CNAs are speaking--but are you listening? Here are insider views on what's right--and wrong--in the long-term care workplace.

With spring around the corner, now is an ideal time for reflection, renewal, and new beginnings--both personal and professional. As the earth bursts with new growth and blossoms, throw open the windows and refresh the environment--the long-term care environment. You may think that your facility, whether it's a nursing home, assisted living community, rehab center, etc., is doing just fine. Surveys are satisfactory, residents and families are content, and employees seem to be happy. But is it fine? While you, as an administrator, are often mired in the countless duties, drudgeries, and decisions critical to operating a first-class facility, the people who put a face on care--your CNAs--are your "eyes and ears."

And they see and hear it all. CNAs also have a voice, and they have plenty to say--to you!

Relax, it's not all bad, as I discovered in September when I attended the Ohio-based Alliance Training Center's 16th Annual Nurse Aide Convention and Nurse Aide Olympics in Clinton, Ohio. Attendees ranged in age from 19 to 64, with new caregivers interspersed among many others with years of experience. I learned that this conference is the highlight of the year for attendees. It is an opportunity to learn, to share, and to celebrate their achievements.

And celebrate they did. Themed "The Sky's the Limit, The Endless Possibilities of Caregiving," 154 enthusiastic CNAs participated in sessions covering topics such as resident mobility, service, and more. They had a chance to compete using their caregiving skills, visit exhibit booths, and go home with fresh ideas, along with an assortment of gifts and prizes.

"That's nice, but where do I fit in?" you might ask. Well, you--the administrator and DON--were the subject of the opening session, "What Would You Change If You Could?" Leah Klusch, executive director of the Alliance Training Center and the driving force behind the conference, gave the audience the opportunity to "talk" to you. She urged the CNAs to tell you about themselves, the peaks and pitfalls of their jobs, and their relationships with their coworkers, and to offer you suggestions on how you could improve their jobs and overall organizational efficiency.

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

The nationally known Klusch, a dynamic educator and presenter, urged the audience to speak up and be heard. The session, supplemented by a questionnaire included in the attendees' conference materials, provided a lot of information, insight, and advice from CNAs that a savvy manager would do well to consider. Remember, they don't have your top-down perspective, but they do offer an enlightening look at your operation from the ground floor.

Who Are Your Aides?

Do you know your CNAs just by name tag, or have you taken time to get to know the people behind the badges? Their diversity in backgrounds, purposes, skills, goals, and achievements makes each one unique. It's not just that they're trying to make a hard-won living. Whether they made long-term care their career choice based on personal experience with caregiving, from an inborn desire to comfort those nearing the end of life, or for spiritual fulfillment, most CNAs given a chance turn out to be dedicated, committed caregivers who do their jobs for pure, unselfish motives. As one aide so poignantly said, "It's an honor to give part of my life to someone who needs it." Another attendee, Sylvia J., says she likes to take care of people, and being an aide is as close as she can get to being a nurse without having a GED. "But I'm working on that," she adds confidently.

A type of "generation" gap exists, however, between longtime CNAs and new hires. The more experienced aides believe that new hires are cut from a different cloth than in the past. They believe that there is a lack of compassion, dedication, work ethic, and sense of teamwork. On the other hand, new hires often feel that experienced CNAs use tenure to pass off their less desirable duties on them. Although this dichotomy is surely not universal, it was often mentioned in the questionnaires.

Of course, longtime CNAs know firsthand how their roles have evolved over the years. Where once resident care was their first and foremost responsibility, they now have to be familiar with computers, regulations, and privacy matters. Steven D., a 13-year veteran, comments: "More laws have come into play over the years, and we have more responsibilities than when I entered the field." Melissa E. agrees: "We have to know, understand, and follow more regulations, such as HIPAA, which means more paperwork." Along with the additional paperwork and documentation, Mary S. notes that "residents are more demanding today." Because of these added responsibilities, Gladys P. regrets that she cannot spend more quality time working with the younger aides.

Here's What CNAs Have to Say

Listening to the audience, I discovered that in 30 minutes or less a CNA can give you a pretty good reading on the state of your facility--from employee morale to resident complaints to equipment needs.

Many CNAs said that if they could talk to their administrator and DON one-on-one, they could suggest simple ways to improve their job that would, in turn, benefit the entire organization. Certainly many attendees voiced dissatisfaction with such "lunch-bucket" issues as wages, benefits, scheduling, staffing levels, and uniforms. For example, Julie B. says that her "hot pink polo shirt" is too heavy to work in all day. Another aide suggested that a standard lift be made available in each corridor because it would be a great time-saver.

Here are a few more items on their wish lists:

* Jodie J.: Provide more flexibility in scheduling for those who want to continue their education in healthcare to attend class.

* Julie B.: We need better training and to have consequences for not coming to work. I think overlapping shifts would encourage teamwork.

* Melissa J.: Listen to employees and don't always assume the customer is right. Hear both sides.

* Karen H.: We need better supplies, more outdoor activities, and a uniform allowance.

* Faith B.: I'd like the administrator to know what nurses' aides really do.

* Erin L.: If someone picks up an extra shift when she is called, don't dock her when she is sick.

* Melissa E.: Aides need to become part of the decision-making process when it pertains to resident care.

If I Were an Administrator ...

"What would you do if you were an administrator?" asked Klusch. Overwhelmingly, CNAs said that they would get out of the office and on to the floors to see staff in action, to see firsthand the relationship between aides and their nursing supervisors, and to meet residents and their families.

"If I were an administrator I'd encourage better communication between nurses and staff," suggests one CNA. Cecelia G. expands that perspective by adding, "Find out how workers and residents get along, and provide customer service tips to staff." Other tacks CNAs would take if they were running the show include:

* Julie B.: I'd go to the floor and ask people for ideas, solutions, and general input.

* Melissa E.: As an administrator, I'd get involved in care planning and get to know everyone in the nursing department.

* Mary S.: I'd interact with staff and always be available to them.

* Sue W.: If I were the administrator, I'd put in an incentive program and spend part of the day on each unit.

* Faith F.: I'd change the CNAs' uniforms and give a cost-of-living raise and a shift differential.

* Shelly S.: I would order electric beds. I'd also meet and greet residents and families.

* Rhonda R.: I'd have a talk with negative employees who resist change or refuse to be team players. I'd also encourage cookouts, parties--things the residents might like.

* Nicole S.: I think it is important for front-office employees to shadow each job. I'd require upper management to have hands-on participation in the admissions process.

* Jessica S.: I'd reward people who come in on their day off.

* Debra P.: I'd change some policies. For example, I'd give three minutes leeway clocking in and out.

* Myrna V.: Above all, I'd treat the aides with more respect.

* Naomi C.: I would increase educational opportunities.

* Sheri M.: If I were the administrator, I'd thank staff for a job well done.

Small Conversations Can Have Great Results

After spending a day with these highly charged, positive people, I returned home with a new respect for what they do and a renewed enthusiasm for my own work. If I were an administrator, I'd meet with each one, maybe over a cup of coffee, to see what they think. Some suggestions might be doable, others not, but this would give you the opportunity to convey the realities of facility management. For example, an administrator's response to a request for more lifts might be: "I'd love to have lifts on every wing, but it's not a financial commitment that can be made right now." It might not hurt to add, "I appreciate your good, practical suggestion and will keep it in mind."

Conclusion

Although these CNAs presented concerns that they'd like to see addressed, they expressed satisfaction and felt they reaped rewards from the work they do. Among the blessings they counted were their coworkers, the love of their residents, their interaction with families and, as one aide said, "a lot of great recipes."

Call Leah Klusch, President of the Alliance Training Center, [phone] for more information on the Nurse Aide Convention and Nurse Aide Olympics. To send your comments to the author and editors, e-mail [e-mail].

BY SANDRA HOBAN, MANAGING EDITOR

RELATED ARTICLE: 'The Sky's the Limit'

A look at the 16th Annual Nurse Aide Convention and Nurse Aide Olympics

Dozens of blue and white balloons hovered around the room and above the tables, and there were more than 100 prizes donated by vendors and corporate sponsors. CNAs, DONs, ADONs, and an administrator or two sat beneath the "clouds" to enjoy a day of education, competition, fun, and appreciation themed "The Sky's the Limit, The Endless Possibilities of Caregiving." Each participant received a T-shirt with the theme of the event as a remembrance of his or her participation. Throughout the program, for which each participant received a certificate for six in-service educational hours, teams competing in the Nurse Aide Olympics moved in and out of the party center's ballroom.

On the lower level, 13 teams of CNAs from long-term care facilities across Ohio went through their caregiving paces competing in five events: handwashing, hair and nail care, mouth care/dentures, pulse and respiration, and perineal care. The judges, who were nurse educators volunteering for the daylong competition, totaled the scores and, at the closing session, the winners were announced (see below) and presented with first, second, and third place medals, trophies, and certificates.

[ILLUSTRATION OMITTED]

While the "games" went on, screams, cheers, and waving hands suddenly erupted throughout the ballroom. The "Aviator" had dropped in "from the sky," his "mission" to deliver gift bags to lucky attendees. The energy continued throughout the day. And during breaks on that beautiful autumn day, attendees enjoyed the sunshine and strolled the grounds discussing sessions, catching up, or posing for photos with their coworkers.

Top finishers in the Nurse Aide Olympics were:

First Place

Brewster Park 

Brewster, Ohio 

Second Place

Hennis Centre of Bolivar

Bolivar, Ohio 

Third Place

Parkside Health Care

Columbiana, Ohio