Retraining support staff has its ups and downs
Retraining support staff has its ups and downs
Cross-training makes supplies flow easier
When administrators at Stanford (CA) Health Services restructured their materials management processes, they created a new position: a support service assistant (SSA) cross-trained in housekeeping, patient transportation, and supply distribution.
Unlike the specialized staff who used to perform these duties, the support services assistant works on the unit as a member of the care team, which is part of Stanford’s goal to bring services closer to patients, says Suzanne Taylor, RN, MS, nurse specialist for program development and the nurse educator who developed the SSA training curriculum.
Having a cross-trained assistant means nurses no longer have to delay discharges or admissions because housekeeping or patient transportation staff are unavailable. Other small tasks the SSA has taken over also have pleased patients. For example, patients used to complain about the time it took nurses to answer call lights. Now the SSA responds immediately, and if she can fulfill the patient’s request, she does. If not, she notifies someone who can.
To train staff, Taylor created a two-week orientation and education program: one week of classroom and hands-on training and one week with a preceptor. Following is Taylor’s explanation of the facility’s training program and the competencies the students are expected to acquire upon completion:
• Housekeeping (three days).
infection control/universal precautions;
biohazardous, radioactive, and chemical waste handling and disposal;
patient room cleaning procedures;
cleaning specialized areas.
• Patient transportation (three days).
body mechanics;
patient transfers: bed to wheelchair/chair or bed to gurney;
assisting with patient movement in bed (turning);
off-unit deliveries;
patient discharges.
• Materials management functions (one day).
accessing nurse supplier;
ordering supplies and equipment;
order inquiry;
cancelling orders;
stocking supplies;
checking availability of emergency equipment;
returning/crediting supplies.
• Team workshop (one to two days).
All the members who will be working with the SSA gather to learn about managing conflict, delegation, communication, and customer service issues. They also review a description of the SSA’s role so the clinicians understand what duties that person can and can’t perform. Special programs include a talk by an SSA, who explains the difficulties inherent in a change process and offers advice to help the new SSAs work through the transition.
• Preceptorship (11¼2 to two weeks).
• On-the-job training.
When the SSAs complete their two-week training course, they still need extensive supervision, a situation that surprised managers. Taylor says the SSAs took an average of six months to settle into their new roles.
"The nurses said they could manage the group, but [SSAs] are different than [clinicians], who are professionally trained," she says. "We assumed they knew more than they did. They really needed a lot more time and patience than we were used to with [clinicians]. It really surprised us how much time and energy it takes to supervise this group."
To facilitate the SSAs learning process, Taylor offers these tips:
• Communicate clearly.
Write down expectations and goals. When you tell them something, ask them to summarize what you just said to make sure they understand.
• Check in with them frequently.
Ask if they have any questions. Make sure they’re comfortable doing their job.
• Make them feel a part of the team.
Taylor says one team would host potlucks and invite the SSAs. "It really made them feel welcome," she says.
Bringing a new position on line can be frustrating, Taylor explains. In fact, after the first year, administrators questioned whether the program was worth the headaches.
"We took a long hard look at it, and we decided that patient satisfaction was so high it overcame the negatives, so we kept it," she says. "If you were to ask people today if they would do it over again, they would. It’s not easy, but it’s worth it."
Here, Taylor shares some problems common to launching a new position and Stanford’s attempts to minimize them:
• Turnover.
To reduce turnover, Stanford instituted a more careful screening process. Applicants are screened for maturity and desire for long-term employment. Also, administrators created two levels of SSAs to allow for promotions.
• Inconsistent quality of work.
The hospital now mandates quarterly inservice training in all areas to keep skills and performance up to standards. Also, representatives from each speciality area, such as housekeeping and patient transportation, now review the SSAs’ work. Taylor says the nurses did not have in-depth knowledge of these duties to know whether the performances met hospital standards. Stanford also appointed a lead SSA position for the evening and night shifts when the majority of the managers have left to monitor the quality of fellow SSAs’ work.
• Injuries.
Stanford brought in a physical therapist to teach an intense body mechanics course during orientation to prevent SSAs from injuring themselves when performing such tasks as lifting patients.
• Cultural differences.
Some cultures fear death and dying, an issue that came up when an SSA had to help transport a body to the cold storage room. To address these differences, Taylor added a session on death and dying and a tour of the storage room to the orientation. Also, the managers are now educated about cultural differences.
"We tell the [SSAs] they need to talk with others about their beliefs," Taylor says. "We learned that you can’t assume things you take for granted are OK with others. At the time it didn’t occur to us that others would have a problem with death and dying, because we were used to people [clinicians] already trained to deal with it. This group didn’t come to us trained in these issues."
Taylor says if you take the time to work through the unique problems of these staff, they will embrace their new rolls. She now receives letters from patients praising and thanking the SSAs.
"They often spend more time with the patient than the nurse, because the nurse is so busy," Taylor says. "They will take pride in their work, but you have to spend the time with them."
[For more information, contact Suzanne Taylor, Stanford Health Services, 300 Pasteur Drive, Stanford, CA 94305. Telephone: (415) 725-0249.]
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