All Hands On Deck
/All Hands On Deck
Hear the administrator and admissions coordinator at Bayberry Commons in Pascoag, RI describe why and how they used a leadership intervention–All Hands on Deck–to reduce stress and instability, and transform from a special focus “nursing home in need” to an AHCA Silver Award winning “nursing home in the lead”.
Their story is captured in the May 2013 issue of Provider Magazine.
All Hands On Deck
What Is It:
“All Hands on Deck” is a leadership practice in which managers help out hands-on care-giving staff members during the busiest times of day
Why Do It:
Management can help alleviate stress for staff and for residents during extremely labor intensive and stressful peak times; Doing so models teamwork, meets residents’ needs, and gives the management team a “finger on the pulse” to see how people and systems are working; Helping out during high stress times has a number of benefits including, but not limited to:
Residents’ care needs better met
Staff stress is relieved
Managers get first-hand knowledge of the work load and workplace dynamics
Managers role-model teamwork
Builds different and better relationships with staff
Breaks the cycle of staff instability
When managers pitch in during stress times, their actions demonstrate that they care about staff and residents, because they are providing tangible help that ensures the day runs smoother for staff and residents.
Staff stress is a primary cause of staff instability. For organizations experiencing staff instability, these benefits can help break a negative cycle of staff turnover and absenteeism. However, this is an extreme intervention, and not a long-term substitute for having enough staff; It is a bridge from instability to stability.
It is important not to mask the problem of understaffing, but instead to use this approach as a bridge to better staffing. It serves as a bridge by reducing unscheduled absences that come from staff stress, building teamwork so that staff work better together, and by providing the management with a first-hand feel for how the work flows, and where more staff is needed.
In organizations with stable staffing, All Hands On Deck builds a culture in which everyone helps each other out. Everyday teamwork helps people and organizations perform at their best.
How To Do It:
This is a management intervention: Managers go first. As staff see management roll up their sleeves and help out during these stressful times, others will follow their lead. However, if managers merely direct non-nursing staff to help rather than commuting to provide personal assistance, the directive will generate resentment rather than goodwill. This is a way of building better relationships, having your finger on the pulse of workflow, and role modeling teamwork.
Find out from staff when and what help is needed: Meet with staff on each unit and shift to ask when they need assistance, and what they need assistance with. Usually, meal times are high stress times. Other labor intensive times may be the time around shift changes, when extra help is needed so that the out-going staff can give proper report to the incoming staff. Additionally, help may be needed for transportation to an event in the home, or an appointment.
Schedule from the top: Have someone on the management team develop the schedule and communicate it to all units and all management team members.
Be reliable and consistent: Set a schedule and keep to it. Once a promise is made to help, it is essential to keep the promise. Treat time scheduled for helping on the unit as protected time that cannot be interfered with. Make sure to get a substitute from the management team if you are unable to meet your obligation.
Report to the charge nurse to be assigned duties during your assigned time to help: While you may have agreed upon tasks, when you come onto the unit, you need to find out exactly what is needed then and there. Checking in with the charge nurse ensures that you can be immediately helpful. It also respects the dynamics on the unit, and shores up the chain of leadership.
Help seven days a week: Weekend staff need the help as well. While it’s harder to arrange to help on the weekends, doing so will have an enormously positive impact.
Monitor at management team meetings: At daily stand-up, check in on what managers are doing and finding. All hands on deck gives managers a “finger on the pulse” of care-giving, and workplace dynamics. Identify strong performers, solid leaders, and people who need more guidance and development. Talk through ways to use the time on the unit to bring out the best in staff. Note areas of stress, and brainstorm interventions that can improve workflow, or areas to target for hiring more staff as you are able.
What Types of Assistance to Provide:
Help at meals: Many residents need a lot of assistance, and eat at a slow pace. Others need to be cued, and talked to so that their meal is enjoyable and digestible. There are many meal related tastes that managers can do that can free up time for CNAs to provide intensive assistance. Additionally, you can pass trays, open milk cartons, poured rinks, transport people to the dining room, get substitute meals from the kitchen, be a companion to a resident who is eating, or answer call bells while staff is assisting with meals.
Answer call bells: The majority of call-bells involve requests for non-nursing assistance. However, should you need to ask for a CNA’s help, offer to pick up something that she was doing, or ask how you can be of assistance to her.
Make fall prevention, comfort rounds, and other check-ins: Go room to room and ask residents if there is anything they need assistance with. Make sure watch pitchers, TV remotes, call-bells, and other items are within a residents’ reach. Do they need a straw, or a snack? Does a resident want their face washed at the end of a meal? Non-trained staff need to be very careful about ensuring these things. Residents can be diabetic, or unable to have water and a straw due to swallowing problems. Managers need to take guidance from nursing staff when providing a helping hand.
Be a “runner”: Ask unit staff, “How can I save you some steps?” Offer to make the trip to the kitchen for any food substitutes, or refills. Does the linen need to be restocked?
Help wherever and whenever is needed: Perhaps a surge of help is needed to transport residents when a lot of people are attending a group activity or special event. Help out when a new resident arrives, when staff are attending an in-service, or when staff is short a co-worker. Discuss these situations in the morning management stand-up and plan together how to provide the support hands-on staff will need. Create a culture where anyone on staff can issue a call for “all hands on deck” and can trust that others will make themselves available to help out.
Who Does It:
Include all department heads and anyone else who regularly attends your management meetings, such as nursing management, head of the business office, admissions, food services, housekeeping, maintenance, activities, and rehabilitation services.
How Long:
Carve out increments of 15-30 minutes, and make a schedule so that every manager knows where they are needed, and when. You may need some people to help out twice a day in order to have enough people spread out over the busy times on all shifts for all units.
Providing help for a special event or responding in the moment to a call for “all hands on deck” won’t take very long. When everyone pitches in, the need is quickly addressed.
What A Facility Policy Should Include:
All activity should be within the scope of each person’s training, and under the supervision of the nurse or other department head in charge.
Check with the nurse or CNA before giving any food or drink to make sure the resident can have it
Only lift or transfer someone if you are trained in how to do so
Follow infection control protocol
Understand any triggers for someone’s behavior
Respect residents’ privacy and customary routines
Make It Part of Your Culture. While “all hands on deck” can be a stop-gap measure when times are tough, it can also become a way of life, so that staff know they can count on help whenever it is needed.