Long-Term Care Survey Alert

Published on Fri May 28, 2010 PDF

This automatic assumption can put a talented caregiver on an unhappy path.

Managerial tactics can make or break a facility's work culture in terms of its ability to attract and keep talented staff. So be on the lookout for these types of scenarios before they take a toll on staff satisfaction and performance, which can ultimately impact resident care.

1. A finger wagging atmosphere. Consultant Barbara Frank recently heard an administrator share how he used to use a "shake the finger" approach but now "checks in with people" rather than checking up on them. By being supportive instead of punitive, he found that staff morale and performance picked up immensely. "And he said he enjoys his job a lot more," says Frank in Warren, R.I.

Ultimate goal: Create a "we're in this together for the residents" culture. Frank saw this concept in action when visiting two nursing homes within ashort distance of each other that were owned by the same company. The facilities had comparable resources. But one facility smelled bad and had signs posted everywhere with various dates on them "scolding people for not clocking in and out when they went outside for a smoke," Frank reports.

By contrast, when walking into the second facility, you "heard residents laughing and conversation between staff and residents. The clinical outcomes were good. Managers were out on the floor helping with meal trays. The difference wasn't in the staff -- it was in the management. And it showed up in the care outcomes."

Bottom line: "A manager with plenty of resources but poor people skills will have poor outcomes compared to a manager with fewer resources who has good people skills and really cares about and supports staff."

Examples: Managers can do simple things to ease stress on staff. For example, suppose a director of nursing (DON) wants to talk to a staff nurse at the end of the shift about planning for an employee recognition dinner, says Francis Battisti, PhD, LCSW, principal of Battisti Seminars in Binghamton, N.Y. The DON can tell the nurse that's why she wants to see her that afternoon rather than having the person stress all day about what it might be about, he says. Even the way in which a manager places her desk can set the tone for interactions with staff. "If you put the desk against the wall, you can swing around to be on the same level as the person sitting opposite" you, Battisti counsels.

Tip: Counter a top-down management approach by asking staff to provide input about how their managers perform in various ways, such as providing needed resources and helpful coaching. Also include peer reviews as part of staff evaluations. Encourage people to provide and use the feedback to become more self aware of how they are impacting others, for better and worse.

2. An environment where change becomes an energy drain. Too much change can be disorienting and lead to burn out. Yet some facilities respond to a problem by creating yet one more form and check-in  system to monitor care without figuring out why the problem occurred in the first place, Frank observes. And in a high-stress environment, the problem may well have been due to "working short," she says. And "having one more form [to complete] just adds to the stress without correcting the problem. Leaders will get better outcomes by helping out, having an all-hands-on-deck approach to relieve staff stress and get the job done."

When you do decide to implement a change,"get everyone to think it through together," Frank advises."Pilot test it on a small scale so you can tweak it and fix what isn't going right. Then bring it out building-wide."

3. A workplace with nowhere to go but up or out. Many people will say the management team is "the A team," observes Kenneth Daily, LNHA, with Elder Care Systems Group in Fairborn, Ohio. But "in most cases you need many more people" who are good at patient care in order for the facility to succeed, he points out. And facilities that only provide recognition and higher salaries for people who take the managerial route may be missing the quality-of-care boat.

Best approach: Help each staff person identify and apply their strengths. Create career options where a CNA can specialize as a restorative or behavioral health aid, as examples, or a licensed nurse who enjoys wound care can specialize in wound assessment and treatment.

Resource: For examples of how one facility developed career paths and opportunities for their staff, check out "Follow These Facilities' Leads to Boost Staff Retention" in Long-Term Care Survey Alert, Vol.11, No. 6, available in the Online Subscription System. If you haven't signed up for this free benefit, which gives you access to a wealth of information searchable by key word, call 1-800-508-2582.