An ‘Out-of-the-Box’ Plan that Would Help Nurse Staffing: Is this a Practical Idea or Too Crazy?

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think outside boxWhat if EVERYONE who works in a hospital or nursing home, (Excluding anyone physically limited) is required to take a 6-8 week Nurse Assistant course?    The CEO or Nursing Home Administrator giving someone a shower or helping change a combative patient who has been incontinent?  A doctor, are you kidding? People laugh and roll their eyes when I suggest this solution, but I’m serious!  Why is it so crazy?  It would solve staffing problems in two very BIG ways.

First, there would always be an extra pair of hands to help out when staff are out sick or there is a shortage of staff for some other reason.  

Second, there would be organizational wide appreciation for the value and challenges of doing the work.  This would indirectly help staffing because it would help to create a culture where these workers are treated like the special resources they are.  This would include making sufficient staffing a priority and a little empathy for how long it takes to provide total care for some one might help with budget priorities.  With enough skilled nurses’ assistants, nurses could delegate more effectively.  Care would be done in the most cost-effective way.

This direct care work is often some of the hardest, critical, and most time-consuming work that goes on.  These para-professionals play a vital role in helping nurses get more complex work done.  It is so important in the care and comfort of patients, and when done well with compassion, patient experience can soar.

It is also back-breaking and much tougher when there are not enough staff.  If you’ve been a patient or have a family member who has received really excellent doc nurse handshakecare from a Licensed or Certified Nursing Assistant you KNOW what I am talking about. Not all LNAs or CNAs are amazing, but some sure are.  I am eternally grateful to the ones who have helped my mother over the last couple of years and the many excellent ones I’ve worked with over the years.  Here are a few stories:

Treasure Our Nurse Assistants! They are Doing One of the Hardest & Most Important Jobs in the World!

Improv, Intuition & Dementia: A Miracle Moment from the Frontlines of Nursing Care w/ Alzheimer’s Patients

Another Miracle Moment on The Alzheimer’s Unit & Two Awesome Licensed Nurse Assistants

Empathy Matters! Late at Night, in Rehab, My Anxious Mom, & ” A Woman Named Wendy”


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9 Responses to An ‘Out-of-the-Box’ Plan that Would Help Nurse Staffing: Is this a Practical Idea or Too Crazy?

  1. Darmel Hudson, BSN, RN, CCM, CCCTM says:

    The insight here, as much as the dialog, are mind stimulating towards a solution to the long-standing problem of inadequate resources in healthcare staffing. It does make for a solid argument as one possible solution towards addressing the lack of a true team-oriented approach to caring for our patient populations, and simply put, not having the empathy or respect for one another’s roles within the healthcare environment.

    I also appreciated Margaret’s input and excellent examples of the possible cons that might be anticipated with the model suggestion and the counter-offer of what could be an alternate approach. Having made these observations after reading all of the content here, I believe Beth offers a plausible approach towards mending some of the fragmentation that exists in part, due to the heirarchy (unitentional or not) among healthcare disciplines.

    Excellent article and excellent dialog for beginning discussion on what we all know is a multifaceted problem that requires a multifaceted solution.

    • Thanks so much for your feedback, Darmel. I appreciate your note that fragmentation may be intentional or not…perhaps some of both, right. If we can acknowledge that and not get in a power struggle over THAT, and try out the idea, I think that the difference will become clearer….Intuitively I would imagine that there would be more resistance from the more intentionally fragmenting leaders and that will surface?

      • Darmel Hudson says:

        Absolutely, Beth! That surfacing of fragmentation and the ability to identify its underlying source may lead to some enlightenment to the source and discussion on ways to minimize or eradicate the fragmentation. One can always hope, right?

        What I liked about your propsal is that it opens the door to see first hand what the other staff really do as a member of the team. Perhaps that insight could lead to increased respect and worth towards that CNA staff members role and the value that work brings to both patient care and the overall team.

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  3. way to Go Beth!!!!

    I have been suggesting just precisely this for the past 35 years!!!

    I call it “walk a mile in my moccasins” but it has been called many, many things over the eons of caring, all the way back to the Lady of the Lamp!

    oh, take a look at the website… it didn’t even exist prior to my nursey nudging

    so keep on keeping on!!!

  4. Hi Margaret,
    Thanks for your thoughtful response! I think your constructive comments and ideas are great and open the door to discussions between staff and administrators that could help come up with a practical model AND build mutual appreciation.

    The dialogues seem are really important and the process key to effective outcomes. I can imagine your model working really well with that in mind. Maybe start with a unit or department?

    Maybe some initial focus groups with staff and admin champions could create some good will and mutual resect while building the list of supportive tasks. Other ways of applying the idea might be to have rotating admin obligation that would promote using and not loosing a particular skill. Or deciding on the most needed/helpful skills and maintaining currency of the skill set. All sorts of ideas and respect might emerge with these conversations!

    Please keep us posted! Beth

  5. Margaret Ecker says:

    This proposal is so full of good will, and kindness even. Maybe even just setting it up would generate good feelings for the staff. Of several down sides that occur to me, however, the most important is that the skill itself is a sort of “use or loose it” skill. As a registered nurse who spent time in hospital administration, I had the experience of trying to pitch in during a local critical event where the emergency room was getting slammed. I was astonished at how bumbling I felt in the moment…couldn’t really steer the gurneys, didn’t know quickly where to document the blood pressures. The staff appreciated the gesture but in reality the gift was more in spirit than in fact. Paraprofessional skills are still skills–learned, specialized, sometimes tricky, sometimes with risk if not performed properly.
    Maybe a proposal down the middle, where you figure out what of your administrative skills could help in a staffing crisis, would be just as good or even better a contribution. Develop and publish an algorithm that describes how administrators will be deployed when staffing reaches a certain point–facilitate discharges by calling attending MDs, make calls from the staffing office, direct traffic in the lobby, whatever. And as a fringe benefit, generate new respect for the value of management skills, working alongside clinical skills.

What are your thoughts?