Two powerful little words.

With state surveyors having immediate access to your MDS numbers via computer modems, these days, you must be sure that your residents' numbers are constantly improving, indicating that you are doing everything possible to keep them at their highest levels of function. Your staff produces these numbers - and when was the last time that you said "thank you"?

That may not seem to mean much sometimes, but to those who work in long-term care, with all its frustrations, it could be the "glue" that keeps them together and aboard, and not resigning after a particularly bad day.

Here is one way to make "thank you" meaningful. In fact, there is no better way to boost staff morale than to let them see you - the administrative nurse - on the floor, personally checking resident care and working side-by-side with your nurses and CNAs. They have no idea of the amount of paperwork and planning required of your position - and frankly, they do not care. They just know that your job looks rather attractive because you have an office, possibly a secretary, you make more money than they do, you may be required to have lunches with your medical director, you leave the facility to attend meetings and conferences that may include an occasional hotel stay and meals out, and you do not punch a time clock. There may be times when these don't seem all that wonderful to you, but think of how they may appear to your staff who are "tied to the building." They're inclined to respect you for taking time to work "in the trenches."

Restorative nursing programs are a major factor in lowering your MDS numbers, and who makes your program successful? You may be lucky and have a therapist who oversees and helps you set up your program, but your nursing staff - nurses, RNAs and CNAs - are the ones who do the daily work to keep it successful. If these people are properly thanked and praised for their hard work, and they see the residents improving, your state surveyors will see this, and enter your facility at survey time with positive attitudes themselves.

Instruct your staff on each area of the MDS that is directly affected by restorative nursing. For example, Sections B and C: Cognitive Patterns and Communication. How long will any human being be oriented if they lie in bed or a geri-chair all day, staring at the ceiling? We have known for years that if you decrease environmental stimuli, a person can become withdrawn, confused and disoriented. Teach this concept to your staff, and then watch them become innovative with approaches for getting people out of bed and up in a sitting position. Then praise them for their efforts and ideas.

Or, how about Section D: Vision. Try looking through dirty glasses and see how much your vision is impaired. Praise your staff for thoughtfully cleaning residents' glasses on a regular basis. (And families will thank you, as well.)

Sections E and F: Mood and Behavior Patterns. Any resident who experiences loss of range of motion and mobility soon develops the disease "learned helplessness." Unless your staff understands the need for residents to do everything possible for themselves, they (with every good intention) will do everything for them. The resulting dependence, incidentally, effects residents' self-esteem and feeling of self-worth, i.e., Section F: Psychosocial Well-Being. Praise your staff when they take the time to allow residents to do for themselves or encourage one resident to do things for others. Yes, this initially takes more time - but it will save nursing time in the near future, and is worth a "thank you."

In one way or another, every section of the MDS is directly affected by immobility. If the resident has contractures of their hips, knees and/or feet, they may not be able to sit on a commode (Section H: Continence). If a resident has a contracture of the cervical spine (head leans forward, backward or to one side), he or she may have difficulty swallowing; hand and wrist contractures affect ability to self-feed; if they emit an unpleasant odor from a closed palm, this in itself may affect appetite. Look to Section K: Oral/Nutritional Status. If the head is severely contractured forward, oral hygiene may suffer (Section L: Oral/Dental Status). Pressure ulcers are a direct result of many contractures, including those that make it almost impossible to perform peri-area hygiene (Section M: Skin Condition.) Does the resident have trouble sleeping because of severe pain related to decreased range of motion, especially when being turned and repositioned? Section N: Activity Pursuit Patterns.

You can develop a plan to improve your MDS scores, but you cannot implement it personally, nor can those nurses involved in completing the paperwork. The CNAs and the RNAs are the ones who can. Train your staff, then thank them, not only for their actual achievements, but for their honest attempts at helping residents. Then watch for the powerful results of a simple thank you.

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