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Organizational Research on Nursing Home Human Resource Management: The Frontline Caregiver Christine Bishop, PhD., Speaking for the Project Team. Schneider Institute for Health Policy Heller School for Social Policy and Management Brandeis University AcademyHealth Annual Research Meeting
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Organizational Research on Nursing Home Human Resource Management: The Frontline Caregiver Christine Bishop, PhD., Speaking for the Project Team
Schneider Institute for Health Policy
Heller School for Social Policy and Management
AcademyHealth Annual Research Meeting
June 26, 2005
Improving Institutional Long-Term Care for Residents and Workers:The Effect of Leadership, Relationships and Work DesignFunded byBetter Jobs Better Care Program
A collaboration of
The Robert Wood Johnson Foundation
Administered by The Institute for the Future of Aging Services (IFAS)
Christine E. Bishop, Ph.D., Brandeis
Susan C. Eaton, Ph.D., Harvard (deceased)
Jody Hoffer Gittell, Ph.D., Brandeis
Walter Leutz, Ph.D., Brandeis
Dana Beth Weinberg, Ph.D., Queens College
Elizabeth Dodson, Ph.D., Boston College
Student Research Assistants:
Almas Dossa, MPH, M.S., Brandeis
Susan Pfefferle, M.Ed., Brandeis
Rebekah Zincavage, M.A, Brandeis
Barbara Whalen, M.P.A., Harvard Frank Porell, Ph.D., U Mass Boston Administrative Assistant: Joanne Jannsen, Brandeis
Philosophy of Management
Staffing ratios · Resident Assignment · Call-outs· Care Planning· CNAs Working Together· Coordinating with Other Departments· Hiring· Training· Promotion· Supervision· Evaluation and Discipline· Rewards· Retention
Direct Care Workers
(Source: Baron & Kreps 1999 p. 189)
(Source: Baron & Kreps 1999 p. 190)
Source: BJBC group interviews with CNAs in 18 Massachusetts nursing homes
What would you change about your job, besides the pay?
“ The communication between the nurses and the CNAs. Sometimes they're supposed to at least let us know about new people, when they come in, instead of us coming in and figuring out on our own. I know it’s like personal stuff, but we’re the one dealing with them, so we should know what’s going on with them. So sometimes they do. They're supposed to; sometimes they do, sometimes they don’t, so the communication is not really there.”
“It’s like a kind of attitude problem, too. Like some of the nurses, they think because -- it doesn't happen to me -- because they are nurses and you are a CNA, it’s like you have to go on what they say. You are the CNA. The problem ... (inaudible) here, it’s like when you go to the nurse and tell the nurse about the patient, you know you are dealing with them, we are the ones who see everything on the patient, but when you go tell them that the patient needs this, the patient needs that, the patient does this, they don’t even pay attention to you, it’s like you have to go so many times before they do something about it.
“And I heard one CNA said when they go to report something to the nurses about the patient, they're like ‘You don’t have to tell me what to do. I'm the nurse.’”
“What we are saying is it is not like we have-- we don’t have any problem with anybody, but there are some things,because sometimes if you are the nurse, and I am a CNA, there are some things I cannot tell you because you don’t think I'm telling you the right thing, because maybe you have another experience of how you handle things, but maybe if we sit down and you listen to it, you're going to see what I'm telling you is better than what you know. And sometimes people see you when you are a CNA, they say, ‘No, I went to school for this and this, you don’t need to tell me nothing.’”
Reports of unit charge nurses
Do CNAs have input into the care plans?
“In a way they do, because we are reflecting on their work ... (inaudible) or whatever they do for the patient. ... (inaudible) so that patient is more tired, we need to ... (inaudible) timely basis so they ... (inaudible).”
“They chart, and we [nurses] look at the charts. They have the kind of diet they're on, their transfer, whether or not they have a restraint, positioning, hygiene, like whether or not they're independent, or any special skin care, limitations.”
“…The care plans, most of the time, will go according to the nurse’s summary, and the nurse’s summary will take into account the CNA assignments. So when I’m doing my nurse’s summary, I’ll look at the CNA’s record, and then I’ll do my summary from there, and then the unit manager will do the care plan from my nurse’s summary.”
“They're the ones directly giving the care, so if they notice a change, they go to the charge nurse and they give their recommendation and their reasoning. If it’s determined a change needs to be done, then it’s changed.”
“Sometimes CNAs will come to the meetings, yes. They try to get them involved, because I think they’re really the front line people. They see [the residents]. They know them better than we do. So yes, they’re encouraged to go. They’ll get the primary aides whenever they’re doing that particular resident, they’ll bring them in. …Besides mine, their input is really important. Because ... anything they will see for the patient, they will be the first. If it’s not any open area like on their face or something that anyone can see, because they’re always changing the patient or doing things, they will tell us what’s going on, if we didn’t see it, like at first.”
“They don’t have an aide go anymore. We used to have aides go to the care plan meetings, which was good. Now, I would say today I went to my very first one in probably seven years and there was just the MDS, MMQ, social worker, myself and the family, and the patient...But we don’t have an aide, which I think might be a better part of that team. Because some of the aides know far more about people than I do.”
Direct care workers are the heart and hands of nursing home care
Direct care workers are the heart and handsAND key eyes, ears, and mindsfor HIGH-VALUE nursing home care