Providence News  July 2010

|   Director of Certified Nursing Assistants Best Practices

SOUTH HOLLAND, ILLINOIS (July, 2010)  |  Debra Brandy is a self-described "early bird." Every weekday, Brandy rises with the sun and reports to work at Providence Healthcare and Rehabilitation Center of South Holland, a facility in suburban Chicago that provides post-acute rehabilitation and skilled long-term nursing care. Brandy checks in on certified nursing assistants (CNAs) who are just finishing up their overnight shifts, which end at 7 a.m. She'll ask them if they experienced any problems during their shifts, or whether they have any new information to report about a resident. Brandy spends the rest of her day circulating throughout the building, trying her best to talk to everyone on the floor. A few days a week, she’ll stay late to speak with the CNAs starting their 3 p.m. to 11 p.m. shifts. And in the morning, she gets up and does it all over again.

Brandy is the Director of Certified Nursing Assistants (DCNA) at Providence's South Holland facility. In that role, which she assumed in 2005, Brandy is tasked with coordinating the care provided by CNAs, ensuring that they are all performing at a high level, and addressing any problems or concerns they may have about their jobs. Providence employs DCNAs at four of its facilities: In addition to the South Holland location, there are DCNAs at campuses in Downers Grove and Palos Heights (both in Illinois), and in Zeeland, Michigan.

The DCNA position is a relatively new addition to Providence Life Services, which dates back to 1960. But it has become an invaluable component of Providence's approach to long-term care, says Linda Schutt, Providence's Vice President of Education. Schutt has firsthand experience with the DCNA position: She was Providence's very first DCNA, promoted from her role as a facility educator in 1999.

Modeling Good Practices
One of the DCNA's most important tasks is to be an effective role model for their staff. The DCNA must "really show what's needed and what's expected from the CNA staff," Schutt says. To that end, DCNAs must make sure to exhibit strong, respectful communication skills in all of their interactions with residents and other nursing staff; the idea is that CNAs will emulate this behavior when they are engaged in similar interactions.

Additionally, DCNAs must mentor CNAs who turn to them for help – and, when possible, match CNAs up with more experienced CNAs for one-on-one peer mentoring. (Currently, this peer mentoring is done informally, but Providence is working on a way to formalize the process. Interested CNAs will have the opportunity to become official peer mentors – and receive additional pay – after completing an yet-to-be-determined application process, which may include interviews and references.) More generally, DCNAs are expected at all times to promote a positive spirit of teamwork throughout their CNA staff. "The success of the CNAs is ultimately the responsibility of the director of CNAs," Schutt says.

Representing CNAs Within the Organization
Brandy says that DCNAs serve another important function: as the on-the-floor advocate for CNAs. DCNAs supervise the CNA staff, but they also work to ensure that they are treated fairly and respectfully by higher-level nursing staff, residents, and administrators. "It's good for the staff to have a director because it gives them a voice," she says. Brandy also tries to foster a close bond with her staff – "to let them know that we're all on the same team" – by working right alongside CNAs as they feed, bathe, and toilet residents. "I believe in being out on the floor... It's important to get to know staff – their individual styles, and how they do things," she says.

Brandy says she tries to formally meet with her entire staff about once a month. The DCNAs themselves design meeting agendas, addressing any issues that need to be brought to the forefront – for example, they must keep CNAs abreast of any changes in organizational policy. CNAs are also encouraged to continue treating residents with patience and respect. Brandy says that she often includes motivational statements in her meetings – at a recent meeting, for example, she reminded her staff that "people might forget what you say, and they might forget what you do, but they'll never forget how you make them feel."

All CNAs within a given facility are expected to attend the monthly meeting, which Brandy says she holds twice, on back-to-back days, to give all CNAs the opportunity to attend. Additionally, Brandy says she meets with her facility's director of nursing at least once a day to discuss care practices; within the Providence hierarchy, DCNAs and nursing directors are considered peers. Brandy is also in regular contact with various department heads and floor managers in the South Holland facility. DCNAs report to their campus administrator.

Outcomes
Freshly Re-committed. As of this writing (June 2010), the DCNA position is in a transitional period. Early in 2010, Providence administrators formally reevaluated the DCNA role. Consequently, Providence has experienced a "renewed passion" for its DCNAs, Schutt says. The organization is freshly re-committed to supporting DCNAs, and is taking steps to ensure that the DCNA role remains strong. For example, Schutt says that, in the coming months, she will begin regularly meeting with the three other DCNAs in an attempt to coordinate their training and mentoring efforts. DCNAs will also begin regular meetings with Providence’s vice president of clinical services to coordinate care practices.

Visibility and Validation. Schutt says that it is difficult to determine the precise effect that the DCNA position has had on the CNA staff. Providence facilities conduct yearly staff satisfaction surveys, and the results are consistently positive, but it is nearly impossible to attribute those results to any specific element of the CNA's jobs, Schutts says. Anecdotally, however, Schutt says that the adoption of the DCNA position has seemed to improve CNA staff morale by increasing their visibility within their facilities.

"If you look at a traditional hierarchical chart, [CNAs] are sort of at the bottom – the last to receive attention and recognition and mentoring and things like that – and they are kind of aware of that," Schutt says. Having a DCNA "changes that perception [by] giving them a department head to go to so that someone can advocate for them... It validates the importance of the CNA." Theoretically, she adds, that boost in job satisfaction translates into an improvement in the quality of care that CNAs provide. "If the DCNA is successful, then we have a lot of CNA staff who are successful."

Lessons Learned
Hiring Strategy. Shortly after instituting the DCNA position, Providence administrators quickly learned that their initial hiring strategy – promoting CNAs from within the organization – would not be as successful as they thought. Schutt recalls that one CNA seemed like an excellent DCNA candidate: well-liked, respected, knowledgeable, insightful. However, Providence found that "going from being a floor CNA to a managerial position is a really large leap" – too large, as it turned out. Today, two of the four DCNAs are registered nurses (RNs), and the other two are licensed practical nurses (LPNs) – including Deb Brandy, who is in training to become an RN.

Recruitment. Schutt says that Providence has also learned over the years exactly what type of person makes the best DCNA. They need to have passion for direct-care workers as a group, and for the individuals that comprise that group. They need to understand what CNAs do, and understand their importance to Providence's success. They must have good communications skills, a strong sense of fairness, and respect for other people. They must have the tenacity to follow up on any unresolved issues within their staff, and the fortitude to make hard decisions. And they must be approachable, evincing genuine interest in their staff's problems, concerns, and ideas. "I love seeing [CNA] staff be proud of what it is they do and feel like they are really making a difference," Schutt says, "and I think that is what the DCNA is able to do."

As reported by the PHI Training & Organizational Development Services website.