This is just sad.

WEST PALM BEACH — How was 92-year-old Madeline Neumann’s death?

Painful, prolonged for days by a doctor against her wishes, with a semi-rigid breathing tube forced down her throat, injections, restraints, all contrary to legal documents in place to stop such efforts?

Or a death made more humane, more peaceful by the doctor and nursing home staff who had cared well for her for years?

Those are the two distinct takes on Madeline Neumann’s death set out Monday in a Palm Beach County courtroom.

Neumann’s granddaughter, Linda Schieble, is suing the Joseph L. Morse Geriatric Center and the board-certified doctor who cared for her, Jaimy Bensimon.

Schieble’s attorneys told jurors in opening statements that Neumann had watched the long deaths of her two daughters and husband and knew exactly how she wanted to go: naturally, with no resuscitation attempts or forced feeding. She was in an advanced stage of Alzheimer’s, but her legal documents - a living will and advanced directive drawn up years earlier - made her wishes clear.

But on Oct. 17, 1995, when she was found unresponsive in her room, Bensimon ordered by phone that 911 be called and Neumann taken to the hospital for evaluation. A paramedic placed the breathing tube in her. At one point, Neumann’s arms had to be tied down to keep her from tearing the tube out, according to the attorneys.

Neumann died at the hospital six days later, surrounded by her family.

[…]
An attorney for the Morse center countered that Neumann’s being intubated and taken to the hospital did not constitute a resuscitation effort but was appropriate treatment.

Neumann had just eaten a full meal. She was unconscious but breathing and there was a danger she could choke on her food, attorney Rachel Studley told jurors.

Neumann’s granddaughters had done the same thing as the nursing home when they cared for Neumann. When she had a seizure, they called 911.

“They did not just say, ‘Oh, she’s having a seizure, she’s lifeless, let’s leave here there.’ No, they would pick up the phone and do what the nursing home did on Oct. 17, 1995,” Studley said.

Next came the attorney for Bensimon, Jim Nosich. He emphasized that the doctor, who is board-certified in three specialties, including geriatrics, had cared well for Neumann in the three years she was at the Morse center. Bensimon had treated her for heart problems, pneumonia and the seizures, conditions that were potentially fatal.

“You never heard the family say, ‘Don’t treat my grandmother … she wants to die from pneumonia … she wants to be left alone,” Nosich said.

I’ll try to keep up with this story as it’s in court now. How sad for everyone involved, and we cannot assume guilt on any party.
It will be a hard case for any jury.

Martha Bell’s health appears to be failing. She was recently found guilty by a jury in the mis management and death of a resident, and the cover up that followed. She was sentenced to 4 years in prison. She hasn’t made it there yet.

Former nursing home administrator Martha Bell has managed to stave off her five-year federal prison sentence for at least five days.

Mrs. Bell, 60, of West Mifflin, was convicted of health care fraud and making false statements, and missed her date to report to a federal prison Monday, after being admitted late last week to Mercy Hospital with chest pains and numbness on one side of her body.

After she was discharged Tuesday, U.S. marshals immediately arrested Mrs. Bell and took her to the Allegheny County Jail.

However, the next day, she again complained of chest pains. That time, Mrs. Bell was taken to an undisclosed hospital, where she remains under secure guard with no access to visitors.

More news about federal funds being channeled into more appropriate needs.

South Carolina is one of 17 states getting part of a $1.75 billion federal grant designed to assist nursing-home residents in moving back to their own houses or to other more suitable places within their communities.

Nationally, the awards could help about 23,000 nursing-home patients move over five years.

The Palmetto State, where more than 80,000 mostly elderly residents live in nursing homes, got the smallest grant of states receiving money. Twenty-one states that applied got no money.

The state will get $5.8 million between now and 2011. The money is designed to move 192 individuals out of institutions to settings such as group homes or back with family.

The Department of Health and Human Services, which applied for the grant, said it asked for funds to cover the number of patients it felt it realistically could move.

A review committee is being formed to set up rules on state resident participation in the program.

The state limited its application to cover only elderly and disabled adults under the grant, a department spokesman said.

Texas got the most money, with nearly $143 million set to be given over five years.

States receiving the grants are required to eliminate barriers to long-term care in the settings Medicaid patients choose and assure that care can be sustained and quality maintained.

The grants were awarded under a “money follows the person” Medicaid program, in which patients are given greater control over how money is spent for their treatment.

Medicaid officials say it saves money and that patients are more satisfied when they have greater roles in determining their care.

Although this is a small amount of money, really, it’s a start. MANY nursing home residents could be moved back into their homes, or into smaller group homes and the like. The savings would be astronomical and the residents, those human beings who deserve so much better, would be MUCH HAPPIER and more than likely better cared for.

Consumers Reports once again has an article about nursing homes and the care provided. In this article they discuss OBRA 20 Years…

Two decades after the passage of a federal law to clean up the nation’s nursing homes, bad care persists and good homes are still hard to find.

In 1987, Congress passed a landmark law meant to improve nursing home care for the elderly. But our investigation reveals that poor care is still all too common, especially at nursing homes run by for-profit chains, now the dominant force in the industry.

Consumer Reports’ analysis found that not-for-profit homes generally provide better care than for-profit homes, and that independently run nursing homes appear to provide better care than those that are owned by chains. In a separate study, we found that many states are lax in penalizing bad homes.

For this report, we analyzed the three most recent state inspection reports for some 16,000 nursing homes across the U.S. We also examined staffing levels and so-called quality indicators, such as how many residents develop pressure sores when they have no risk factors for them.

It’s no secret among CNA’s that for profit chain owned nursing homes are the worst when it comes to quality. We work in these places and we see, firsthand, the reasons for poor care.

The Consumer Reports Nursing Home Quality Monitor, formerly the Nursing Home Watch List, lists facilities in each state that rank in the best or worst 10 percent on at least two of our three dimensions of quality. By examining the kinds of homes that tend to cluster at either end of the continuum, we can make some judgments about how likely a facility is to provide proper care.

This is a good tool. Click on your state to see recommended nursing homes and places to STAY AWAY from. I’m going to add this NHQM to the sidebar here.

Our investigation found that the state agencies responsible for overseeing nursing home care have often failed to correct problems. But consumers can increase their odds of choosing a good nursing home if they narrow their search to certain types. Our findings:

• Not-for-profit homes are more likely to provide good care than for-profits, based on our analysis of inspection surveys, staffing, and quality indicators.

• The same analysis shows that independently run homes are more likely to provide good care than chains.

• Through its influence in politics, the industry has whittled down the protections of the 1987 federal law.

So is OBRA effective anymore?

Some other highlights:

Nursing home researchers say that the most serious problems sometimes show up in small, for-profit chains within a state. In New York, for example, Healthcare Associates, wholly owned by Anthony Salerno, jointly administers a network of 12 separately incorporated facilities. Salerno is the largest shareholder in all the facilities. Three of the homes have been on our quality-monitor list.

Earlier this year Eliot Spitzer, New York’s attorney general, sued one of the three homes, the Jennifer Matthew Nursing and Rehabilitation Center in Rochester, alleging abuse and neglect. Investigators used a hidden camera to show that call bells were placed out of residents’ reach and that patients would go unturned and unwashed for hours. That facility was a four-time repeater on our lists.

And:

One reason the independently owned, not-for-profit facilities might do a better job is that they tend to have more staff, which experts agree is crucial to good care. We found that on average, not-for-profits provided almost an hour of additional nursing care each day per resident, compared with for-profit facilities. They also provided nearly twice as much care from registered nurses.
In 2002, a study conducted for the federal Centers for Medicare & Medicaid Services (CMS) noted that without a daily average of 2.8 hours of care from nurse aides and 1.3 hours from licensed nurses, residents were more likely to experience poor outcomes–pressure sores and urinary incontinence, for example. “Most nursing homes are staffed significantly below that,” says John Schnelle, director of the Borun Center, a joint venture of UCLA and the Jewish Home for Aging that does research on long-term care.

Staffing levels are KEY to good care. No other way around it. HOWEVER the staff must be well trained, have good work ethic and need to be well supervised (not micromanaged).

Nursing homes are not major donors to national political campaigns, but they wield considerable clout in state capitals, where their $500, $1,000, and $3,000 contributions count with gubernatorial, state legislative, and judicial candidates.

In Arkansas, for example, the industry was a top contributor to state candidates in 2004, according to Followthemoney.org, a nonpartisan database of campaign contributions. The Arkansas Health Care Association, which represents for-profit nursing homes, gave almost $100,000 that year to candidates in the state.

Appalling:

Messages from legislators, subtle and not so subtle, filter down to regulators, who have learned that nursing homes will challenge them if they press too hard. Grachia Freeman, a former nursing home inspector in Arkansas, says that supervisors “would not let me write deficiencies I wanted to write” for a facility she was inspecting. Now a nurse at a VA hospital in North Little Rock, she adds, “They were angry with me for investigating and told me not to complete the survey.” We made several efforts to interview regulators in the long-term-care unit of the Arkansas Department of Health and Human Services but were repeatedly rebuffed.

Has anyone seen evidence of this:

Although the number of deficiency citations written by state inspectors has increased 7.6 percent since 2003, according to the CMS, inspectors appear to be watering them down. Each one carries a letter code, from A through L, indicating the scope and severity of the violation. Citations labeled G through L denote actual harm or the potential for death. Codes I through L indicate that the harm was widespread, affecting many people.

State inspectors are now writing fewer deficiencies with codes that denote actual harm, such as avoidable pressure sores and medication errors. “We are going back to a less stringent and simpler enforcement,” says a federal analyst familiar with nursing home inspection data at the CMS. “Everything is becoming a D level. Nursing facilities are going to challenge anything above a D level if it carries a mandatory penalty, can be used in a tort case, or will be publicly disclosed.”

Finally-

The CMS can disqualify a home from the Medicare and Medicaid programs, cutting off federal funds. But that remedy, the most drastic in the agency’s arsenal, is used less frequently than in the past. In 1998, the number of terminations peaked at 51; in 2005 there were only 8.

It’s difficult to say whether nursing homes have improved or not. We see less fines and all, but according to this report there are many factors behind this. It’s a very long article and worth the time to read, no matter how one looks at it.

One reason why so many CNA’s hate their jobs is working with others who have attitudes that drag us down.

Kevincity is such a CNA:

Wow, ladies and gents, witness an example of the spin that the sucker-ups to the status quo can put on the true facts. Just when one thinks that this extravagant liar is finally gonna stick up for her own, she hops on her high horse to defend tyranny and run roughshod over us.

This is what he left as a comment to my post about Keeping Unions Out.

Sweet.

You know, no matter how hard one tries, people like Kevin will always be ready and more than willing to knock down ANY effort to make things better. People like Kevin are determined to undermine those who actually like this work, and who chose to stay in the field for a long time. Kevin assumes that people who are long term employees in this field survive this work by kissing up to the bosses. He’s wrong. And he’s a negative influence to everyone around him.

I am very hurt by his comment, and have put him on notice: He needs to start being a part of the solution instead of being a part of the problem. Of course I realize he doesn’t see himself as a problem; he sees aides like me as THE problem. I’ve been doing this work for a lot longer than he has, I have much more experience and I’m 100% sure I have seen much worse than he has. I don’t think Kevin has done anything except stir the pot. And for that I have banned him from my site. I have enough to deal with at work- the good and the bad. I don’t need his negativity here.

I’ve worked in the worst nursing homes in my area. I’ve been assigned to 35 residents by myself. I’ve been forced to stay over and work extra shifts, many times. I’ve seen neglect and abuse, and felt the impact of reporting these things. I’ve been under the fire of management who tries to cover up the neglect. I have been accused of not being a “company aide”. I’ve seen ass kissers get away with the worst care. And I’ve been hurt on the job and lost out on pay and benefits because management decided I needed to come back to work before my doctor said it was safe.

I worked for an assisted living home where a demented resident eloped in the middle of the winter, who fell down and froze to death. And wasn’t found until the next day. I have met with my state ombudsman when reporting incidences of abuse and cover ups. And I’ve lost some jobs because of this. I witnessed nurses hitting residents and withholding medications. I’ve seen a DON remove drugs from the med cart and swallow them. And I’ve been threatened to not tell anyone…as I got on the phone and called the police and the Board of Nursing.

I’ve seen more than my fair share of Nazi nurses torment good aides. Yell at them. Make unreasonable demands of them. Give them the worst assignments. And I’ve spoken up to them in their faces and demanded they be fair.

I’ve done CPR on residents who are found not breathing. I’ve removed them from their wheelchairs as they have passed out during a choking event; I’ve picked up bloodied and beaten old ladies who were the object of a combative male resident. I’e walked into dining rooms to see dozens of residents slumped over at the tables, waiting to be fed. And I’ve asked the nurses and administrator and others to help me out because I’m the only aide working.

I’ve testified before Congress on issues. I met Senators Grassley and Kennedy in Washington, to discuss wage pass thru laws and mandated ratios. I’ve attended the National Citizens Coalition For Nursing Home Reform’s yearly conferences and met many wonderful people. I’ve communicated extensively with leaders of the National Clearing House of Direct Care workers; I’ve also helped out with The Paraprofessional Healthcare Institute.
I’ve written articles for the now defunct Nursing Assistant Journal. I’ve been asked to help with books authored by Barbara Acello- the author who writes CNA educational books. I’ve met Jeni Gibson and attended her trainings on how to be an effective change agent. I’m a member of the big CNA groups. I do a lot for my fellow CNA’s. THIS site alone has been around in various forms since 1997. I’ve come to realize through my experiences that alone, CNA’s cannot change their work. But working with others, including those who have a vested interest in our work, will be far more effective. This means management. And families.

If this makes me a BAD aide, than so be it. One doesn’t have to have a dark cloud hanging over them to be a GOOD aide.

In reading the posts about unions and management AND CNA’s, I got to thinking about WHO causes them (the CNA’s) the most aggravation. It’s not the Administrator. It’s the charge nurses and the DON. One leads to the other. While I think the DON has more management experience (in most cases) the nurses do not. They claim to, but I have yet too see any proof if this. I’ve been a CNA (LNA) for almost 17 years. I’ve worked in nursing homes, hospitals, assisted living, home health care and hospice. I’ve also worked in an MD office.

In this light, it would be great to see nursing homes get the charge nurses some training with real management skills.

Charge nurses are supervisors, whether they like it or not (for union related benefit.)

What is “Supervision”?
There are several interpretations of the term “supervision”, but typically supervision is the activity carried out by supervisors to oversee the productivity and progress of employees who report directly to the supervisors. For example, first-level supervisors supervise entry-level employees. Depending on the size of the organization, middle-managers supervise first-level supervisors, chief executives supervise middle-managers, etc. Supervision is a management activity and supervisors have a management role in the organization.

What Do Supervisors Do?
Supervision of a group of employees often includes
1. Conducting basic management skills (decision making, problem solving, planning, delegation and meeting management)
2. Organizing their department and teams
3. Noticing the need for and designing new job roles in the group
4. Hiring new employees
5. Training new employees
6. Employee performance management (setting goals, observing and giving feedback, addressing performance issues, firing employees, etc.)
7. Conforming to personnel policies and other internal regulations

Out of the list above, charge nurses in nursing homes are not responsible for everything. They do organize their unit and the aides working on their shifts; they SHOULD notice the need for more staff; they usually do NOT hire but they DO oversee training;
they DO employee performance management with the exception of firing. Most charge nurses have a lot of say in evaluations.
And they make sure aides conform to (often outdated and silly) policy and internal regulations.

To be fair, charge nurses don’t have the time to adequately supervise. They pass meds, perform assessments of residents, respond to nursing needs and treatments, deal with doctors and families. WHEN they have time, they keep an eye on the aides. There is a say among CNA’s:
Behind every good charge nurse stands an excellent aide.
It’s true.

I think nurses should have extended training in these areas:

Setting Goals
When setting goals with employees, strive to design and describe them to be “SMARTER”. This acronym is described in this guide, in a subsection listed above, and stands for:
1. Specific
2. Measurable
3. Acceptable
4. Realistic
5. Timely
6. Extending capabilities
7. Rewarding

Supporting Employee Motivation
Clearing Up Common Myths About Employee Motivation The topic of motivating employees is extremely important to managers and supervisors. Despite the important of the topic, several myths persist — especially among new managers and supervisors. Before looking at what management can do to support the motivation of employees, it’s important first to clear up these common myths.

Observing and Giving Feedback
1. Clarity — Be clear about what you want to say.
2. Emphasize the positive — This isn’t being collusive in the person’s dilemma.
3. Be specific — Avoid general comments and clarify pronouns such as “it,” “that,” etc.
4. Focus on behavior rather than the person.
5. Refer to behavior that can be changed.
6. Be descriptive rather than evaluative.
7. Own the feedback — Use ‘I’ statements.
8. Generalizations — Notice “all,” “never,” “always,” etc., and ask to get more specificity — often these words are arbitrary limits on behavior.

Conducting Performance Appraisals/Reviews

Yearly performance reviews are critical. Organization’s are hard pressed to find good reasons why they can’t dedicate an hour-long meeting at least once a year to ensure the mutual needs of the employee and organization are being met. Performance reviews help supervisors feel more honest in their relationships with their subordinates and feel better about themselves in their supervisoral roles. Subordinates are assured clear understanding of what’s expected from them, their own personal strengths and areas for development and a solid sense of their relationship with their supervisor. Avoiding performance issues ultimately decreases morale, decreases credibility of management, decreases the organization’s overall effectiveness and wastes more of management’s time.

Addressing Performance Problems
1. Note that performance issues should always be based on behaviors that you see, not on characteristics of the employee’s personality

2. Convey performance issues to employees when you see first see the issues!
Don’t wait until the performance review! Worse yet, don’t ignore the behaviors in case they “go away.”…
AND MUCH MORE!!

Just some ideas. For those who want and desire a fair and healthy workplace. Charge nurses have a lot on their plate; it is fair to expect them to be the supervisors who do all the above AS well as pass those meds, deal with the MD’s, tackle families and all the other things they typically do on an average day? Maybe, aides feel a sense of hopelessness because they know they are not being supported and well supervised?

About workplace teams- groups brought together in an effort to make change, seek input, tackle problems and issues:

Why Be Part Of A Team?
You’ve been asked to participate on a team to accomplish some task. Immediately your decision-making process begins.

* What is the purpose of the team?
* Is it a topic that interests me?
* Who will be on the team with me?
* What kind of authority will we have?
* Is it important to management?
* What is the reward for participating?
* What is the risk (perceived as punishment) for not participating?
* How long will it run?
* Will I be better off as a result of my participation?

And:

Factors That Influence Team Motivation

I. Purpose
I have asked people for years to describe the characteristics of their most successful and rewarding team experiences. At the top of almost everyone’s list is a clear purpose, focus, or mission. But further, for long-term motivation, it must be a purpose or mission that they find aligns with their personal wants and needs.
[…]
II. Challenge
Another term that I hear frequently when I ask about team motivation is challenge. The human species, as with most animals, has been given a survival mechanism called fight or flight syndrome. When presented with a challenge, our defenses are alerted to move us to action….to run away from danger or address it directly.
[…]
III. Camaraderie
If one studies highly effective groups, one finds that the most successful groups over the long haul tend to address both the technical needs and human needs. These groups are at the same time competent in the work they perform and highly functional in their interpersonal relationships. The group is well balanced in both technical and human skills.
[…]
IV. Responsibility
In general, people and teams are stimulated by being given responsibility. Having ownership of an identifiable block of work is a long-held tenet of motivation in groups.
[…]
V. Growth
Finally, personal and team growth can provide another basis for sustained motivation. When people feel they are moving forward, learning new concepts, adding to their skill base, and stretching their minds, motivation tends to remain high. Personal growth adds value to the individual, enhancing self-esteem and self-worth.
[…]
VI. Leadership
A good leader can be a catalyst for motivation in the short term, but the best leaders create the conditions for the team to motivate itself.

Lots of other good stuff here.

The perils of Assisted Living.

Peer into the files of Pennsylvania’s assisted-living industry and confront a catalog of horrors.

Betty Trainer, 81 and suffering from dementia, died of heat exhaustion in 2005 after wandering off from her Bucks County care home during a fire drill. They found her body near her husband’s grave.

June Loth, 74, who raised her family in Levittown, succumbed to complications from when she was raped in 2004, authorities say, by a live-in handyman in a home outside Pittsburgh.

In December, John Lambert, 95, tumbled down an unsecured basement stairwell at a sparkling Main Line complex and broke his neck. At the same home a few years before, a resident killed another resident.

I suspect one could reasonably say this is true of every state.

Quick growth,

looser oversight

The personal-care industry mushroomed after state mental institutions began closing in the 1970s. Small homes sprung up as housing of last resort for many with mental illness.

Then, after scandals beset nursing homes in the 1980s, corporate-run assisted living came to be seen as a more humane alternative.

Assisted-living residents tend to be elderly, disabled, mentally ill, or some combination of the three - a population extremely vulnerable to abuse, neglect and exploitation.

These residents live in a gray area: They are infirm enough to need help with daily living, but legally they are not supposed to be sick enough to qualify for more elaborate and expensive nursing-home care.

Unlike nursing homes, which are subject to federal regulations, assisted living operates under less stringent state-by-state rules. For years, Pennsylvania had some of the country’s weakest regulations. A recent update put the state in the middle of the pack, experts say.

In 1999, a federal study of assisted living in four other states - California, Florida, Ohio and Oregon - found that state regulators had cited more than a quarter of the facilities for five or more serious deficiencies, including poor care, understaffing and medication errors.

Some thoughts and ideas about nursing homes and Unions and how to avoid them.

To avoid unionization, management must act like a union when employee grievances arise

The number of unionized workers in the private sector continues to diminish; it is estimated that no more than a small fraction of the nongovernmental workforce is currently unionized. To maintain a productive nonunion workforce, however, the management of nursing homes and assisted living facilities needs to assume the role that unions played at an earlier time in corporate America.

Nursing homes are typically managed in a very autocratic manner. Staff are given little to no leeway in the day to day tasks they are assigned to do. CNA’s are paid poorly and the work is very hard on them. Many aides seek union representation based upon these things: Better pay and benefits; less forced overtime, a voice in policy and procedure planning. These are the nut and bolt reasons aides want to join unions.

But another set of reasons is very clear as well. For whatever reason, the nursing home environment is very degrading to so many. Staff disagreements, disrespect, poor treatment from charge nurses and others; family who make demands that are often superficial and often leave other residents with less time for care. The workplace culture of the typical nursing home is a sad sight. Aides are left feeling they have no recourse for their concerns and issues. They feel helpless and devalued.

Unfortunately, not many nursing homes and assisted living facilities have managers trained to “supplant” unions, and that lack of training can be a significant detriment to a company’s overall well-being.

This is very true…the lack of sound and basic management experience we see in so many who lead is evident…the administrators try hard to be fair, to be honest, to do the right things…but MANY of them have no real MANAGEMENT experience. Sure, they are college educated with business degrees. Yes, they are licensed to do their job. But to actually manage staff— I don’t think so.

Some ideas to make a nursing home UNION FREE:

Alternative Dispute Resolution Programs

Human resources (HR) executives must be expert in administering alternative dispute resolution (ADR) programs, of which there are many types. ADR programs are generally welcomed by both management and employees, because they are cost-effective and swiftly arrive at fair resolutions. One obstacle that I frequently encounter, unfortunately, is management’s fear of giving up its traditional power. Yet by involving employees in the process, management will not be perceived as arbitrary or capricious. I always try to explain to administrators and managers that by being proactive rather than reactive, they create a general feeling among employees of inclusion, and that goes a long way toward increasing productivity and morale.

While there are many ADR programs that I recommend as part of an overall proactive program, the three most common types are:

* Arbitration. This is an adjudication process during which a third party hears both sides of a dispute, weighs the evidence, and renders a decision. Both sides may agree prior to the commencement of arbitration that the arbitrator’s decision will be binding, or they may agree that there could be an appeal to another body to reach a mutually acceptable decision.

* Mediation. In this case, the third party does not render a decision but facilitates open and ongoing communication designed to lead to a mutually acceptable settlement. In most cases, the mediator is an outside professional without the authority to render a decision.

* Peer review. This is a representative adjudication process that relies upon a selected panel of managers and employees. A majority of the panel is required to render a binding decision. Peer review should not threaten management’s perquisites, because in most cases employees will side with management.

These programs give all employees a voice in every aspect of their work. Usually the issues that would be addressed by these programs would be disciplinary actions, evaluations and pay raises (or lack of). Most times, the employee filing a concern is found to be correct with their issue. Management has to agree to accept the terms of the agreements made and so do the employees.

Focus Groups

When management successfully supplants the role of a union, it also undertakes one of unions’ traditional roles: listening closely to what employees think and feel about their jobs, their futures, and their company and its policies.

One of the best means of doing this is through focus groups, which provide management with significant opportunities to gather reliable and representative information about its workforce and their attitudes. Focus groups also permit management to communicate real issues through ongoing employee involvement.

Not just with employee attitudes, these groups can render extremely valuable information about procedures, risks, quality of nursing care, safety and budgetary issues. CNA’s, housekeepers and dietary workers have a lot of really good insight into the ways and hows and means of their jobs. They also have ideas for improvement and innovation. Listen to them!

Team Building

Focus groups lead to team building. While focus groups are exploratory, teams are the instruments that implement strategic plans designed to accomplish specific goals.

Historically, unions have created a sense of employees playing on the same team, a sense of employee solidarity. In today’s complex work environment, management can create that same spirit of solidarity to accomplish commonly shared productivity goals and to solve important problems.

Teams can serve such purposes as enhancing communication and resolving conflicts, but teams are most effective as a means of increasing productivity and enhancing employee morale. When it comes to meeting certain productivity criteria, for example, the entire team is mutually responsible for reaching those goals. One need only look at various sports teams to see how valuable mutual cooperation is to winning. In successful corporations, no one is an individual sprinter, although individual initiative is extremely important to the overall success of a team and the achievement of its goals.

I have two thoughts about team building. I think there are two different types of teams to be spoken for…the actual teams that work together each shift…in each unit and department. And then there are other teams- groups brought together to address problems and issues. BOTH groups need to learn to work together to accomplish anything.

1) Unit based teams can and should be given some autonomy as to how they work together. Group norms, expectations and problems can be dealt with by the members of the team, without management involvement. Scheduling, assignments and activities can be planned by the staff who regularly work these units. In order to achieve a well run team it’s leader MUST be well versed in leadership skills…and most charge nurses have no real management experience. So this is risky.

2) Teams pulled together to address broader company wide issues need to be educated on how real teams work. Ideas about building consensus, debate, and all those other skills are not naturally learned.

Coaching
An essential spur for a team’s success is having an effective coach. A coach is a counselor, not a disciplinarian. The coach encourages employees to do better, to accomplish more; the coach works to rehabilitate negative employee attitudes, emphasizing what’s positive; the coach is not a punitive taskmaster.

Team leaders, focus group leaders ALL must get out of the BOSS mode and get into the “We’re working together to make it better” mode. Management has to drop it’s hat and allow others to help them MANAGE.

Of all the advice offered up through this article I have linked to here, this is one of the best:

Employee Advocate Representative

As unions have shop stewards who represent the interests of the union members by reporting back to union officials, so nonunionized companies can have what is known as an Employee Advocate Representative (EAR). The EAR position is usually a trial assignment aimed at improving morale by involving employees in a broad spectrum of management activities and decisions. When employees want to make their concerns known to management, the EAR listens and then voices those concerns to management. The EAR is both the ears and voice for employees. This position may or may not be salaried and is held for a limited time. Once a term expires, another employee is either chosen or volunteers to be the EAR. To enhance a sense of employee inclusion, the EAR position should be filled by as many employees as possible. Such rotation ensures the greatest amount of employee inclusion and further guarantees that no employee is perceived as a being a tool of management. In small companies, the EAR can work in that position for an hour or two each week.

An in house mediator…someone who is trusted to speak up for those who don’t want to speak for themselves. Someone who is respected and fair; someone who has the ability to see ALL sides of issues YET someone who works on the units. The person who accepts this role must be emotionally strong as well. Management must allow this person the time to perform the very important tasks needed. This might mean a shift a week of being assigned to NON NURSING duties.

This happens FAR too often. It’s preventable. A simple head count does the trick. Often. Like every hour.

MARION, Ind. — An Alzheimer’s disease patient froze to death after he wandered away unnoticed from a nursing home, authorities said.

Staffers at Bradner Village Health Care found Clarence B. Elliott, 76, dead about 3 a.m. Thursday outside a locked door, Grant County Coroner Stephen Dorsey said.

“He had a history of walking outdoors,” Dorsey said. “It looks as if he possibly fell and tried to crawl back to one of the doors to gain entry.”

An autopsy determined that the preliminary cause of death was hypothermia and that it was accidental. Temperatures fell below zero overnight in the area.

Elliott had lived at the nursing home’s Alzheimer’s unit since May 2003, Bradner said in a statement.

“Bradner Village is fully cooperating with local law enforcement authorities and Indiana State Department of Health personnel. We ask the community to please join us in prayer for the Elliott family,” the statement said.

A nurse noticed about 2:30 a.m. that Elliott was not in his bed, Marion Deputy Police Chief Cliff Sessoms said. Investigators were working to determine why a bed check normally done about four hours early was not conducted and why no one heard the alarm on the door by which Elliott was believed to have left, Sessoms said.

What a way to die.