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5 secrets your line staff wishes you knew

April 26, 2012
by Eleanor Feldman Barbera, PhD
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Click-clack. Click-Clack.  The hard-bottomed shoes of the administrator echoed through the halls once again, this time accompanied by the high heels of the director of nursing. The crepe-soled nursing staff moved about the floor, silently hoping the bigwigs would notice and address the problems that frustrate them on a daily basis.

Do you ever wonder what your staff isn’t telling you? Are you puzzled why, despite all your efforts, the organization isn’t functioning as efficiently as you’d hoped? In January, I revealed the secrets your line staff doesn’t want you to know. Now, here are the secrets the staff won’t say, but wants to—secrets that will transform your facility.

1. The staff members who are doing their jobs properly wish you’d be on the floors more often. 

They’d never “rat out” their coworkers, but they’d like you to catch how often their colleagues disappear for unscheduled breaks, or the way they talk to some of the residents. Your frequent and unexpected presence raises the level of professionalism of your staff and keeps you in touch with the realities of day-to-day care. By taking some time to sit at the nursing station, for example, workers can observe and emulate your style of interacting with the residents and their families. Participating during the change of shift report can offer the opportunity to influence the type of information offered during this important transition. You become more familiar and approachable, rather than a “bigwig” in an office, and find out more of the information you need to know to make your nursing home proactive and productive.

2. All this disorganization is driving them crazy.

It’s not in the nursing job description to reorganize the file drawer—but isn’t it in somebody’s job description? Please, send someone over to put the forms in place, because if it takes each staff member 10 minutes to locate the MD order form, that is way too much time wasted. While you’re at it, organize the linen, pantry and supply closets—and make them the same on every floor, so floaters can quickly find the things they need. The time it takes to do this properly—with some forethought and planning about what goes where—will quickly pay off as multiple staff members on multiple floors can easily locate the tools essential for their jobs.

3. Staff members hope you’ll help them talk with coworkers in other departments.

Each department has a method for handling their own interactions—they know their people and have their meetings to address problems and systems. But when interdepartmental issues arise—as they frequently do in a team approach—it’s difficult for them negotiate peer-to-peer problems. For example, the nursing staff is supposed to be preparing residents for activities, but the residents are still dressing when the recreation staff arrives for transport. In another instance, the nursing staff records maintenance issues in the logbook, but the repairs never come. These types of situations lead to interdepartmental friction, staff frustration and reduced resident care. The line staff from each department can only bring the problem to the attention of their supervisors. The supervisors can only influence their own line staff. The solution needs to come from above, by someone who, along with the supervisors, can identify the problems within each department that affect another and find solutions that work for all departments involved. Tack a few extra minutes on to interdepartmental meetings to identify issues affecting multiple departments and to set up a time to address them.

4. They’d like you to coordinate a unified approach to working with residents with dementia.

The key to success with residents living with dementia is to offer an environment that reduces rather than exacerbates their symptoms. If one aide has a knack for calming her residents and engaging them in their care, but her coworker’s style creates distress, the agitated residents will disrupt the entire floor. If the nurse attempts to create a peaceful setting for her unit, but the serenity is interrupted by frequent overhead pages or challenged by squeaky meal carts, her efforts are stymied. Dementia care—even on units that aren’t designated as being for residents with memory impairment—requires attention to the atmosphere, which is beyond individual control. Providing engaging activities while reducing unnecessary noise and disruptions will help staff make the most of their independent efforts.

5. They’ve got their own problems.

A stressful job. Low pay. Family issues. Alcoholism. Health concerns. The line staff has a lot on its plate, and sometimes it shows in absenteeism, tardiness and poor work performance. Many of these problems can be remedied by offering an employee assistance program that provides individual staff members with brief counseling and referrals to additional resources, as well as in-house training and education to create a healthier and more productive work environment. For more on EAP programs, visit the Employee Assistance Trade Association at easna.org.  To address difficulties staff is having with residents and their families, consider hiring your consulting psychologist to provide an hour or two of weekly open office hours where staff can discreetly resolve these situations.





As a licensed nursing home administrator for 30 years and a former line staff worker (more years ago than I care to remember), I very much appreciate your post. I especially connected with your first secret, which is one that I have preached for many years. The presence of the administrator and the department heads out on the floor projects a powerful message to all staff. Not only will your staff appreciate a management presence out on the floor but it will also be noticed by patients, visitors and vendors. Successful facilities, without exception, are led by administrators that are out, visible and accessible to everyone.

We are in the business of caring for people, what better way to show that by being out there among them.

Dr. El,

Thank you for a great article! I was trying to figure out if we could start with just one thing, what would it be. I don't know, #1 is particularly important, but all of them alone could transform an entire facility.

Thanks, Doc. I'll be taking this one in this morning and sharing it with leadership staff. We all need these reminders now and again. I thought the point about unified care for residents with dementia was very interesting - something I need to work on for sure.

I'm glad my article is generating a discussion.

LHNA, you make a good point about the visibility of the administrative staff making an impact on residents and families as well as on the line staff.

Anonymous #1, I agree with suggestion #1 as a starting point. With the administrative staff on the floors more often, the other suggestions will become more apparent and the course of action to correct them will be more clear.

Anonymous #2, great to hear you'll be sharing this article and looking at new ways of addressing dementia in your organization.

~Eleanor Feldman Barbera, PhD

These are all very realistic approaches to everyday struggles of line staff. Thank you for reminding us, bringing them to our attention.