Consistent Assignments The Leadership Role By: Bobbie Banach, RN, DON St. Anne’s Salvatorian Campus Milwaukee, Wisconsin

Objectives 1.Why implement this change? 2.How did we convince leadership to start? 3.How do we promote this?

Why do this? * Staff Retention 1. Staff KNOW what their routine will be. 2. Staff are prepared for the next day, look forward to and know what the day will bring. 3. Staff enjoy getting to “bond” with not only the residents, but their families.

Staff Retention (cont.) 4. Staff know the likes & dislikes of each resident. 5. Staff become “protective” of their group and take on a new “ownership” of their duties, cares, and mission towards quality care. 6. Staff get to KNOW WHO the resident is, not just know the name and a face or room number.

Helen with Jennifer, CNA “I felt the baby move numerous times”

Resident & Family Satisfaction Happier Families Happier Residents Families get to know each caregiver on a more personal, familiar basis. They begin to TRUST the caregiver at a different level. Family & Resident Surveys have proven to be more satisfied & happier, with more productive outcomes.

Family & Resident (cont.) Surveyors “family talks” have shown to be more positive, as concerns and problems are addressed more rapidly, and handled more personally & productively. Surveyors have commented “boy, your staff really know their residents…”

Convincing Leadership to Start A more positive Satisfaction Survey from Residents & Families. NHA to attend Resident Council to discuss options with the resident. Decrease in Accidents / Incidents. Increase in Retention of Staff. Less costly, as less training / orientation need to occur.

Convincing Leadership Less weight loss – staff more involved and encouraging when they CARE / BOND… this also is monitored more closely. Cognitive - Staff become more “in tune” to handle any behavioral issues. Approach, cares, etc…. More apt to follow the POC more closely when working with the resident on a daily basis. Infections - changes in urine / resp. status noted more quickly.

Convincing Leadership Continence Patterns - Consistent staff recognize the toileting needs better than inconsistent staff. Pain - able to say to the charge nurse, that the resident “isn’t himself” today. They KNOW their residents, and can detect even the subtlest of changes.

Convincing Leadership Skin Care - Pressure sores or changes in skin, are recognized more quickly. Physical Functioning - able to recognize a decline in ROM quicker or are able to recognize residents whose need for help with daily activities has increased. Therapy interventions occur quicker and thus, rehab reimbursements escalate.

Promoting Consistent Assignments Must Prepare and Support the Staff. Discuss with the Residents at Resident Council Meeting. Review any Risks or Benefits. Discuss the subject of burnout and stress in caring for the same resident on a daily basis.

Resident Council Discussion: “I don’t have to explain everything everyday.” “My nurse knew what was going on with me…” “ I feel safe” “ I don’t know if I’m coming or going half the time… I would love it if I had one person who I could speak to and who knows me. “It’s too stressful when I have to have someone new all the time…”

Resident Council (cont.) “I see some giving hugs to the residents, and they give them a lot of attention.” (said by a resident who is not on a consistent assignment wing) “My aide is very concerned about me …”

CNA Meeting Discussion A. “ The residents know my face.” B. “They look for you every morning.” C. “ It’s a feeling of being secure vs. insecure… I like knowing what to do when I come in” D. “ I know them…. We develop a routine…”

CNA Meeting Burnout and Stress Discussion Actually, there is less burnout and stress because of what you know to expect every day. There is a comfort zone on the unit and in the cares provided. Stress & Burnout come from the fear of anticipating the unknown as well…. There is no fear here….

CNA Meeting (cont.) Staff Hesitation Occurs….but staff now wouldn’t change the unit that they are on for the world! The burnout of caring for the same individuals was a fear, but that was all it was…. A fear…. Didn’t happen…. Even on the Dementia unit. Although training needed to occur and you need to hire staff or train staff to be dementia certified.

Other concerns Unions - Like to have input on everything. Spend some time talking with them about the plan, and the outcomes. Acuity - Spend some time reviewing Section G of the MDS. Figure out the acuity and place those residents on the assignments so that there is a fairness. Have CNA’s provide that input as well.

In Conclusion A WIN-WIN Situation: For the Residents For the Families For the staff For the Facility

“ Bestest Friends”

“You’re my favorite nurse”