Photo by Jeanne Rouillard | Unsplash
Nursing home residents and staff need our support amid the COVID-19 crisis. As of November 24, of the 260,000 COVID-19 deaths in the US, more than 100,000 have been residents and staff at long-term care facilities, a figure that does not reflect the anticipated post-Thanksgiving surge in cases. In fact, across the country, long-term care facility deaths make up approximately 40 percent of deaths from COVID-19.
Burnout was a challenge for nursing home staff before the pandemic, and it is reaching a critical point now.
IHI is a participant in the AHRQ/Project ECHO National Nursing Home COVID-19 Action Network, a partnership between the Agency for Healthcare Research and Quality (AHRQ), the University of New Mexico’s ECHO Institute, and IHI. IHI has developed the 16-week curriculum for this network, which has been convened to train and support US nursing homes in evidence-based practices to support residents and staff in COVID-19 infection prevention and control.
The IHI Training Center is delivering this curriculum to five cohorts of nursing homes based in Delaware, Florida, Georgia, Louisiana, and North Carolina. As facilitators and staff members supporting this “all teach, all learn” program, we have seen firsthand the innovation, dedication, and compassion of these nursing home staff members. They provide high-quality, safe care for residents while simultaneously supporting staff and creating a just culture.
Over the past nine weeks, participating facilities have generously shared their processes for supporting staff members during these especially challenging times. With new and evolving requirements, nursing home staff members are increasingly pressed for time. Consequently, one way to improve their well-being is finding ways to save time and/or redistribute responsibilities. To do this, nursing home training centers nationwide are sharing support and lessons learned. The following ideas are from the IHI Training Center:
- Make mandatory testing convenient. We heard from facilities describing challenges with encouraging staff to come in for testing. This includes part-time staff members for whom coming in represents an extra commute, and staff members based in counties with lower case counts who are confused by requirements to undergo increased testing. Facilities shared their tactics for making testing more convenient:
- Combine testing with mandatory education.
- Offer testing on weekends.
- Utilize rapid testing.
- Hire a contractor for regular testing to reduce burden on staff members and improve process reliability.
- Obtain sufficient PPE and make it readily accessible. This includes having equipment at the point of care. If PPE is visible, abundant, and available, staff members will be reminded to wear all necessary pieces.
- Huddle daily. Consider starting each huddle with positive messages to set the tone. Don’t feel the need to bog performance improvement projects down in extensive planning every time. Instead, consider trying an ad hoc process improvement project on the spot to test a change immediately.
- Communicate often. A significant number of participating facilities have said that they use mass communication programs to get messages to staff quickly and consistently. Sending a regular newsletter encourages transparency and can help staff stay updated on policies. Also, using SBAR (Situation-Background-Assessment-Recommendation), an easy-to-remember communication framework, can be useful for framing conversations with all staff, not just clinicians.
- Provide professional development. Offering a Personal Care Attendant (PCA) training and mentoring program can assist staff members with obtaining a Certified Nursing Assistant (CNA) certification. This can help reduce staffing shortages.
- Involve chaplains or other spiritual counselors in facilitating connections between residents and their families, rather than leaving this responsibility solely to nursing or activities staff.
- Listen to staff. It’s important to ask staff at the point of care what they need and what barriers make it hard to comply with directives. For example, if staff say there aren’t enough hand sanitizer dispensers, providing them with personal bottles will make it easier to make hand hygiene easy and convenient. If staff say the current brand of hand sanitizer leaves a sticky residue, provide one that isn’t so staff will be more inclined to wash their hands.
We hope you find these ideas helpful in your own organization. Start small, test your changes, and see how it goes.
Gail A. Nielsen, BSHCA, FAHRA, RTR, is faculty for the IHI Training Center of the National Nursing Home COVID-19 Action Network. Marina Renton, MPhil, is an IHI Project Manager.
You may also be interested in:
National Nursing Home COVID-19 Action Network details and registration
Driving the Urgent Need to Improve Nursing Home Care