At the heart of it all.

Have you ever noticed that when you're having a bad day, everyone around you is having a bad day, too? Is your bad mood actually a "virus" spreading throughout the facility, ultimately affecting the care of your residents? It is not easy to say this at a time when there are so many stresses bearing on DONs, but be positive. It can make all the difference.

Begin by leaving your personal problems outside the workplace, and recommend that your staff do this, as well. I remember, as a DON, advising staff to look at work as an escape from the problems they're having at home. Punching the time clock was a signal to them to leave those problems aside as much as possible. Everyone knows how the virus of negativity can spread, and if you have identified a "carrier" (and it isn't you), take time to have a confidential discussion with that person. It's possible that just a sign that somebody cares will be enough to get that individual back on the right track. Don't give personal advice, unless you're an expert in the area being discussed, but at least show some concern.

There may even be practical remedies you can effect. Perhaps the staffer needs a shift change in order to spend more time with a spouse and/or children. Maybe the staffer needs a week off to deal with a particular problem or just have some time away from the job. Document that you've had this discussion and ask the staffer to sign off; explain that although this discussion is confidential, this is a way of showing how the facility tried to help with the problem should any questions arise.

There is also a "hard-nosed" reason for doing this: Should the problem escalate into an employee discharge situation, you will have documented the facility's efforts to address the problems, should any wrongful discharge claims be made. Face the fact: Discharge could become a factor, because there comes a time when keeping a troubled person on staff may end up costing the facility in having valued employees leave voluntarily (i.e., the "virus" has spread). But to get back on the positive track, which is the basis for avoiding most of these situations, try to remember to recognize staff's good performance as caregivers at every opportunity. Saying "good job" is one way, but there are many other steps you can take - e.g., by encouraging staff training and education so they can progress from CNA to RNA or CMT, or from LPN to RN, etc. - or by clearly showing a staffer how to improve daily performance because "I know you can do it." Positive response is a very critical administrative function.

How many times have you seen a CNA or nurse who has been an excellent employee for years start to backslide and develop a sour attitude, only to revert to their old attitudes upon beginning an educational program? It only illustrates the old saying that those who are not moving forward are slipping backward. And positivity spreads in its own way: When caregivers are happy and excited, their fellow workers and those receiving their care will be happier.

Some years ago the Wall Street Journal published a list of work-related affirmations based on the writings of Benjamin J. Stein. I remember them still: "I will be friendly to people I work with and be grateful they are there. I will look for something to praise in others. I will try to see the good in every situation. If I correct someone, I will do it with humor and restraint. I will see that everything I do is done correctly, but I won't try to break any speed records. I will work with confidence and not question my abilities. I will be grateful that I live in a time when I don't have to work in horrible circumstances. I will feel happy that I'm at work, alive and well. I won't wonder 'what's in it for me,' but only what I can do to help in every situation. When I leave work today, I won't dwell on what could have or should have been done. I will look forward to the evening and be thankful for what I have accomplished today."

As a nursing manager, you must find a balance between being kind and supportive and making sure everyone carries his/her share of the load. That has never been easy in nursing homes, and increasing demands upon staff only add to the challenge. But creating a positive work environment is a must, whether it means working with your staff or on yourself. There are good "business reasons" for this, but you can also look at it this way: If your residents don't hear appropriate laughter from your staff, they may never hear laughter at all. NU

Karen Bonn, RN, ROF, a former Director of Nursing, is founder and president of Restorative Medical, Inc., Brandenburg, KY.