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Long-Term Care Survey Alert

MANAGEMENT:

Ditch the Turf Battles: Put Your Staff on Common Ground in Resident Care

Published on Tue Mar 17, 2009 Print Friendly and PDF PDF

6 ways to promote positive staff relationships.

In the quest to achieve optimal outcomes, facilities sometimes overlook their most precious resource -- each other. Positive relationships among staff can pave the way for improved care and a CMS 2567 to write home about.

Key point: The "technical clinical stuff" isn't so much what gets nursing facilities in trouble, "it's the interactions among staff and with customers. That's what burns out staff and can lead to complaints,"says Cheryl Boldt, RN, NHA, who presented "Tips on Playing in the RAI Sandbox," at the fall 2008 American Association of Nurse Assessment Coordinators conference in Las Vegas.

First task: To build team spirit,everyone has to get over the notion that frontline staff members are "just a" nursing assistant, dietary aide,etc., Boldt urges. Instead, create a system that values everyone's contribution and eliminates the temptation for someone to say, "It's not my job," she adds.

The bottom line: When staff feel important because of their jobs and role in caring for people, they provide better care, says Sheryl Rosenfield, RN, BC, a consultant with Zimmet Healthcare Services Group in Morganville, N.J.

5 More Pearls of Wisdom

Boldt and other experts provide several more strategies for getting and keeping staff relationships on track, as follows:

1. Offer more inservices and information on relationship issues. The information should include the expected code of conduct, and conflict resolution, Boldt suggests. "When you don't have open lines of communication, people develop perceptions about their co-workers that can lead to escalating [conflicts]," she cautions.

Delve into victimology: Teach people to recognize when they are "playing victim" with comments such as "I always help her but she never helps me," Boldt notes.Rather than complaining to others, the staff person could "step up to the plate" and talk to the co-worker in an attempt to make the relationship more reciprocal, Boldt says.

2. Develop systems that promote a team approach. Examples include team-based rounds for falls,or a dining approach where everyone helps out, advises Boldt.

To make quality improvement work, expand your subcommittees, including CNAs and dietary aides, to tackle selected problems, such as falls, suggests Sheila G. Capitosti,RN-BC, NHA, MHSA, senior healthcare specialist with PointRight Inc. in Lexington, Mass. Then let QA subcommittees chronicle their successes on storyboards posted in various areas of the facility, suggests Capitosti. "It can be very creative," she says, and also creates great camaraderie in working toward a common goal.

3. Empower staff to fix certain issues on their own. This not onlysaves managers time -- it improves customer service, Boldt points out. "Customers aren't in the position of wanting to wait until Monday for a manager to get back with them about a concern," such as lost laundry, which frontline staff can address.

4. Don't breed or feed negativity. "When managers spend a lot of time and attention on negative people, they convey a message that you have to be negative to get attention,"cautions Boldt. That doesn't mean, however, that managers should tune out staff tension or conflict. "You can't walk by and ignore it. Patients and families are witnessing what's going on." In a negative work environment, you can typically find a couple of people "stirring the pot," observes Boldt.

The antidote? When those individuals complain, managers should ask them to come up with a couple of solutions to improve things, she suggests. Negativity can occur when a system doesn't tap people for their input and opinions, Boldt notes.

But more often, you can trace a negative environment to "lack of personal accountability" where the administration hasn't set the bar high enough for staff performance, Bolt points out.

Solution: "The administrator and DON should set up the expectations for stellar performance" and provide the systems and framework for achieving it, says Boldt.

5. Offer fun ways for people to get to know and be with each other. "We don't need people to be best friends," says Boldt. "But we do need respect ... and some humor and connection with others to keep the environment positive."

Example: One group exercise involves asking staff to "translate the essence" of who they are into three things: a moving vehicle, a fragrance, and a zoo animal, noted Anne Basting and Beth Meyer in a presentation on storytelling at the fall 2008 American Association of Homes & Services for the Aging annual meeting.

It's a good exercise, said Meyer,especially if staff is thinking of culture change or starting by focusing on relationships.

Example: If a couple of people in the group, for example, characterize themselves as Volkswagens, and explain why, they suddenly have all these things in common with each other. People can also use the nonthreatening exercise to tell a story about themselves indirectly, and recognize that someone else may be their polar opposite, the speakers noted. And that's a good thing to find out in order to avoid conflict and take the opportunity to learn from each other.

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