Preventing staff infection: strategies for a healthier summer.

It's early in the season; campers and staff across the nation are drifting into their summer camp worlds. Orientation messages are--for now--at the fingertips of most folks. New staff ask, "How am I doing?" Returning staff are slipping into routines from last summer while adapting to the new elements of this season. Camp leaders are wondering what they forgot to cover; is everyone really ready for the season?

Most of us do a solid job of orienting staff. We puzzle over orientation schedules, making them reflect the "true nature" of camp. We create lists of topics and check each as it's covered in the orientation process. We put staff through skill checks and teach them new skills.

And we talk about staying healthy.

But we don't do much that bridges that talk into behavior. So around week three, all the bright eyes and brilliant smiles of staff give way to dull affect and slow movement. Their get-up-and-go got-up-and-went. We have more beasts than beauties surrounding us. What's a camp to do?

Start at the Beginning

Preventing "staff infection" begins when staff and their supervisors understand the stressors--both good and bad--of being a camp staff member. Camp life has some unique stressors for today's emerging adult. First, camp places them in close and intimate contact with other people--for days on end. Privacy needs get minimized in the quest to adequately supervise campers, and staff are exposed to campers "all the time." Access to food, water, and downtime changes. Attention shifts from a peer group to campers, young folks whose developmental need for care is the antithesis to the young adult's need for risk-taking.

Using orientation to discuss these and additional stressors is a starting point. What makes the conversation richer and what lays the groundwork for the rest of the summer is the bridging discussion about how one copes with these stressors. For example, camp staff often benefit from taking the campers' daily schedule and plotting their own schedule along side it, noting times when "on duty" and "downtime." One-on-one conversations with supervisors might follow, providing opportunity to identify behaviors targeted to reduce, if not eliminate, daily stress, things like when one might take a run, log on to e-mail, or simply visit with other staff.

Other health-related messages to intentionally work into staff information include:

* Normal people need eight glasses of liquid a day; camp staff are not "normal" people. They tend to work in a fluid-leaching environment; consequently, drinking eight glasses a day is simply the start point for camp staff. A similar thing can be said with regard to eating. Camp life usually increases a person's caloric needs. Eat to maintain weight and energy. Think in terms of good nutrition rather than calories per se.

* Staff were hired to do a job. It is, therefore, reasonable for camp administration to expect that staff manage their personal lives so they remain capable of doing that job. This includes getting adequate sleep. And yes, some people can get by with three hours a night while others need twenty-seven. The point is to stay well-rested so when the performance appraisal question is asked--Did this staff member manage their personal health so they remained capable of doing their job?--the response is a positive one. (By the way, remember to put that kind of statement on the staff performance appraisal tool.)

* Because we're human, we get ill or injured upon occasion. As a staff person, the expectation is that, once ill or injured, one then gets better--not worse. This message is particularly important with regard to summer colds, the scourge of many camp health programs. As adults, we tend to keep ourselves busy in spite of minor inconveniences like a cold. This is just fine as long as progress toward recovery is occurring, but it's a problem when a simple cold ratchets up to something else like sinusitis or bronchitis. The key message is that each staff person must attend to what they need in order to recover. At camp, this might well include talking with one's job supervisor if modification of the work assignment is needed to promote recovery.

* Take advantage of personal "downtime." Rather than run ragged in an attempt to keep up with every interesting thing at camp, be selective so personal time is available to use as needed. There's a great adage on this topic: blow out one end of the candle before lighting the other end. This can be tricky when uncertain about what constitutes "downtime" and is, as a result, a great coaching point for supervisors (and something their example should demonstrate).

* Make friends with the head cook and the camp nurse. They're handy folks to know when need arises!

* Every once in a while, look in a mirror and ask yourself, "Would I leave my child with me?" The health of campers and the ability to manage a group so injury and illness are minimized, if not eliminated, is a critical skill. Healthy staff are much more able to do this; it's a duty owed to the children we care for. So practice laughter regularly, value prevention more than treatment, and seek advice when the pit of one's stomach is reacting to the gray of the moment.

Distinguish Between Staff and Camper Healthcare Plans

Here's an interesting question to pose to supervisory staff: how do the camp's health expectations for staff differ from those for campers? Given that staff are employees and campers are clients, it stands to reason that there should be some distinctions. Staff provide services to clients. An employer's interest in employee health is based on supporting their ability to deliver those services, the reason for which they were hired. That same employer's interest in client health is based on different parameters, ones often associated with program satisfaction.

So why do camp staff usually get treated exactly the same as campers when they get ill or injured?

Staff who supervise other camp staff--the head cook, the waterfront director, lead counselors, activity heads, and so forth--do so to accomplish specific tasks. Yet these supervisors often neglect to hold employees accountable when health status impacts ability to work. Supervisors certainly recognize the impact but, in the camp setting, they often lack tools to address accountability. This needs to change. Modification of performance appraisal tools and using strategies such as including the supervisor in the care planning process makes logical sense.

In turn, it's also important to talk about this with staff. Most have no trouble understanding their responsibility to do what they were hired to do, and most understand that's made much easier when in good health. The health care provided to them should be based on an occupational health model, not the care-giving model used for campers. But all too often, there isn't a distinction; staff with health concerns are treated as though they were campers, resulting in blurred boundaries. While what is done in the health center to treat specific injuries and illnesses may not vary between staff and camper clients, the distinguishing element for staff is to determine how their job tasks are impacted. As soon as this is introduced, supervisors must be folded into the discussion and a plan developed that addresses recovery while also getting jobs done. The impact of admitting a staff member to the camp's health center is very different from admitting a camper.

Articulating supervisor-employee strategies when health impacts work performance is critical to a staff health program. It's the element that puts "teeth" between understanding the impact and seeing that carried out on-the-job. Doing so also helps people act in a caring manner while preserving the work relationship.

Identify the Staff Role in Camp Health

In the quest for a healthier summer, preventing "staff infection" includes articulating the staff role in maintaining the health of the greater camp community. For example, health center staff may screen people upon arrival, but it's the day-to-day attention of each staff member that catches things that may slip through the screening process. It's the use of universal precautions and attention to risk-reducing strategies as basic as hand washing that keeps staff and campers as resilient as possible. It's staff use of common sense and their individual commitment to intervene when they notice things jeopardizing safety that puts strength in health initiatives.

A strategy to initiate this commitment is to pull last summer's incidents out of the file, provide summative information to staff--time when the incident occurred, where, what factors contributed to the incident happening, what factors contributed to successful resolution of the incident, etc.--and, based on this information, develop two or three risk- reduction strategies for this summer. Write the strategies using measurable objectives and post them. Revisit the topic weekly; check progress toward achieving the outcome and/or making necessary adjustments as the camp season unfolds.

Having a plan to address overall health can be complemented by similar objectives that are activity or cabin based. These, in particular, make the actions of individual staff members more apparent. For example, if the kitchen staff has a history of burns and cuts, some of which need physician attention, a reasonable goal for this summer might be to reduce last year's number of incidents by 25 percent. Coupling this with specific behaviors like using hot pads that cover the hand and forearms or sharpening knives before cutting vegetables strengthens the likelihood the objective will be reached while also capturing individual efforts (or the lack of them!).

Finally, staff who are empowered to make a difference--and are recognized for doing so--do make a difference. Note their efforts to both maintain their personal health status as well as make a difference within the camp community. Provide coaching tips to make the impact of their actions even more profound. Intermittently reinforce (reward) them; coupons for a snack from the camp canteen or sitting down with pizza to discuss their effort validates while also reinforcing the message. And remember: any strategy that captures accountability keeps the message focused in a manner that also allows intervention if things don't go as expected.

A Bit of Wisdom

We're dealing with humans at camp. Hu-mans bleed and throw-up upon occasion; we'll never eliminate all health challenges. The wisdom lies in recognizing the times when intentional action, particularly on the part of staff, will make a difference. That's often the elements of our camp world that we control: the rules we ask staff and campers to follow, the schedules we ask them to keep, and the facilities in which they function. When one of these causes injury or illness, that's our cue to pay attention. It marks a place where we can make a difference.

And if you think you, by yourself, might be too insignificant to make that difference, you've never been in bed with a mosquito.

Linda Ebner Erceg, R.N., M.S., P.H.N., is assistant director of health and risk management for Concordia Language Villages, Bemidji, Minnesota, and executive director of the Association of Camp Nurses. In addition to writing this column, Erceg authored the seminar, "Managing Camp Health Services," and is part of the "Healthy Camps" injury-illness surveillance research project. She is a frequent speaker at conferences, a standards visitor, and serves on ACA's National Board and National Education Committee. Contact her via e-mail at [e-mail].

Originally published in the 2006 May/June issue of Camping Magazine.