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Just one more question

April 1, 2008
by Gary Tetz
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Like the great TV detective Columbo, Long-Term Living columnist Gary Tetz (Funny You Should Ask) always has one more question. In this bimonthly feature, he talks with long-term care leaders about anything that pops into his mind. He's as surprised as you are that they'll speak to him, and apologizes in advance for whatever inanity he might blurt out in the pressure of the moment.

The last time I saw Lori Porter, she was being greeted like a rock star by a few hundred CNAs as she took the stage at a National Association of Geriatric Nursing Assistants (NAGNA) convention. Founded in 1995, the organization she co-created is now called the National Association of Health Care Assistants (NAHCA), and is still seeking to elevate the profession through education, advocacy, and empowerment.

In a 25-year career in long-term care, Lori has been a dietary aide, CNA, nursing home administrator, and operations director. She's also a nationally known speaker and author of the book, Everything I Learned in Life I Learned in Long-Term Care. I tracked her down at the association's world headquarters in Joplin, Missouri. The conversation began with an unexpected accusation.

Hey, Gary. How are you?

Doing well, Lori. How are you?

I'm doing fine. Did you just yawn?

No! (Incredulously) Absolutely not.

Oh. I thought you did, and it made me want to.

(The allegation rendered me temporarily mute, but after a moment of awkward silence, I pulled myself together and continued the interrogation.)

So what's going on at your organization?

I'm sure you've caught on that we don't call ourselves NAGNA anymore. Many of our members are from healthcare settings other than geriatrics, so we started a new corporation called the National Association of Health Care Assistants (NAHCA).

In 2005, we created the Academy of Certified Health Professionals to run all our education certification programs, and now we're launching our full career ladder virtual campus. It is state-of-the-art online continuing education training that's never been present in long-term care before. We're real proud of it.

What's your main focus right now?

Well, here's what I know. We're in deep trouble if we don't change the culture. It is devastating for long-term care to continue to operate in a desperately seeking workforce mode, but if we recruited 500,000 nurses and nurse aides today, we'd be short again in a month because we don't have a workforce culture that is welcoming to new people.

The old image of the low man on the totem pole, peon, and butt wiper was born out of an organizational chart that has only one measure of value in long-term care—who is responsible if things go wrong. It perpetuated the idea that one person is more important than another, so I work with facilities to create a value chart where every position is on the same line with equal value.

When I was a CNA, our administrator would get up in front of us and say, “You're the backbone. We couldn't run the place without you.” Well, that led us to believe we were the most important, which was a terrible thing to perpetuate. Let dietary stay home a day or two. Let housekeeping all call in at the same time. We find out very quickly just how important every single position is to meeting the residents' needs.

Why is workforce culture so poor?

Burnout is the number one cause of turnover in our profession, but we don't pay attention to it. We think it's just an inherited condition, even though it's largely caused by the fact that people cannot see the end result of their work. We have a mandatory fire safety in-service every year, but as I've often said, we'll lose far more people to burnout than will ever burn up. When people can see the end result of their work, they know their contribution means something. So that's the focus of a lot of our programs.

You can take a 40-year-old building or a brand-new Taj Mahal built for culture change, and the old facility will outperform the new building if the workforce culture is as it should be. Because when it's all said and done, it isn't the bricks and mortar. It's the human capital inside.

Any miracle cures for burnout?

Let's say you're a 2 p.m.-10 p.m. nursing assistant. Day shift has jumped on the wheel and turned it as fast as they can for their eight hours—getting people up, getting them fed, delivering care, getting them to bed. Then they jump off the wheel and you jump on, turning it for your eight hours. This continues day in and day out, and you never see the final score because it's never really final. This leads to burnout.

One good way to fight it is to get everyone invested in some other area of the facility. For example, I ask administrators to set up a budget and finance team that might include a couple CNAs and maybe a housekeeper or cook—people who will learn outside their own role what it takes to make long-term care work. Does the administrator really need their financial help? No, not really. But what it does is expand their knowledge base about budgeting, and lets them see that the facility's not getting rich and paying them little. When they understand that, it's a step toward creating a workforce culture of mutual respect and understanding.