long-term care infection prevention
long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Address Noncompliance in Your Staff With This Simple Yet Powerful Approach
The point here is simple : If you struggle with staff noncompliance — in any area — it ’ s time to do things differently . Evaluate why your staff are breaking the rules , help them understand why your rules and policies exist , and then work together to find common ground .“
On a recent visit to a long-term care facility , I encountered a situation I frequently run into in one form or another — one that can have profound implications for staff and residents alike . As I walked the floor with the director of nursing ( DON ) and the infection preventionist ( IP ), we saw a large open bag of soiled linens leaning up against the wall .
The DON and IP looked at each other and then at me . “ Oh my gosh ,” the IP said , clearly embarrassed . “ Here we go again . This always happens !”
I paused for a moment , then asked them why they thought the bag had been left there . “ The CNAs are lazy and don ’ t like to follow the rules ,” responded the DON . “ Maybe ,” I said . “ But maybe it ’ s something else .” This situation — or some variation of it — probably plays out in your facility , too . Staff members break the rules and get accused of being lazy or willfully defiant . That creates tension and discord among employees and , depending on which rules are broken , can also threaten residents ’ health and safety .
As frustrating as noncompliance is , blaming your staff for being lazy or defiant won ’ t solve anything . A better approach is to rethink how you communicate with and educate your staff . Making a few minor ( but impactful ) tweaks in how you address noncompliance can improve morale and bring about much-needed change . To show you what I mean , let ’ s return to the soiled linen incident .
While there are exceptions to every rule , almost everyone who works in a long-term care facility cares about the residents . With that in mind , I asked the DON and IP if I could offer a different point of view about why the soiled linen had been left out . They agreed , so I started by pointing out the laundry receptacle in the hallway was too small to hold the bag of soiled linen . Then , I asked them where the CNAs were supposed to put dirty laundry .
“ They should tie the bag and take it down the hall to the soiled utility room ,” the DON said . We walked over to the room , which was fairly close . There were lots of empty bins inside the room , ready for laundry . But the CNA was nowhere in sight . “ Where ’ s the aide ?” I asked them . “ She ’ s down the hall helping a nurse with a resident ,” said the IP .
Ding ding ding ! “ Is it possible she got called away before she could finish tying the bag and dropping the linen off in the soiled utility room ?” I said .
They looked at each other again . “ Yes , it ’ s possible ,” said the DON . And it was possible — in fact , it was likely . Nobody at that facility was just hanging around doing nothing . Every single person was busy .
The same is probably true at your facility . That ’ s why , if you notice one of your staff isn ’ t following the rules , don ’ t just assume they ’ re lazy or defiant . Dig deeper into their why . For example , instead of saying , “ You aren ’ t supposed to do X ,” or “ You need to stop doing Y ,” invite them to explain why they did what they did . Then , take steps to set them up for success : come up with solutions — together — that allow them to adhere to your facility ’ s rules and policies .
We can change the perception of a situation like this from contentious to an opportunity for improvement and problem-solving .
This advice applies to all instances of noncompliance . For example , maybe your staff continually eats and drinks at the nurses ’ station , despite being told it ’ s against the rules . Rather than taking punitive measures , explore why this behavior is occurring . Maybe your break room is down in the basement , and your staff don ’ t have time to get to it when they ’ re thirsty or need a quick snack . If the nurses ’ station is conveniently located in a central location on the main floor , then suddenly , your staff ’ s decision to eat and drink outside their break room makes sense .
The point here is simple : If you struggle with staff noncompliance — in any area — it ’ s time to do things differently . Evaluate why your staff are breaking the rules , help them understand why your rules and policies exist , and then work together to find common ground . Perhaps that means strategically placing bins throughout the facility that CNAs can drop soiled linen into if they ’ re called away before they can take the laundry to the utility room . Perhaps it means creating a hydration station on every floor so your staff have a place outside of the nurses ’ station to get something to drink .
No matter what the situation is , when you ’ re facing noncompliance , asking the noncompliant staff member to tell you more can be very helpful . When you do , you demonstrate to them that you ’ re ready to hear more deeply , to understand more deeply . You show them you want to meet them where they ’ re at and find solutions to the challenges they ’ re facing . Best of all , you create a culture of better communication throughout your facility — a culture where real and meaningful change for the better can occur .
Buffy Lloyd-Krejci , DrPH , CIC , LTC-CIP , is a leading authority on infection prevention in the long-term care industry . Her firm , IPCWell , delivers in-person gap analysis , training , and support to nursing homes across the country .
24 • www . healthcarehygienemagazine . com • may 2024