Spend a little on aides to save on hiring, training
Spend a little on aides to save on hiring, training
Expect the best, get the best
(Editor s note: In this third and final article in our series on hiring, training, and retaining home health aides, Hospital Home Health shares hospital-based home care agencies' best tips for boosting aides' morale.)
One of the best ways to cut costs is to keep employee turnover rates down. This is especially true with home health aides, who hold the lowest paying job in the industry, and who turnover more quickly.
Keeping home health aides happy and retaining them is a problem for everyone," says Kathy Murphy , RN, MSN, CNAA, the care center director at St. Cloud Hospital Home Care Services in St. Cloud, MN.
Here are some tips for keeping your home health aides well prepared and happy with their jobs:
* Explain industry trends and your company's finances to aides.
Murphy is moving her company toward using shared leadership, and she wants employees to feel comfortable asking about the company's finances and operations.
"I might speak about these things in different terms than I would with my nurses, but I still tell them all about our finances," she says.
This has worked, so far. The home health aides recently asked in a meeting how secure their jobs were. Murphy explained to them that the demand for home health aides is going up due to many factors, including:
-- the trend toward using fewer skilled nursing visits, brought about by managed care;
-- the rising population of elderly people;
-- patients being discharged earlier from the hospital.
"I told them that home health aides' jobs are essentially the most secure in the whole industry, even more than their supervisors or even my job. Of course, they were relieved," Murphy says. "I appreciated that they asked me this question. I want them to feel comfortable asking me these types of things. It gives them more of a sense of ownership and control."
* Offer opportunities for learning.
Giving aides chances for increasing their learning bolsters their sense of self worth and the value they see in their jobs, Murphy says. She offers her aides one hour inservices every month on subjects including:
-- medications administration;
-- back safety awareness;
-- transfer (bed to chair to tub, etc.) techniques;
-- hospice training;
-- communication;
-- nutrition.
For example, Murphy might ask one of her physical therapists to put together a one-hour inservice on back safety for the aides.
Inservices improve services
The inservices are not mandatory, but many of the aides go to them. The cost to the company for this isn't great, (less than $100 for the therapist's time) but the rewards are. An hour per aide spent on an inservice instead of patient care isn't a great loss. And it benefits patient care in the end," Murphy says.
Murphy also offers educational funds for aides who want to take a workshop or class specific to their field of work at the local technical or community colleges. "I maybe spend a couple hundred dollars on this a year at the most. The cost is low, but the return is high for this type of thing," she says.
* Send aides to conferences.
If there are half-day conferences within driving distance on subjects useful to home care aides, Colleen Usrey, the director of Kewanee (IL) Hospital Home Care and Hospice sends a few aides to them. Her state association often has workshops for aides and volunteers, for example.
"This helps with morale among aides because we need them to see that what they do is so important," Usrey says.
Full-day workshops are too long for aides because they don't usually have the time to devote to them. Also, aides often don't feel comfortable going into the conference atmosphere because they are not used to it like nurses are, Usrey says.
"If your aides haven't been to a conference or workshop before and don't know what to expect, they might benefit from a little advice on attire and comportment before they go," Usrey says. She realized this after a few of her aides went to a conference wearing clothes that were too casual for the event, and talked a lot among themselves during the seminars.
Now when she sends aides to conferences, Usrey tells them ahead of time what the proper attire is and what the proper decorum is during the seminars. So as not to sound condescending, she uses words such as these to convey this message to her aides: "I know you've never been to a conference, so I'll tell you what the attire is, or "The subject matter of the conference is real important to the company and to me, so I want you to pay close attention to the information you get."
* Write thank-you notes.
"Ann Landers has advised doing this for years, and it s still good advice," says Betty Baker , RN, CETN, the director of home care at Alliance HealthCare in Ft. Morgan, CO. All you have to do is write a little note saying, 'You did a great job with so-and-so,'" Baker says.
"It takes a minute, it doesn't cost me anything, and it goes so far toward making the aides understand how important they are to me. Everyone should do this for their aides, and they should do it often," she says.
The effect of the thank you notes on home health aides was recently reinforced for Baker after she had a busy couple of months when she didn't take the time to write any to her aides.
At one of Baker's monthly meetings with the aides, they were critical in areas in which they wouldn't normally have complained.
"We'd had two deaths, and it had been a rough couple of months. It was stressful but normal for this line of work. I couldn't understand why they weren't handling it well. Then I realized that I hadn't written any thank you notes in a while," Baker says.
Immediately, Baker understood that the aides simply needed acknowledgment of the hard work they'd been doing. Soon after that meeting, there was a week when two of Baker's aides were out, and the remaining aides had to visit 10 or 12 patients a day to pick up the slack. After that week was over, Baker put a thank you note and a can of fancy cocktail nuts into each of the aides' boxes.
"My next meeting with the aides after that went perfectly smoothly," Baker says.
* Praise aides in front of nurses, and the nurses will follow your lead.
Giving aides a lot of praise will get you a lot of mileage, but doing it in front of your nurses so they can see and hear your appreciation of the aides' work, will go a lot further, Baker says.
"My nurses follow the steps I take and treat the aides the same way that I do. Sometimes I hear them praising the aides, too, and just generally recognizing that being an aide is a tough job," Baker says.
"It's important for home health aides to know they are respected in the eyes of nurses," says Annetta Poe, BSN, RNC, the executive director of Amarillo (TX) Area Hospital Home Care. "I try to say things like, 'You did a great job with that patient,' when the nurses are around, so the aides can know that they are as important as the nurses are," she says.
As far as patient satisfaction goes, aides are very important. Also, nurses rely on the aides a lot to monitor patients' conditions. "We have to continually remind the aides of how important they are to us and to contribute to their sense of self worth. A little job satisfaction goes a long way," Poe says.
Poe also will take her aides out to dinner (she only has 10 of them) just to let them know that she values their work. She also makes clear to everyone that the aides are included in any company activities.
* Counsel nurses on how to treat aides.
Your nurses must be aware of how their behavior affects aides' job satisfaction, Poe says. She asks her nurses to be careful not to make aides look bad in patients' eyes. For example, when her nurses do once-a-month skills tests in the field on home health aides' abilities, the nurses talk to aides about their performance after the visit is over, not during.
"You don't want to humiliate the aides in front of the patients. Our patients love our aides, and you don t want to do anything to change that," Poe says.
If the nurse observes the aide doing something that might harm the patient, however, the nurse corrects it immediately, rather than waiting until the visit is over.
Boost morale by treating aides with respect
During orientation and evaluation times, Usrey explains the importance of home care aides to her new nurses. She tells them that aides' morale and satisfaction is connected to how well their nurse supervisors treat them, in the same way that nurses' job satisfaction is tied to how well doctors treat them.
To keep tabs on how well supervisors treat aides, Ken Wessel, the executive director of the Visiting Homemaker Service of Passaic County in Paterson, NJ, surveys his aides about their satisfaction with their supervisors' performance. The survey asks aides to use a numerical scale to rate statements such "as my supervisor treats me with respect." Conducting the survey helps keep the aides happy, and the results let Wessel know whether his supervisors need any explanation on how to treat aides.
Competency brings in referrals
* Share patient satisfaction data with aides.
Murphy gives her aides the feedback the company gets from its quarterly patient satisfaction surveys, whether the comments and data are good or bad.
"If a patient mentions an aide's name and says she or he did a really great job, I tell the aides this, and I explain to them that this is what brings in more referrals," Murphy says.
* Compensate aides as well as you can afford.
St. Cloud Hospital Home Care offers benefits, travel time and mileage compensation, and guaranteed hours. This makes the company's total cost per aide higher than most companies, but the overall long-term cost to the company in aide turnover, orientation, and training is less, Murphy says.
"It costs $350 to $500 to orient a new aide, so if you reduce turnover you can reduce your costs there," she says. *
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