Risk mitigation strategies for supporting employees too! – Guest columns

Last month I wrote about risk. I shared that risk in a nursing home originates from many places: residents and families, federal and state regulators, vendors, payers, insurance companies, referral sources and partner relationships, to name a few. Many astute readers commented that risk also comes from their employees, and they are right!

Poor support of staff contributes to a negative reputation in the community, complaints to an ombudsman or the local department of health, or even whistleblower complaints, among others. As a result, your facility might experience undesired resident outcomes, a lawsuit, an allegation of criminal actions, or investigations by external oversight agencies. 

The 10 strategies that I presented last month can be applied to support your employees and lessen the likelihood you’ll experience these negative consequences. Here they are:

1. Expect things to happen, and get ahead of them.

Providing a safe environment for your residents, visitors and staff is obvious and non-negotiable. In general, nursing homes do a fine job with this, but the potential for mishaps is always there. Schedule periodic environmental walkthroughs on all shifts, every day of the week. Ask other staff members to conduct these safety checks. Their fresh eyes will always identify something that you might have missed. A nurse assistant, therapist and social worker will each spot different environmental hazards.

But in addition to the environment, life happens. And we all find ourselves in the circumstances of being an unexpected caregiver to elderly parents, sick children or other family members and friends. Does your organization support your team members in times of personal crisis, or does it discipline them for being late or calling out? A while back I wrote about Archangels. Archangels is an organization that provides support to unpaid caregivers. Check them out! They’re doing wonderful things to support our nursing home industry and can help you to support your staff. 

Your staff has feedback to share. If they don’t have a place to do so with you, they will share with others. Residents, families, employee unions, departments of health, surveyors and other people will hear the concerns that you are not. Acknowledging staff and creating a safe place for them to voice their concerns is necessary. The distance between the breakroom and the boardroom is vast. Dispelling the “us versus them” mentality is essential and benefits everyone.

2. Sail into problems. 

Celebrate the opportunities to do better. Your skills at root cause analysis come into play here! We all understand the concept of a resident council, but have you considered an employee council? Every complaint is a gift, and often a second chance.

Some of the greatest challenges I experienced as a charge nurse in a nursing home involved helping nurse assistants to cope with abusive residents and families. The physical abuse that they received from residents was nothing compared to the hurtful verbal abuse that they endured. Though it mostly stemmed from residents’ cognitive impairment, sometimes it did not, and that was especially hard. Though “the customer is always right,” remember that our coveted staff are our customers as well. Confronting these challenges is essential, even if there is no obvious solution.

In the city nursing home where I worked for 10 years, I encountered a unique set of challenges. Its staff represented tremendously diverse cultural backgrounds, and so did its residents. Sometimes these differences resulted in conflict, but turning the conflict into opportunity had a tremendous benefit. I distinctly remember facilitating conversations around end-of-life care and pain management by asking staff to share their cultural beliefs on these sensitive topics. Through open dialogue we learned about each other. We contrasted our beliefs with those of the residents, and suddenly differences became opportunities and not barriers. It was magical. 

3. Call with good news.  

Staff don’t want to only hear from their supervisors in the context of a performance review, or when they’re being “written up” and given “tough love.” Instead, how about “catching them” doing something good? Celebrating birthdays is great, but do people really need to wait a year to know they’re valued? Role-modeling appreciative behavior is key. Remember, it doesn’t need to always fall on you, but creating an environment or a culture where positive feedback is common — “You are so kind to Mr. Yanny.” “I love how much you helped Sheila during orientation.” — helps cultivate a wonderful place to work. Create a vehicle for peers to nominate a coworker for an award or some type of acknowledgment. 

4. Make data your superpower. 

You are sitting on a treasure trove of staffing data. For example, what happens to the data you accumulate through your employee hotline? Check out CMS’ Care Compare and examine your overall and RN turnover rates. How do your turnover rates compare to your closest peer group nursing homes and the state average? 

What about employee satisfaction surveys? Many of you conduct them, but what happens to the results? Are they driving change? Supporting existing practices? Shared with staff? Or tucked away without review?

5. Read charts. 

Here I’m not referring to resident charts, but rather accumulated staff information. For instance, I often wonder about exit interviews. Do you do them? Are you doing them “for real” or just as a formality? What about call-outs? Does a pattern emerge when you pull back and look at the data? These are opportunities to learn about your staff and prevent future attrition. For many reasons, it’s easier said than done. Do your best, which I suspect is pretty darn good. 

Now consider your PBJ data. With some digging, you can examine your contract staff utilization compared to others in your market. Are there days of the week you tend to run significantly low? Expect your next survey to occur then. From reviewing employee incident reports, do incidents tend to happen on a particular shift, weekend or day? What makes these time periods more problematic than others? 

6. Put your money where their mouths are. 

Many nursing homes provide free meals to their staff. Sometimes this is only for hard-to-staff shifts like weekends, but I’ve also heard of nursing home kitchens providing to-go meals at cost or even free to their staff. 

Nursing homes excel at hosting holiday events for residents and families. Potluck and other food activities seem to induce hugs and smiles. Feed your residents warm soup at night when they have trouble sleeping, and encourage staff to take a moment and enjoy some soup with the residents as well. 

Your mind is probably racing through the regulatory obstacles inherent in some of these suggestions. But take a step back and consider: At what point can you watch your staff’s backs instead of your own backside? Legal offices, don’t forget what business you’re in. 

7. Don’t rotate staff.  

Ten years ago, I wrote about the merits of not rotating nurse assistants and engaging them in the creation of assignments. It’s been a while, but the tangible benefits of this approach remain. Treat floating and agency staff as guests. Assign them a staff buddy to help them during their shift. Bottom line, you are grooming your next hire. This is a relationship business; we understand that concept in terms of our residents and families, but it should extend to our valued team members. 

8. Put yourself on hold.  

Call your facility and listen to the outgoing message when you are placed on hold. Sure, you talk about the outstanding care that residents receive, but is there any messaging about the staff that cares for them or the benefits of joining your team? 

Go to your nursing home’s website and submit an employee inquiry online. I did several. Often, I didn’t get a response to a general employment inquiry. This happens when servers go down or emails get jammed. Read the mission statement posted on your nursing home’s website. Does your awesome mission also embrace your staff? 

There are plenty of places online where you can read what staff are saying about your nursing home. Indeed, Yelp, Google and Glassdoor are a few examples. Remember, these aren’t just forums for staff to post their gripes; there always is an opportunity to learn. 

9. Stop admissions.  

You send a powerful message to staff when you put a temporary freeze on admissions. Now, this doesn’t need to be all admissions, but if your staff are telling you that they are overwhelmed or unable to care for a specific resident cohort, stop and take a pause. These actions speak volumes, and your staff will become your greatest champion. Since most nursing homes are part of a larger corporation, this ideology must be supported throughout the organization. Delegation of decision rights therefore must be part of this process. 

10. Learn how to apologize. 

We all make mistakes. If you blow it, own it and apologize. Foster a culture of forgiveness and humility. When you miss the mark and are not the role model that you strive to be, say you are sorry and mean it. Be specific and ask for forgiveness, then forgive yourself. Identify how you would have wanted to act in the given situation. Learn and grow. 

You can mitigate employee risk and put a stop to the negative consequences and future losses. But ultimately, nursing home operations will never be free from risk. Hopefully these 10 actions will result in more empowered and committed staff — a winning combination for you and your residents!

Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.


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