Clint Maun, CSP
Spreading responsibility across all employees in the facility relieves stress in individual staff members.
Stress of all kinds pummels those who work in long term care. Facilities are expected to deal with major reimbursement changes, staffing concerns, regulatory compliance changes, consumer awareness issues, and higher resident acuity. Getting staff involved in an information-intensive team environment with strong management support can help alleviate stress and turmoil.
Stress has been defined as conflict between mind and body. Negative stress can result in problems for the organization, including morale issues, apathy, absenteeism, turnover, customer service problems, quality issues, and general disarray.
Today’s long term care managers must have specific techniques for preventing stress inside the facility on a daily basis.
Staff comes under stress for a variety of reasons. Marketing staff worry about census. Business managers worry about turnover. Nurses worry about outcomes. And all staff feel stressed by the sheer number of tasks that must be accomplished in any given day.
Management can reduce stress by implementing a team-based structure. The entire staff will learn to take ownership of the responsibilities of the facility as a whole, as well as share in its successes.
For example, when the minimum data set (MDS) nurse is the only one who knows reimbursement and the prospective payment system (PPS), that nurse is often stressed by being the only employee knowledgeable about and responsible for documentation and assessment periods.
Education in the MDS process will show staff, for example, how their documentation efforts are invaluable in successful outcomes and appropriate reimbursement. At the same time, the MDS nurse will have the comfort of shared responsibility. Similarly, putting the responsibility for quality on a few quality assurance individuals instead of the team will result in heightened stress throughout the organization.
To get people started in the team-based model, administrators should implement a training program that educates staff in all aspects of a facility’s operations, including PPS and each discipline’s role in the care-delivery process. Knowing the responsibilities and goals of each discipline helps staff understand how they fit into the big picture and how they can share the responsibilities and rewards of successful facility operations.
Management must educate the staff about how this can benefit them as well. For example, say the facility wishes to decrease its usage of temporary workers’ pool. Providers can point out to staff that money saved from high use of the pool can go toward more supplies or better equipment, and nurses will not have to follow up on work that may be left undone by a temporary nurse who does not know the system.
Once staff realizes the value of the team concept, they will pitch in to make goals a reality. In the case above, nurses will be motivated not to frivolously call in sick, or they will be required to arrange their own replacements when they are absent. Residents gain from continuity of care, and the continuity of care can also be used as a selling tool by marketing staff.
But staff will not accept ownership of the facility if they are in the dark about what management is doing. Therefore, managers must share information with staff including turnover rate, census, customer satisfaction survey results, and key indicators of residents’ conditions, such as the number of residents with pressure ulcers.
When the facility initiates programs to improve certain numbers, all staff can share in the progress. For example, if the goal is to increase occupancy from 225 beds to 250, managers should post weekly progress reports in a prominent place for the staff to review. This encourages staff to invest in the program and take responsibility for its success.
Once staff is in the habit of sharing responsibility, stress levels will plummet. And staffs who are motivated to plan for successful outcomes are less likely to be overcome by stress borne of an inability to act.
Dealing With Disgruntled Staff Members
One of the greatest contributors to stress are staff members who are continually moaning and groaning. Their negative influence can travel like wildfire and must be dealt with decisively. The only way to deal with this kind of negativity is for management to foster a positive culture change in which negativity is not tolerated. Management must make it clear that continual whiners and malcontents will not be tolerated.
Also, management should teach shift leaders how to communicate information to the next shift positively. For example, if a problem has occurred on the night shift, the shift leader should say, “Mrs. Johnson had a bad night. But here are some suggestions for how to make her day easier,“ rather than, “My, are you going to have your hands full with Mrs. Johnson.” A pervasive positive attitude throughout the facility is an antidote to stress.
Wasted Time Causes Stress
An inefficient use of valuable time can frustrate employees, leading to stress. Therefore, every shift, meeting, conferences, or training session should begin on time, be under control and be upbeat.
Team meetings and all staff gatherings should have focused agendas and be solution-oriented and prioritized. This focus and orientation will foster staff confidence in a job that is going smoothly and efficiently. Staff should not be allowed to derail meetings with irrelevant comments or complaints on other topics.
Many organizations foster stressful situations by allowing employees to waste time at the start of the morning with shift adjustments and getting themselves ready, even while they complain that they can’t get everything accomplished by the end of the shift.
Management must make sure that staff arrive on time and begin work promptly because, if tasks remain undone, the surplus work will be passed on to the afternoon and night shifts, causing staff more stress.
Early on, managers must identify and confront any potential problems that could throw the day off course, causing stress, such as staff relationship conflicts, combative residents, or equipment malfunctions and operational issues in the facility itself.
Sharing the Workload on Busiest Shifts
Another big cause of stress is overwork. Providers may not be able to increase the number of staff, but they may employ techniques to spread the workload.
The morning shift – frequently set from 6 a.m. to 1 p.m. – is the busiest time of the day. During these hours, staff must help residents arise, dress and prepare for the day.
During the first shift, staff must serve two meals, administer tests such as blood and urine, give treatments, distribute medications and supervise activities. They also have to deal with whatever care crises might arise unexpectedly. Thus, the first shift can be a particularly stressful period.
Management can spread some of this work out by starting the first shift at 7 a.m. rather than 6 a.m. That way, nurses from the night shift can help with morning work by getting some residents up, helping them to dress and administering tests or medications as appropriate.
Managers should also be called on to help. The facility administrator and director of nursing (DON) should be in the building and out on the floor during the first seven hours of every day. All managers should postpone paperwork responsibilities and vendor or other business meetings until later, less-busy hours of the day so they are available to help if problems arise.
In addition, managers should run training programs that cannot be scheduled later in the day in small modules of two or three employees so floors or units aren’t emptied of staff during critical hours.
Making Mealtime a Pleasant Experience
Mealtime can be a particularly stressful time for staff. Six hours of a resident’s life each day are spent in the pre-dining, actual, or post-dining experience and meals are labor-intensive for staff. It’s important for the facility to make sure this is a smooth, wonderful experience for both residents and staff.
Management can head off mealtime stress by ensuring that the administrator, DON, department heads and other management team members are involved in the dining experience.
Unless the manager is a nurse, managers cannot help with nursing activities such as assisting a resident to dress. But they can help by assisting residents with wheelchairs or walkers from their rooms or activities to the dining room, getting them comfortable at the table and fetching coffee.
Managers also should be involved in making sure that interchanges between departments (especially dining, dietary and nursing) are positive and that their relationships are turf-free.
Managers should be scheduled at all meals, including nights and weekends when residents’ families visit, since family members often have questions or concerns that can be handled on the spot.
This practice has the added advantage of making families feel that managers are directly involved with residents.
If the facility makes it to the end of the first shift smoothly, other shifts – unburdened by carryover problems or unfinished tasks – have a chance to get a fresh start. Then it is likely that the rest of the day will run well and staff will carry out their jobs without unneeded stress.
Providers should look at each day as an opportunity to produce the desired outcome of happy residents and stress-free staff. Administrators and leadership team members should promote openness and communication, weeding out counterproductive lethargy and negativity, and look to the critical times of each day. They should check to see if their routines need retooling to accommodate the appropriate emphasis on shift starts, changes of activities and meals. Most importantly, they should encourage the teamwork necessary for a stress-free operation.
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