Presented by Glyndon Ruth Kimbrough, Executive Director of Miramont Pointe and member of MOVE’s Education Committee, and Catherine Stocker, CNA and Lead Aide.
Those attending the November 1, 2012 quarterly education meeting were treated to a practical and inspiring presentation by Glyndon Ruth Kimbrough and Catherine Stocker about their experiences in developing and implementing key elements of culture change: self-scheduling by direct care workers, consistent assignment, and Lead Aide program.
These workforce practices are important in supporting workers who are the backbone of long-term care services, yet often feel powerless, unappreciated, and burned out. Glyndon Ruth got many of her ideas from a MOVE meeting with David Farrell. (His ideas were also captured on a CD which is available through MOVE).
Benefits include closer staff relationships and greater accountability among staff. This in turn resulted in fewer call offs, not working short, and no use of agency staff since the program was fully implement. Some suggestions for implementation:
- Begin with a no fault attendance policy, maintain high expectations, and treat staff like the vital people that they are.
- Give the entire staff written 30 days notice of the new policy.
- Hold small group meetings to discuss the policy and how it will be implemented.
- Have routine 4-days on 2-days off schedules for everyone so that schedules are predictable.
- Have a bulletin board where staff can post available shifts (for example, when someone needs to trade or find someone to work for them) or let others know they are interested in picking up shifts.
- Once the scheduling is implemented, do it for at least 90 days (that is, don’t give up if things get tough at first).
- Meet again to talk about experiences and suggestions for improvement.
- Hold staff accountable for not arranging someone to fill in.
- Discuss and clarify self-scheduling policies when interviewing job applicants.
This practice is associated with positive and close relationships among staff and residents and fostering interactions that are mutual. It provides both residents and staff with a sense of belonging. Staff notice changes in resident function and behavior sooner if they are with them consistently, and providing care is often more efficient and faster because workers know and can anticipate needs. Suggestions for implementation include:
- Having CNAs make the assignments, but also seek input from and preferences of residents.
- Assignments must be perceived as fair to the worker.
- Issues of challenging behaviors and personalities and care needs must be addressed explicitly.
- Consider changing assignments if there are changes in care plans or heavy care responsibilities.
- Alert new staff to consistent assignment policy as part of the interview process.
Some questions that emerged from the general discussion included: how does self-scheduling contribute to or interfere with consistent assignment? Does consistent assignment of teams work as well (or better) as consistent assignment of individuals?
Lead Aide Program
Lead Aides manage the day-to-day operation of directing and performing resident direct care. The team developed a job description (available on request) that includes making rounds with staff from the prior shift; reviewing a 24 hour report book; reviewing the appointment book to identify which residents have medical appointments, etc.; assigning breaks and lunches. The Lead Aide also communicates with the charge nurse — for example, to make sure staff is ready for people moving in or transferring to the hospital or other setting. These activities include making sure the room is ready for people moving in, preparing a roommate that someone is moving in, making the resident feel welcome by introducing them to other residents and staff. Establishing a Lead Aide position not only makes sense for resident support and team work, but it demonstrates that the organization has a career ladder for active and positive CNA staff.
Thank you Glyndon Ruth for a great afternoon!