Long-Term Care Survey Alert

Selecting the right nursing staff is the most important step a facility can take toward protecting residents and its survey record.

Below, experts share the secrets to hiring honest, caring employees and weeding out those applicants who may be at high risk for abusing or neglecting residents.

For starters, its important to assume that any prospective caregiver is capable of abusing or neglecting residents.

"Its just as important to hire the right LPNs and RNs as nursing assistants," emphasizes Judy Smith, a geriatric nurse practitioner and president of Clinical/Operational Innovations Corp. in Indian Hills, CO. "Being a professional doesnt exempt you from that risk for abuse and neglect of nursing home residents."

Also, dont rely too much on a persons past work history unless a previous employer says it wouldnt rehire, which is a definite red flag that requires further investigation.

"Previous employers are hesitant to give you an honest evaluation because of company policies or human resource concerns," says Clare Hendrick, vice president of operations for HealthEssentials in Louisville, KY. "So unless you really know someone through a nursing circle who will give you the honest truth about a CNA or other potential hire, you cant rely on this method."

That being said, in Hendricks view, one of the most effective ways to find the right person is through word-of-mouth recommendations from people you know and trust. It helps if these people feel their own reputation is put on the line by whom they refer to work in your facility.

Once a potential hire walks in your door, one of the best ways to get a personal impression of the person is to accompany them through the facility and see how they respond to residents and interact with people, Hendrick suggests.

"Take them into the area where residents are eating or into an activity and watch for signs of a caring nature or lack thereof," she suggests. Does the person appear quite uncomfortable, upset or bored? If so, those may be some of the most glaring warning signs youll see that the person wont be right for the job.

"We can teach nursing assistants how to perform their job and the rules and regulations, but you cant really teach that inner sense of caring for others," Hendrick cautions.

Hendrick has also been known to suggest applicants bring their family or children to the interview. "You cant ask questions about their family dynamics," she says, "but you can observe how the person interacts with their children."

If you want to know what the applicant really thinks and does when management isnt in the picture, ask the applicant to take a tour of the facility with another nursing assistant known for her standards of care and ethics. "You can ask the nursing assistant to report back to you her impressions of the applicant, including anything the person said that may have rung some alarm bells," says Hendrick.

In her experience, prospective CNAs tend to let their guard down with someone whom they view as a peer. "Youd be amazed at what they may ask, such as, OK, how are things really done here? Or they may share some dangerous shortcuts they have taken in other places theyve worked, or share some negative attitudes about elderly people," says Hendrick.

Its also a good idea to ask the applicant to describe how theyd handle various scenarios with residents, families and coworkers. "There are companies that have developed software and video testing that claim they can identify qualities such as caring, dependability and honesty in prospective caregivers," says Hendrick.

As an alternative to the use of such instruments, the director of nursing can prepare some scenarios ahead of time. Hendrick suggests including one situation that tests basic common sense in an emergency, such as a fire or a patient who suffers a fall or other accident.

Hendrick advises that "another scenario should involve something related to families, such as What should the person do if the residents family accused her of not caring for the resident well?"

A third scenario would involve dealing with a resident who is abusive or difficult to care for in one or more ways, such as a resident who slaps the caregiver or yells a racial epithet.

A fourth scenario should test whether the nursing assistant is likely to adhere to a "code of silence" where she wont report medical errors, neglect or abuse. "Ask how the person has handled situations in previous jobs where they saw a coworker doing something inappropriate or dangerous," Hendrick suggests.

If the person denies encountering such situations, thats a red flag in and of itself. "You have to believe they have encountered such situations if they have worked in nursing facilities or other areas of employment."

Finally, dont dismiss an uneasy feeling just because the person looks great on paper or the facility desperately needs staff. "If I am uncomfortable with someones attitudes thats a trigger for me not to hire the person," says Myra Peskowitz, a nursing consultant and principal, The Peskowitz Group in Syosset, NY.

Doris Van Mullen, director of nursing at St. Thomas Hospitals subacute unit in Nashville, TN, says she wouldnt hire someone who shows signs of an angry demeanor or a "chip on their shoulder," which may glimmer through if the interviewer asks the right questions or if the applicant feels stressed. "If I see that at all during the interview, I would know theres probably a deep-seated problem."

The director of nursing should also honestly explain the facilitys staffing pattern and what the job entails to prospective hires, suggests Hendrick. "You want to include the positive aspects, the potential challenges and what the administration is doing to address and resolve certain issues." The same is true when interviewing the professional nurse or LPN.

Hendrick also believes in stressing the 90-day probation period as a mutual one for both the facility and new hire to see if the job is going to work for both parties.

"Thats what that 90-day probation period is for to correct hiring mistakes," adds Hendrick. "Hiring the right person is not a science. We have all hired people we swore would be wonderful who did not work out for one reason or another."