Nursing Home Hospice Impact on Certified Nursing Assistant (CNA) Staff (Research, Video 1:56)

Hospice care in nursing homes continues to increase as more people become aware that hospice services are available wherever they live. Back in the 90’s when I first started hospice volunteering, many people told me they thought hospice care was only at private homes or in free-standing hospice facilities. On the negative side, there were those who thought nursing homes would get kickbacks from hospice referrals. Speculation about nursing homes receiving additional staff hours at no cost, which could lead to decreases in nursing home staffing, was mentioned.

What has happened in terms of nursing assistant staffing with the introduction of hospice care in nursing homes? Researchers at Warren Alpert Medical School at Brown University studied this process for several years with these staffing results:

“The introduction of hospice services in a nursing home did not result in statistically significant changes in nursing assistant (CNA) staffing. Instead, increases in hospice volume resulted in small increases in CNA staffing.”

As a hospice volunteer working directly with patients, I had many opportunities to observe and communicate with CNA staff members who were often first responders in meeting resident needs. Many exhibited dedication and genuine care for residents in spite of their own expressed hardships on the job such as low pay, high staff turnover resulting in increased workloads, and lack of appreciation. The following video titled I am a Nursing Assistant shares their caregiving challenges and rewards:

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Patient Violence Against Healthcare Staff (Research, Video 2:46)

The first time I saw a female nursing home resident with dementia attack a female nursing assistant (CNA), I really wasn’t surprised. Violence has become so embedded in our society that it’s expected, even in healthcare facilities. I was a hospice volunteer in an urban nursing home. The incident happened so quickly, I almost missed the facial punch that struck the CNA so hard I thought she would fall to the floor. What followed the punch is what impressed me most. There was a brief pause while the CNA steadied herself and walked away. Another CNA immediately interceded and calmed the resident who may have forgotten what she did later.

Long-tern care staff members are at high risk for experiencing aggression from residents. They need ongoing safety information to prepare themselves. Reported in the Journal of Clinical Nursing, results of a focus group study involving the interviewing of 30 nursing home staff caregivers revealed these three caregiver themes regarding patient aggression:

1)   Caregiver explanations regarding the occurrence of aggressive behavior and contributions of residents and caregivers

2)   Measures for handling the aggression of residents

3)   Caregiver self protection and coping with aggression

While staff caregivers use many interventions to reduce aggression, too often they ignore their own practical knowledge about connections between aggressive behavior, pain, and other physiological issues that may cause aggression. More education and emphasis on a systematic approach, including factors leading to aggression, is needed to help staff caregivers better manage resident aggression and their own coping strategies.

This video reminds us that violence against healthcare workers impacts everyone:

Frances Shani Parker, Author

Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback at many booksellers and in e-book form at Amazon and Barnes and Noble booksellers.

Hospice and Nursing Homes Blog

Nurses and Nurse Assistants (CNA’s): Stress in Nursing Homes

Who knows stress better than the people who carry it around everyday? These research results came directly from nurses and nurse assistants (CNA’s) in twenty-five nursing homes in North Carolina. This is what they had to say:

Nurses:

The situations most stressful for nurses were not having enough staff, having too much work to do, interruptions, having non-health professionals determine how they do their jobs, poor pay, and being responsible for patients' outcomes. Nurses were more likely than nurse assistants to report stress because non-health professionals (e.g. surveyors) determine how they must perform their services.

Nurse Assistants (CNA’s):

The most stressful situations for nurse assistants included poor pay, not enough staff, and too much work to do. Nurse assistants were more likely than nurses to report stress because they do not have adequate information regarding patients' conditions.

Conclusions:

The findings of this study support the need to increase recognition for nursing, improve staffing, and provide competitive compensation in nursing homes. Were you surprised by these results? I wasn’t either. But it’s still another validation of the staff stress problems and the need for positive changes in nursing home reform.

You can read more about this research in the "Journal of the American Medical Directors Association.”

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Hospice CNA/Nursing Assistant Story: “Little White Box” Video (5:13mins.)

Sometimes a nursing home patient needs someone to solve a special problem. The urgency becomes especially important when the patient is in hospice care, and death is imminent. “Little White Box” is a video story from “The Life and Times of Roger Dean Kiser.” A hospice volunteer, I was reminded of a hospice story in my own life when I read this story. In my story, I helped to locate a missing key for a beautiful music box owned by a patient who had never heard the box play before.

In “Little White Box,” Mrs. Mathers, a dying patient, keeps saying, “Before I die, my little white box, please.” But no one knows exactly what she means. To her rescue comes a caring and determined CNA/nursing assistant who successfully solves the mystery. With Celine Dion’s breathtaking singing in the background, this story will grab the handle of your heart and make you smile. Click here and enjoy "Little White Box."

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Nursing Homes: Managers, CNA’s (Certified Nursing Assistants), Residents

Sometimes I read research that has fairly predictable results. But the fact that the results were discovered through research validates them more. Consider these words: nursing homes, managers, CNA’s, residents, satisfaction. There is a general thread that connects them in a nursing home setting.

It’s common knowledge that managers generally set the tone at the workplace. Having been a school principal, I know that to be true. This research focused on the role managers play in creating a person-centered workplace. In order to develop this kind of workplace, managers must interact with staff in ways that will encourage their satisfaction, loyalty, and commitment. When this is done successfully, residents benefit.

In this 2007 research study explained in the “Journal of the American Medical Directors Association,” CNA’s and residents’ families from 156 nursing facilities completed surveys to measure their satisfaction, loyalty, and commitment. I already knew CNA’s would have plenty to say on this, because these are popular topics when I talk to them at nursing homes I visit as a hospice volunteer. The survey responses were analyzed.

What was the conclusion of the research? You’re probably way ahead of me. The conclusion was that the work setting that managers establish greatly impacts the lives of the CNA’s. Caring managers who produce a person-centered workplace can inspire workers to become excellent caregivers who enhance the lives of patients. This principle is so simple and so important. It’s a shame it’s not practiced in all workplaces.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Celebrating Nurse Aides, CNA’s and Nursing Assistants

They go by several names. During my hospice volunteer rounds in Detroit, I tend to say “nurse aide,” maybe because it’s older and easier to pronounce. But no matter what they are called, they are called often, sometimes too often when there’s a staff shortage. They are generally first responders meeting patients’ needs. Patients frequently think of them first when they evaluate their nursing home experience.

These are two comments I have heard nurse aides express to me about their jobs:

1) “I love working here. It’s not perfect, but we try to work as a team. I treat my patients like they are my family. For some of them, I’m the only one they can really talk to about their true feelings. I know what I do matters.”

2) "This place is depressing. I usually have more patients than I’m supposed to, and nothing I do is enough. It’s low pay with high pressure, but I need the job. It’s not right the way nurse aides and patients are treated here. When I try to make suggestions, nobody listens. I’m really frustrated."

Like people, all nursing homes are not good, and all are not bad. But dedicated nurse aides, no matter where they are, do hard work for low pay and often with little appreciation. A work climate suffers greatly when large numbers of staff stay discontented. Nobody benefits from a negative environment.

Some serious problems that plague nursing homes will require major systemic reform at local, state and federal levels. But administrators of individual nursing homes with negative climates can initiate certain changes themselves by committing to basic reform in staff, patient and caregiver relationships. Welcoming constructive input from all stakeholders validates everyone. Oral or written words of appreciation, when deserved, can go a long way in healing trampled self-esteem. Ongoing opportunities to improve job skills encourage professionalism. An added benefit will be decreased staff turnover. When the word gets around, more nurse aides will choose a nursing home where they feel respected.

As former principal of an urban public school with a high poverty level for many years, I know that setting a positive tone, even under stressful conditions, is a good beginning in changing the culture of any institution. I celebrate everyone who is doing a fine job working in nursing homes, but this post especially celebrates nurse aides, CNA’s and nursing assistants. Cheers to you!

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog