Staff Evaluations in Long-Term Care

Hiring for Fit, Empathy Important

staff evaluations
Hire for fit and reduce turnover. Consistently evaluate and keep good people.. Getty Images

Long Term Care is known for high staff turnover rates, particularly among CNA's. However when you hire for fit you can increase the odds that there will be fewer staff turning over. And when you consistently perform staff evaluations in long-term care, you increase the likelihood that good people will stay.

Unquestionably, the work is hard and the money is tight. As I recovered from serious injuries in a car accident, I became a resident of the nursing home where I was administrator.

During this time, I began to process this turnover issue from a different point of view. Stable staffing has many advantages, including continuity of care, financial savings, and improved quality.

As administrator, when I interview a potential new caregiving employee, I begin by asking, "So why did you want to become a nurse/CNA in the first place?" It's a good icebreaker question. Anyone can answer it, and it gives me a glimpse into who the person is. Usually, what I hear is something like "I enjoy being able to put a smile on someone's face" or "I can learn so much from the elderly" or "We took care of grandma while I was growing up and I realized how much I enjoy the elderly." In fact, those are the answers I want - something to do with relationships. If I don't hear something about relationships, it's a red flag to me.

I also have a mental test: I once had a resident whose son was a lawyer.

They were a wonderful family, attentive to the mother, supportive of the facility. Mentally, I pictured myself taking this new hire down the hall, introducing him/her to the son, and saying, "I'd like you to meet ______. I think she'd be a wonderful caregiver for your mother." If I could not envision this scene, then I knew there was a problem.

Once this person is hired and oriented, we introduce him/her to a small group of people, saying that we want him/her to develop a relationship with each - essentially, to care ABOUT, as well as care FOR, these people. Everything goes well for a while, until the initial 6-month or 12-month evaluation comes along. Then that evaluation form comes out, which asks questions such as: how often were you absent? How often were you tardy? How often was your documentation late or missing? In other words, we catch staff doing the wrong things wrong, rather than the right things right.

Where did these evaluation forms originate? Probably from a factory where productivity is king. When was the last time you saw an evaluation form that said: I saw you take a resident outside on a sunny day ____ many times this year. I saw you bring a smile to a resident's face ____ many times this year. I saw you holding the hand of a crying resident ___ many times this year.

On a subconscious level, employees will then begin a shift in their performance.

"I thought you wanted me to take time to relate to the residents, but apparently I need to speed things up." Then managers criticize staff for treating residents as objects on an assembly line, not realizing that we're unintentionally creating that expectation.

One day I came across a CNA singing and dancing with a resident in the hall. She saw me, her face grew red, and she apologized. Why? This was a resident who was notorious for refusing to walk with staff to maintain her mobility. By making the activity fun, this CNA had successfully engaged the resident. I told her there was no need to apologize because I was thrilled to see the resident walking, dancing, and smiling.

Then I began to wonder, “What am I doing that would lead my staff to think they should apologize for having fun and developing a relationship with the residents? What do I need to change to support that culture?”

People teach to the test, and perform to the test. We all want a good evaluation, to meet or exceed our boss's expectations. If we find that PRODUCTIVITY is valued over RELATIONSHIP, then that's what will be provided - robotic, unemotional, dispassionate care. Today's healthcare environment forces us to "do more with less", and the money isn't available for more staff, so a balance needs to be struck.

Exit interview results often show that a major reason people leave long term care is a lack of time to form relationships with the residents. This shouldn’t come as a surprise; our staff tell us what they want, and it's the same thing managers, residents, and families want: relationships. And the other great thing: it also results in quality patient outcomes! Focusing on relationships creates a win-win situation!

Thanks to Philip DuBois, CNHA, FACHCA for contributing this article. He is Assistant Program Manager, Long-Term Care Administration at Saint Joseph's College of Maine, and a national speaker on topics of foster/adoptive care, living as a resident in the nursing home where he was administrator, workplace safety, ethics, forgiveness, and the Christian response to grief. He is the Maine chapter Past President and Fellow of American College of Health Care Administrators; licensed Advent Christian minister; licensed foster/adoptive father; member of Hope for Maine Kids; Maine Heart Gallery coordinator. He released a CD of Christian music, "Songs of Deliverance," in 2010.

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