Empowering the CNA: with encouragement, CNAs can teach others.

Have you ever wished that there were enough resources and personnel to improve some of the services that your facility offers? Wouldn't you like to make mandatory in-services more interesting or present policies in a new way? Unfortunately, head nurses are overwhelmed, department heads have no time, and staff nurses say they have too much to do. But these goals can beachieved if your direct-care staff are willing and able to help. How about involving the nursing assistants?

Nursing assistants can take on this new challenge and do a fantastic job. Why not? They know everything that goes on in the facility regarding residents and families because they spend more time with them than any other team member. Residents and family members often are more comfortable telling them things that they might not tell other staff members.

At Broadway House for Continuing Care in Newark, New Jersey (an affiliate of the University of Medicine and Dentistry of New Jersey), we've taken a fresh look at nursing assistants as a long-term care resource. Outside the workplace, direct caregivers take on various roles. They run households, maintain budgets, hold positions in civic organizations, participate in church activities, and serve on school PTAs. They have a multitude of skills that we have not accessed. Right in our midst are valuable unpolished jewels waiting to sparkle.

Broadway House is New Jersey's only specialized HIV/AIDS nursing care facility. Our mission statement embraces the concept of empowerment, which started with a program called Strength for Caring. A major pharmaceutical company wanted long-term care facilities statewide to initiate a program focusing on the caregivers of people with HIV/AIDS. Strength for Caring outlined how caregivers should set aside time for themselves by practicing relaxation techniques, how they can recognize burnout, and how the resident feels about having HIV/AIDS. In 2003, when a four-day preparatory meeting was held in Chicago, instead of having nurses attend, we gave two exceptional CNAs the opportunity to represent Broadway House. They were the only CNAs representing a facility at the meeting, and they returned home excited, energized, and eager to share the concepts they learned.

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Because this was the first information presentation to be led by nursing assistants, we pulled out all the stops to publicize the event. Flyers were distributed throughout the facility, posters featuring photos of the presenters were placed at the facility entrance on large golden easels, and invitations were sent out to local facilities. The CNAs' work schedules were adjusted to provide ample time for them to practice their presentation. At first, rehearsals were a little scary for them but, as they became comfortable with the material, their confidence grew. Standing behind a podium and speaking into a microphone put them in a position of authority, acknowledging them as experts on the subject--individuals with a voice, important team members. As they practiced, the administrative staff and the CNAs' peers would stop by to offer words of encouragement that not only made them feel good, but also valued.

As the presentation date drew near, the excitement grew. Our CNA presenters received corsages to wear on that special day, and their families were invited. Every department came out to support their coworkers. The in-service was well received, as evidenced by the glowing program evaluations. In addition, representatives from the pharmaceutical company attended and commented that the presentation exceeded their expectations.

We often say that direct caregivers are "first line" and are "our eyes and ears." We say "we could not do our jobs without them." At Broadway House, we gave our frontline caregivers an opportunity to demonstrate their talents and capabilities.

Based on what we learned from this experience, here are a few tips:

* Keep the presentations simple, concise, and to the point. It is most likely the CNAs' first experience at presenting; do not set them up for failure by making the presentations complicated.

* Until they develop confidence, keep the CNAs' information simple. The content can always be revised to add more information later.

* Rehearsals should be held, if possible, in the room where the presentation will occur so that the presenters will feel more comfortable with it.

* At first, limit practice sessions to about an hour and then gradually increase the time.

* Encourage coworkers to stop by during rehearsals so that the presenters can get used to having an audience.

* Advertise. Make posters and flyers. Take photos of the staff presenters and incorporate them into promotional material.

* Host a reception after the presentation, with refreshments.

* Have the executive director send a letter to the presenters recognizing their participation, and place a copy in their personnel files.

* Give the CNAs a bouquet of flowers after the presentation, an extra day off, a special lunch outside the facility, or a gift certificate to a department store. You will be surprised how uplifting these gifts are. If your budget is limited, keep the gift and recognition tokens simple. But let your imagination go and you will come up with great gift ideas.

The CNAs' feeling of empowerment snowballed, and when I approached the next group of presenters, they were excited and ready to go. As a DON, I had an opportunity to develop a deeper relationship with the CNAs, and it's one that I cherish. When we are presenting "on the road," I am so proud watching my CNAs. All it takes is a willingness to work with staff and the belief that they can do it. Dare to believe in the potential of your staff.

Lois Beatty, RN, BSN, is Director of Nursing at Broadway House for Continuing Care in Newark, New Jersey. For more information, call [phone] or visit www.broadwayhouse.org. To send your comments to the author and editors, e-mail [e-mail].

BY LOIS BEATTY, RN, BSN

RELATED ARTICLE: Other Programs in the Broadway House Direct Caregiver Program

Caregivers Against Pain

In this program, nursing assistants conduct in-services on pain management and the CNA's role. The presenters have received certificates from New Jersey's ombudsman for their work in this field.

Infection Control CNAs

Selected direct caregivers assist the infection-control coordinator in presenting in-services on handwashing and the proper use of personal protective equipment. And we've spread the word: An article about keeping residents safe from the flu was in the September 2005 issue of Nursing Assistant Monthly and featured Broadway House Infection Control CNA Gladys McKinnis.

Dancercise Program

CNAs interested in exercise therapy work with the physical therapist to help lower-functioning residents have fun while doing low-impact exercises. In addition, the CNAs conduct a program for staff entitled "Women in Red," the American Heart Association's Healthy Heart Program.