RECRUIT RETAIN REWARD.

Three innovative programs geared to boosting the three Rs of staffing

A facility might be the most attractive, well-equipped and progressive one in town, but if its staff are unmotivated, uninvolved, ambivalent, underappreciated and transient, that facility can lose residents--and, quite possibly, its reputation.

Achieving high-quality resident care and fostering staff dedication both start, obviously, with hiring the best candidates available. Keeping good staff--essential to maintaining the desired quality of care--then hinges upon encouraging and rewarding them for work well done.

Three industry experts--Kevin M. Kavanaugh, MA, director of public affairs for the Illinois Council on Long Term Care; Daniel O'Neill, administrator at Riverwood Health Care Center in Grand Island, New York; and Anne Willis, past president of NADONA/Kentucky Chapter--each address one of the three Rs of staffing by discussing innovative programs their organizations have launched.

Recruiting Through the Media

Because low unemployment rates have made it difficult to attract high-quality, committed staff members, long-term care providers have had to resort to temporary staffing through nursing agencies to bolster their personnel rosters. To address the image of nursing facilities and promote the quality of their staffs, the Illinois Council on Long Term Care embarked on an innovative public awareness campaign--"HEROES Have Many Faces."

According to the Illinois Council's Director of Public Affairs Kevin M. Kavanaugh, MA, this campaign introduced and reinforced the heroic roles that long-term care employees play in caring for and comforting nursing home residents and their families. These "heroes" are gratified, satisfied and fulfilled in taking care of those who need them. Their spirit, joy and dedication enhance the performance of their duties.

"Not merely a recruitment campaign, the goals of 'HEROES' were to update the public's perception of long-term care, increase the number of people entering the long-term care profession, improve staff morale, reduce turnover and positively impact prospective legislation," says Kavanaugh.

The "HEROES" campaign centered around four 60-second radio spots delivered by two nurses and two nursing assistants working in the long-term care field. "'Keeping it real' was the focus of the campaign, and actual personnel contributed to its authenticity," remarks Kavanaugh. The spots began: "John F. Kennedy, hero. Martin Luther King, Jr., hero"--followed by the name of a staff member providing his or her testimonial. Linking that person's name with those of famous heroes dramatized that heroism is manifested in small ways, as well as large.

For example, one long-term care hero's radio testimonial tells the public that:

...The special part of working in long-term care is that I get to know my patients and establish relationships, know their families, background, and help them.... It's the most satisfying and rewarding job in the world. I feel very honored and blessed that I work in long-term care, because it's made a difference in my life, and I hope that my work has made a difference in other people's lives.

The radio spots close with an 800 number to call for employment opportunities. Kavanaugh notes that, although the six-week radio campaign is over, they have received more than 600 queries about long-term care opportunities.

To accompany the radio spots, a poster and direct mail pieces were designed featuring real-life caregivers. A staff member from each of nine facilities volunteered to be photographed for the campaign. Featuring a wide range of staff positions--from activities director to food service worker to CNA to maintenance staffer, and more--the posters introduced the people, position and lengths of service to the public. Posters and desktop table tents featuring the 800 number and the HEROES Web site were sent to CNA training and other nursing programs and employment agencies.

When an employment inquiry was received via the 800 number, according to Kavanaugh, the caller's background information was entered on a standardized form and a broadcast fax was sent to facilities within the applicant's geographic area. A packet of information describing the employment opportunities in long-term care was sent to the applicant.

This campaign not only encouraged the public to rethink their concept of nursing homes, but it also made existing staff feel good about their work. The Illinois Council has succeeded in giving a face to long-term care. A platform now exists on which to base future efforts, whether addressing recruitment, legislative issues or public information.

Kavanaugh feels that, in the final analysis, "It is imperative that the industry begins to aggressively use the media to dispel misconceptions by enhancing the overall image of long-term care and the people who make it work."

Retaining Staff Through Job Enrichment 

Although a facility's staff are well qualified, ambitious and delivering excellent care, it is important to maintain this performance level over time. In-services and career-related improvement programs are vital to preventing on-the-job ennui and burnout. ElderWood Affiliates, Inc., based in Williamsville, New York, addressed this problem by adding a mentoring program to its enrichment programs at long-term care facilities, subacute care units and assisted living communities.

Daniel O'Neill, administrator at Riverwood Health Care Center, one of ElderWood's skilled nursing facilities, explains that everyone is eligible to participate in its mentoring program. "All CNAs are eligible to serve as mentors, provided certain requirements are met. They must be model employees, as determined by the annual employee evaluation, which uses a 45-point scale to assess personal traits and behavior. An employee must qualify for participation in the mentoring program by scoring at least 36 points."

"Prior to serving as mentors," says Diana Bell, director of nursing at Riverwood, "mentoring candidates must attend a 'train the trainer' in-service program developed by ElderWood's Training Center staff. This seminar makes use of role playing and visualization techniques to develop guidance skills. Candidates receive literature and handout materials to reinforce the principles they learned in class."

"Mentors are used in a variety of ways in our facility," says Jamie Marzo, personnel director. According to Marzo, the hiring process makes use of mentors by having them escort prospective employees on a facility tour. Because a mentor spends time with the candidate in a relaxed atmosphere, the mentor can get a general "feel" of how the applicant will "fit in" with the facility's personality. It is not unusual for mentors to provide input on prospective employees. Identified by a special badge, mentors also work to acclimate new hires with the facility and its policies, procedures and personnel.

If administration identifies an instructional need and develops a new program, CNA mentors play a vital role in that development. Their input is valued, because they often have the best feel for how things should be done. For example, the 13-module resident lifting and transport training program was a team effort involving CNAs from ElderWood's Crestwood and Heathwood Health Care Centers. These CNAs collaborated on the scripting and production of an instructional video that accompanied the in-service program.

Along with guiding new hires--and hence improving caregiving techniques in their facilities--mentors can hone their own leadership skills while still serving as CNAs. According to O'Neill, the mentoring program has helped reduce Riverwood's turnover rate--not only for CNAs, but across the board. This mentoring program has fostered an environment that people don't want to leave.

Rewarding--Credit Where It's Due

Maintaining a stable, committed staff requires recognition and reward. Even a small "thank you" or "nice job" goes a long way in letting an employee know his or her efforts are appreciated. Showing appreciation leads to growing pride in a job well done and pride in being affiliated with a quality facility.

The Kentucky Chapter of the National Association of Directors of Nursing Administration in Long Term Care (NADONA) has adapted a recognition program recommended by the national organization. "The purpose of the Nursing Assistant Recognition Program is to recognize and acknowledge outstanding nursing assistants practicing in long-term care throughout Kentucky," says Anne Willis, past president of NADONA/Kentucky Chapter and director of nursing at the Episcopal Church Home in Louisville.

Through a nomination process, each member facility is encouraged to select an outstanding nursing assistant for recognition. A panel of five judges reviews the written nominations and selects a nursing assistant quarterly during the year. Each quarter, all nominees are invited to a luncheon where each is introduced by his or her respective director of nursing and recognized as an outstanding nursing assistant. The Nursing Assistant of the Quarter is acknowledged and receives a framed certificate along with a monetary award.

At year's end, the four quarterly winners are interviewed by the judging panel that selects the Nursing Assistant of the Year. The person so honored is feted at a holiday luncheon in Dccember. "Along with an engraved plaque and a larger monetary award for the winner, the facility receives another plaque for display throughout the year, indicating that it employs an outstanding nursing assistant," says Willis. "This is a 'traveling' plaque that is passed on to the facilities where subsequent winners are employed."

A scholarship award offered by the NADONA/Kentucky Chapter is another popular recognition tool that is administered through an application/nomination process. These scholarships have made it possible for a nursing assistant to take a step further along the healthcare career path. "By offering these incentives," states Willis, "we demonstrate the high regard with which we view these frontline caregivers. Their service, dedication and quest for advancement must be recognized."

When facilities address the areas of recruitment, retention and recognition in a positive way, staff will bring more to the table. They'll know they're respected and appreciated. These people don'tlook for "greener pastures." They're already there.

A Mentor's Experience

Colleen Krauss

Dorothy Connock has been a CNA at Heathwood Health Care Center, and ElderWood Affiliates facility in Williamsville, New York for 15 years and a mentor since the program began in 1996. At Heathwood, mentors interview prospective new staff, work with new hires during their "work days" and prior to clinical and written exams, and attend quarterly mentoring meetings to discuss recruitment and training issues.

During the interview, Connock focuses on each candidate's comfort level within the long-term care setting, especially with resident interaction. She encourages candidates to ask questions, which help determine their interest and commitment to the position. Following the interview, Connock meets with the director of nursing to provide her assessment of the candidate.

After a candidate is hired, Connock concentrates on those aspects that she and the facility have deemed to be most important in the daily activities of a CNA. "Safety, particularly the need to continually reference the ever-changing care plan of the resident, is critical. A commitment to teamwork and cooperation among coworkers as well as the ability to organize and prioritize tasks are keys to a CAN's success" according to Connock.

Based on her experience as a mentor, Connock recognizes that once her proteges "graduate," they will establish their own routines using the tools she has provided them. Says Connock, "My job is to prepare them for their new roles and to be here as a resource when they have a question or problem."