in light of regulatory guidelines. MUSIC

As mentioned earlier, here are four unsupportive reactions you may receive. They are grumbling, attempts at guilt, over-apologizing, and revenge.

#2 Grumbling
The first negative response, grumbling, occurs when a department head, for example, the speech therapist, may comply with your request and is not openly aggressive to you at the time, but begrudges, resents, and grumbles about you, either to your face or to others. As long as this behavior doesn’t cause a problem in the facility, I feel the best way to deal with badmouthing, unkind remarks, or grumbling, is simply to ignore them. Many times, when a grumbler realizes that his or her grumbling is not getting your goat, so to speak, his or her behavior will not be reinforced, and therefore, will decrease. This most likely will be the case, especially if other people in your facility respect you for your efforts to provide a quality activity program. If you were to angrily reply to the grumbler, it could complicate things and make the grumbler even more disgruntled along with possibly alienating others who are in earshot.

So, rule number one when you ask for changes, don't be shot down by grumblers, just expect them and move on. Remember you have the support of the administrator, not to mention you have a personal commitment to providing a quality program, whether regulations required it or not. It's just that the regulations give you the legal teeth, so to speak, or clout, to place yourself in a position of influence to make these requests for staff support. When you hear the musical tone, turn the CD player off, and list the department head or staff member you feel will grumble when you request a change.

#3 Guilt Trips or Complaining
The second negative response you may receive is another staff member's attempts at guilt. Someone you talk with about transporting residents to activities may not like being told that they are to do something differently, and therefore may try to make you feel guilty for assertively dealing with the problem. They could act offended, or go into the old mantra of being understaffed, or some other dilemma which the stress of your request will add to their stress. Or the staff member may create some other reason regarding why you should feel guilty and retract your request for CNAs to transport residents.

#4 Over-Apologizing
Along with backbiting and attempts at guilt, another response is over-apologizing. In order to ensure they don't offend you, they apologize needlessly. This can even make you feel guilty. After all, you can empathize with them, as you may have been non-assertive in the not-so-distant past. An effective way of dealing with an over-apologizer is to let them know that you aren’t upset at them, and they don’t need to feel so sorry about an issue which has already happened.

The fourth negative response is revenge. If your confrontation is misinterpreted by an aggressive person or causes them to feel threatened, they may take steps to make your life at work harder. When you notice that a staff member is taunting you or deliberately inconveniencing you, it may be a good idea to try and open discussion regarding the reason for your requests based on surveyor guidelines. If the department head or staff member still react aggressively or are generally unaffected by your explanation, it may be necessary after much consideration to inform the administrator or whatever level is directly above that staff member. If this type of situation should escalate to this point, be sure that you are not in fact reporting them out of revenge yourself, but because you honestly cannot do your job with such a conflict in the facility. This may be the course of action to pursue if the Speech Therapist from the last track refuses to make schedule changes.

On the next track, we will examine three ways to deal with lack of cooperation: timing of your request, stating your observation, active listening by rephrasing, giving the reason for your request; using of the Broken Record Technique by repeating your request, and escalating.

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