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The Basics of Staff Education

April 1, 2002
by root
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They can lead to staffretention and high - quality careBy Leah Klusch
It involves much more than mandatory in-services,
and pays off in many ways
No matter where it is located or the level of acuity it treats, a long-term care facility often echoes with the words "in-service meeting" or, better yet, "mandatory in-service." Just walk past the employee entrance or the time clock and you will see these words in print, as well. Regulation directs facilities to educate their staffs, requiring them to present specific topics at defined time intervals and to include various groups of employees.

These education and training duties are, in many facilities, delegated through the nursing staff. Frequently these hardworking professionals see only the tasks and the requirements involved. They miss the vital point that the task of educating staff is so much broader than the typical assignment to "get the in-services done" and "make sure everyone signs in to get his credit." In fact, the knowledge base of a facility's staff and management is the foundation of that facility's quality of care, as well as of its regulatory compliance. Including staff education and competency evaluation in the facility's strategic plan gives management the opportunity to design the knowledge base of the employees and direct everything that flows from it.

The good news is that this approach is not expensive, and yet the impact on resident care and employee retention will be obvious. When considering expense, think of all the meaningless or counterproductive programs that we have scheduled and demanded that our staffs endure without any measurement of the results. For example, the "mandatory end-of-shift program in a warm room or you won't get your paycheck" scenario comes to mind. Each minute we waste in any facility process is expensive, but the habit that staff acquires of attending the program and not learning or being held accountable for learning is even more expensive.

Facilities must realize, of course, that development of effective staff education is an investment. Each time you gather a group of employees to learn, you are investing significant resources; just figure the hourly rate for the employees for that time period, plus the time and effort required to prepare and present the material for the session. But the expense begins to make sense when you ask yourself, does the training room promote learning? Are staff present just to be compliant, or are we stimulating thought and changing behavior?

Starting Off on the Right Foot

The foundation of the staff development program begins with an investment in orientation. Many orientation programs do not begin the educational process properly. Design of an orientation program must begin with the question, what is the knowledge base our employees need to work in our facility? The orientation program must focus on practical information, facility policies and procedures, employee attitudes and competency evaluation (which will be discussed later). The facility's mission must permeate the program.

Some further thoughts on orientation: Ingredients of a successful orientation include regulatory "survival training," communication skills, core clinical requirements, easy-to-read reminders ("cheat sheets") and mentoring of new employees by selected staff members. Competency testing should be included, as well. Most orientation programs don't allow sufficient time for the new staff person to ask questions. Finally, the expectation that learning will be an ongoing part of the job must permeate the orientation process.

Developing the Programs

Training programs for caregivers, as required by federal and state regulations, must fit into the facility's overall strategy. The nurses teaching these programs must understand the necessary conversion from clinician to trainer they must make-a very difficult task for some clinical professionals. Many learners, meanwhile, have their own barriers to contend with because of their educational backgrounds and life circumstances. To expedite the process for everyone, facilities need clinically accurate, well-organized, easy-to-implement materials that are presented clearly and pleasantly. (A recently published textbook/resource for nurse aide training classes from Hartman Publishing, Reach for the Stars! The Complete Guide to Successful Nursing Assistant Care by Diana Dugan, RN, is an excellent example; see Product Spotlight, p. 12.)

Classes must be structured with the learner in mind. That means, for example, using short periods of lecture presentation and skills demonstrations, with open discussion and problem solving as a focus. As for topics, it is very important that the caregiver training program include current regulatory information so the trainee can understand the reasons for procedures and policies. (Remember, new caregivers could meet a surveyor the first day after the class; they need to know what to do and how to respond to surveyors' questions.) Also, since the Minimum Data Set (MDS) is used in all nursing homes, caregivers should know not only that it exists, but that the MDS information they gather about the residents and their resulting care delivery will be recorded in the facility's database for reimbursement and quality assessment.

Clinical material presented should not only focus on resident care, but provide the trainee with the basic concepts of infection control, resident and staff safety, communication, resident rights, restorative care, and resident care observation and reporting.