Delegation or Delegation

If you'd like to enter to win a $100 Gift Card to Amazon.com, read below and learn how to enter.

So I finished up the Medication Conference today that was put on by WHCA. It was cool & I got a lot out of it, but it wasn't meant for me. I wasn't overseeing medication staff. I'm not writing policies & procedures. I'm not doing Med Audits & I am NOT doing a med pass. I do training. At night I work for hospice and give meds in client's homes on a very individualized basis. I don't do anything near the definition of a med pass anymore (& if you know someone who does...take them a Snickers tomorrow...They work really hard).

I was sold on the invitation when I saw that they were going to be talking about Nurse "delegation" in the Nursing Homes.

Yep... The rumors are true. I've heard talk of this hear & there. Nothing official, just talk. In healthcare, there is talk everywhere & I work in 3 different fields of nursing (acute care, long term care & education) so I get talk from EVERYWHERE (and we all need to start being a bit nicer with our words, but that's another blog post)! So when I saw that someone from the Department of Health was going to be giving a presentation on this, I was sold and knew I had to go.

So why do I put the term "delegation" in apostrophes?

Well, anyone who knows me knows that I'm quite sarcastic. So yes, I'm being a bit sarcastic because that's who I am. But there is a bigger reason. When we talk about Nurse Delegation in Nursing Homes, we are misinterpreting the word. Let me tell you the difference:

Nurse Delegation: The Program

In Long Term Care (Assisted Living, Adult Family Homes & Individual Providers) we have known of Nurse Delegation as a DSHS Program. It's an alternate for our residents who need medication administration. It allows stable & predictable residents to get medication administration in their home without requiring them to move into an institutional setting or hire round-the-clock nurses. It's a good program & there is a good amount of data from other states that shows that Nursing Assistants who are properly trained & delegated have significantly lower med error rates than nurses. There are ALOT of requirements and ATON of paperwork.

Delegating Nursing Assistants: The Nursing Commission

 When we become nurses, we are instructed on our Scope of Practice & the expectations that come with our with our license. Nursing is becoming more & more everyday, an administrative/supervisory position. We are allowed to delegate nursing procedures to trained staff members. Nursing procedures include a lot more than medications. In Hospice we "delegate" our NACs to do bed baths, vital signs, nail care & (sometimes) housework. As part of our "delegation" we are expected to oversee their competency in these nursing tasks. In fact it is a Medicare requirement that we "supervise" (this means asking the family if they are getting their needs met) the nursing assistant every month. When we use the term "Delegating" is this respect, it isn't a PROGRAM, it's part of our SCOPE OF PRACTICE. In the same respect, we often "delegate" housekeeping staff to clean up hazardous waste & contaminated equipment. These are nursing procedures that require more than a knowledge of 409 & Dawn. They have to be trained Infection Control & know their safety risks. So "delegation" according to the Nursing Commission is not just with nursing assistants & not just with medications. It's much broader.

Medication Assistants Endorsed (MAEs)

So now, the Department of Health is offering a new program called MAEs. This is a new credential. When I've been hearing rumors of "Nurse Delegation in Nursing Homes", I saw today, that we are using the wrong terminology & it's leading to a lot of confusion. This is NOT an extension of the DSHS Nurse Delegation Program. This is a whole new credential. It's not a new REQUIREMENT. It's an optional program that facilities may utilize if they wish.
This is a good thing! This means that facilities have more flexibility in the way they provide care to the residents. It's another option and when we have more options, then residents get much better care.

I will talk more about MAEs in the weeks coming up. I hope to be able to offer the program (although I have a few hoops to jump through). I also am always interested in programs that give ur communities more options at great care & I think this may be one of them.

I am trying to wrap my head around what communities are looking for and how NAC's are feeling about adding this credential and education to their portfolio. I've put together a short & simple survey that I'd love your help in. Everyone who fills it out will be entered to win a $100 gift card to Amazon.com. If you share the survey, I will give you an additional entry. If you leave me a comment, I'll give you another entry.

Your opinion matters. Tell me what you think! Contest will go on for 2 weeks & end on September 11th at midnight.

http://tinyurl.com/MAECred

Gait Belt - 31 Days of Necessary Equipment for Caregivers

Series 31 Days of Necessary Equipment for Caregivers

Back in November, I wrote a diddy to my love of Gait Belts. I had recently been teaching a class where a student who knew everything (just ask her) loudly proclaimed to the entire class (of beginners) that Gait Belts were only used in Nursing Homes.

You probably remember the loud crack heard across Washington State as my heart broke.

The fact is that I don't teach any transfers or walking without a gait belt. There are 2 disease processes that I can think of where a Gait Belt is contraindicated, but they are so exceedingly rare that I doubt you would ever see them.

A gait belt is ESSENTIAL for every single transfer and every single time you are doing stand by assist. They:

• Give you something to hold onto
• Of note... If you are ever giving me care and use my pants to lift me and give me a wedgie...I will kick you very hard in the shins
• Also... If I am on a limited income and you tear my clothes because you are holding onto them to help me transfer, I'll fire you
• Gives security to your client. They feel supported and safe
• Protects your back if something starts to go wrong. You NEVER know when something might go wrong. Even our strongest consumers may:
• Trip on the rug
• Have knees that go out
• Fall during an earthquake
• Have an underlying infection you don't know about that would cause them to be weak
• could have a seizure
• etc, etc, etc

I also really believe that you should own your gait belt and not rely on your work to provide you with one. I think it should be worn as part of your uniform (you can wear it under your clothes) so that you have it immediately if you have to help someone up or someone needs to go somewhere.

The Cotton Webbed gait belts are the most common. They cost about $10.00. They need to be thrown into the wash every night for infection control reasons.

My favorite and what I personally use is a Nylon Gait Belt that has antiseptic imbedded in it. It's pretty (looks like the American Flag) and it's very easy to wipe down in-between clients with an alcohol wipe. It's much better for infection control. Mine also has a plastic clasp which I find easier to work with than those metal teeth things.

I do carry around gait belts when I'm doing classes and sell them at cost because I believe so strongly that caregivers should have them.

If your client doesn't like the gait belt used, try this:

• Explain the importance & safety. Focus the safety on YOU. Clients sometimes make choices they know will hurt them, but they rarely want you hurt. They depend on you. So let them know it is safer for you and they are much more likely to use it.
• Try getting a pretty design or color. Gait belts come in all kinds of colors & designs. I took care of a lady once who was part of the Red Hats group. When I brought her in a Red Gait Belt and told her it looked nice with her dress, I never had a problem again.

One last couple of tips:

• Never leave your gait belt at work. It WILL get taken.
• Always put your name on your gait belt. Otherwise it WILL get taken.

Do you use a Gait Belt?

Mentor - 31 Days of Necessary Equipment for Caregivers

Series 31 Days of Necessary Equipment for Caregivers

Day 1 - The Mentor

Every good caregiver needs a really good mentor. The nursing/healthcare world is a crazy, confusing, mixed-up, frustrating, amazing world. If we are to survive it, then we need someone who we can share the triumphs with and learn about the pit falls.

Things to look for in a Mentor

1. Someone who "gets" you ~ You need to be able to share your intimate feelings with this person, so they need to understand all your quirks and weirdness.
2. Someone with more experience than you. ~ You need someone who's been through the weirdness of healthcare and can give you some perspective in confusing times
3. Someone with a need for learning ~ You want someone who is constantly improving themselves. This will motivate you to improve yourself. Everyone should be continually learning.
4. Someone with a Positive Outlook ~ Healthcare is hard. Don't get bogged down in people who are full of drama. Find someone who enjoys problem solving and challenges and can boost your mood when you're struggling.

Do you have a Mentor? Who?

31 Days of Necessary Equipment for Caregivers

As I wind down another Core Training class, I have heard once again this statement from some students:

"We don't use that at our work. I need to talk with my boss to get one."

This is usually a Gait Belt discussion, but it also surrounds the Button puller & stethoscope.

I want caregivers to take control of their job and profession and really believe that there are some things that caregivers should have of their own and take care of.

Depending on employers to provide you with essential equipment is a recipe for disaster. Employers don't often provide 1 of everything for each caregiver which leaves you looking for items that other caregivers are likely using. If employer equipment gets lost or broken, you'll have to go without until they can reorder which puts both you and the employer at risk if someone gets hurt (you or the client).

So everyday in July, I want to talk about 1 item that I think Caregivers need to own for themselves and take care of.

Enter to Win

To celebrate the awesomeness of our caregivers and nursing assistants, I am giving away a $100 gift card to Amazon at the end of National Nursing Assistant Week. You can enter everyday and get some extra entries for doing some cool social media extras.

Contest starts tomorrow, June 13th and ends on June 20th!

a Rafflecopter giveaway

Be sure to thank a caregiver or nursing assistant today!

National Nursing Assistant Week!

National Nursing Assistant Week starts this week on June 13th and goes until June 20th. This year's theme is Nursing Assistants @ The Heart of Care.

To celebrate how awesome and integral our nursing assistants and caregivers are, I am going to raffle off a $100 Gift Certificate. You may enter daily starting on June 13th and ending on June 20th. The raffle will be available via:




Facebook www.facebook.com/EssentialTrain
Twitter @EssentialTrain
and this blog.

To enter, use the Rafflecopter app on Social Media. Bonus entries for those who comment and share this blog.

Please be sure to find and thank a Nursing Assistant this week. It's also OK to buy them a cup of coffee or take them out to lunch. Without skilled and kind caregivers and nursing assistants, health care would fall apart as we know it!

Happy Nursing Assistant Week!

http://cna-network.org/

I Was Cured Today... Were you?

I am absolutely fascinated by the study and treatment for mental illness. For several reasons. #1 being that I am a sufferer of mental illness. I struggle with Major Depression and Anxiety. When my husband came home from his nursing program last year telling me he had to write a paper on anxiety disorders, I jumped up & down and said "I can help with that. I've got most of them!"

I also became very interested in it when a friend of mine from high school took her own life in 1999. I felt absolutely awful because I didn't understand her illness and often did not give her the kind treatment that she so desperately needed. I watched her parents cry at her funeral and sitting in the pew 4 months pregnant thought "I pray I never have to go through this".

So today something really significant happened. We got a new diagnostic manual. Today was the 1st day that you could get the DSM-5 (I've written an extremely brief and over-generalized history of the DSM at the bottom if you're interested).

I've been really watching this book and it's development for awhile. I've been uber-curious about it. That was made difficult because those working on it weren't allowed to talk about it, so updates were few & far between.

I've also been very curious because of the tragedies that we've seen that I have felt have come one after another after another. While I'm not a fan of guns and won't have them in my house, I can't shake the feeling that we are completely missing the point when we are focused on guns and not of the mental status of those committing these horrendous acts. I thought for sure that with the new DSM book coming out, it would start more intense dialogue about mental illness.

Yep... I was wrong. We're still not talking very much about it.

So I was cured today of a mental illness. Shyness. Severe forms of Shyness used to be considered an anxiety disorder (medical speak is 'social anxiety disorder'). This wasn't really removed, so to speak, but was revised and additional criteria was added. So now I'm normal.

I find this fascinating, hilarious and infuriating all at the same time.

I have an excellent counselor that has really helped, but my Depression is chronic and today was a bad day. It's hard to describe how painful and crippling major depression can be. I thought I was doing fine and then out of the blue, I feel terrible low confidence, crippling sadness and tears poring out of my eyes. I sit in bed and use my "tools" to talk myself out of the negative thought patterns and focus on my blessings and health.

And as I do this, I become so angry that I truly have no answers for why I go through this and why treatments are so hard to manage. Medications for me always caused me to be worse and suicidal. Meds just don't work for me and there's a lot of evidence that show they don't work for a lot of people.

The reason I feel so angry is because since 1840 when "insanity" was recognized as a mental illness, we are really no closer to effective diagnosis and treatment. So yesterday I was mentally ill and today my anxiety disorder is cured because a bunch of REALLY educated people decided that I was 1 symptom short of ill. huh????

It's great that we keep trying to get a grip of mental illness, but I can't shake the feeling that we are still missing out on:
Prevention
Diagnosis based on biology (not symptoms)
Environment
Deep Research
Social Stigma
Cultural influences
and more...

Why is it that in my very blessed life (healthy body, healthy happy children, amazing husband, mortgage paid, good friends, etc etc), I am still trying to deal with a period of intense sadness and I still break out into tears. What's wrong with my brain? Chemicals? Electricity? Thoughts? Emotions? What??? The DSM 5 doesn't give me that answer. If I had diabetes, I'd have that answer. I'd know exactly what is wrong down to the individual cells involved. I'd know what chemicals are responsible and what organs are malfunctioning. I'd know exactly what to eat and what medicine to take. With my Depression or my parent's addiction or my patient's schizophrenia... I get none of those answers and for someone like me THAT HAS TO KNOW, I feel like all this DSM stuff does is add to my mental illnesses.

So if you see me walking by... would you give me a hug? I'll be doing more research and writing new programs and it's going to be hard for me to get through these changes. Guess it might be time for me to make another appointment and go back in to learn so new 'tools'.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


The DSM (Diagnostic Statistics Manual) is a book of codes and symptoms and resources to help diagnose mental illness.

The history of the DSM book is kind of a funny one. In 1840 "insanity" became an official illness. In 1917 the "Statistical Manual for the Use of Institutions for the Insane" was released and had 22 diagnosis.

The 1st DSM was released in 1952. This included 106 mental disorders and recognized "nervousness" and "personality disturbance" as mental illness.

The 2nd DSM was released in 1968 and had some minor word changes. It had about 180 diagnosis'. There was a reprinting of the DSM-II in 1974. This was really significant because of the emergence of gay rights and gay activism. The term "homosexuality" was replaced with "sexual orientation disturbance".

DSM-III came out in 1980. It included over 280 diagnostic CATEGORIES. Each category having several to many diagnosis'. In 1987 a revision removed "sexual orientation disturbance" and those wanting treatment for homosexuality were lumped into a category called "sexual disorder not otherwise specified." The focus at this time was not on homosexuality itself, but severe anxiety over one's sexual orientation.

The DSM-IV which is the manual we've been referring to up until today was released in 1994 with a revision in 2000. The DSM-IV started using "AXIS" system. Where patients are diagnosed on:
Axis 1 - All mental illnesses except 'mental retardation' (which has received a new name in the DSM5) and personality disorders
Axis 2 - 'mental retardation (again, so glad that name got changed) and personality disorders
Axis 3 - General physical medical condition
Axis 4 - Psychosocial and environmental factors
Axis 5 - Global Assessment functioning (which is a number scale that shows how someone is functioning with their disorder)

So today... We come to the DSM 5. We see a removal of the AXIS system and subsections of Schizophrenia added.

Book Club good for DSHS Approved Continuing Education

I read this book about over a year ago and it has completely rocked my world. It's an amazing fun story about David Ponder and how he goes from complete despair to complete success. I read it in 1 night and have read it several times since.

"Forty-six-year-old David Ponder feels like a total failure. Once a high-flying executive in a Fortune 500 company, he now works a part-time, minimum wage job and struggles to support his family. Then, an even greater crisis hits: his daughter becomes ill, and he can’t afford to get her the medical help she needs. When his car skids on an icy road, he wonders if he even cares to survive the crash.

But an extraordinary experience awaits David Ponder. He finds himself traveling back in time, meeting leaders and heroes at crucial moments in their lives—from Abraham Lincoln to Anne Frank. By the time his journey is over, he has received seven secrets for success—and a second chance. The Traveler's Gift offers a modern day parable of one man's choices—and the attitudes that make the difference between failure and success."

Cost: $55 - For the Book and a DSHS Approved Continuing Education Certificate for 4 hours (with successful completion of the course)

How it works: Read The Traveler's Gift by Andy Andrews. Follow the chat on my blog once a week for questions to discuss every week for 4 weeks.

This is an amazing book and you definitely won't want to miss it!

REGISTER here to join the club.

Be sure to email me with any questions or concerns!!

Are you Afraid? I am.

It's Time to Look at Workplace Violence

Did you see this event that happened on Monday? A resident at a Long Term Care Facility shot an employee in an altercation.

http://www.king5.com/news/Resident-at-Stanwood-senior-living-home-shoots-employee-189741271.html

While I am sad and, frankly, nauseous, I am not surprised.


Long Term Care has all the risks of hospitals:
>Visitors/Families under stress
>Confused residents
>Overwhelmed staff stretched very thin

But Long Term Care also has some additional challenges when it comes to worker safety:
>No formal security
>Employees and Residents have more intimate relationships and Professional Boundaries get blurred
>A Home-Like environment that sometimes encourages residents to bring in guns or illicit drugs (I once had to shoo out not 1, but 2 prostitutes with drugs when I served my time as Director of Nursing)
>Less restrictive visiting hours
>Doors that are not monitored

This is not a new problem. I remember being 12 years old and my mother coming home early from her job as a Nursing Assistant. She was crying because a resident had grabbed her in a completely inappropriate place, held on very tight and smacked her so hard, her contacts came out and tore. That was 14 years ago.

I also remember what her response was and as I look back on the situation, I am truly sad at her response. Not because of her by any means. My mother is the strongest person I know. Because her response had nothing to do with the violence. It was a response that workers still give today because noone has any answers to this problem.

As a single mother with absolutely no dispensable income, her response was to be thankful that the nursing home she worked at was going to replace her contacts and pay for the rest of her day off.

She didn't talk about how the administration was going to take steps to reduce this violence. She took no extra classes on how staff could protect themselves. She wasn't invited to take part in a Safety Committee that specifically focused on Workplace Violence.

And... She went back to work the very next day. Just like Healthcare Workers today do.

I don't have any easy answers. Answers to Workplace Violence aren't easy to come by. OSHA (Occupational Safety and Health Administration) does have some suggestions:
1) Employers and Employees should develop and maintain a violence prevention program as part of the facilities safety programs
2) A Worksite Analysis should be done. A Step by Step common sense look at the workplace to find existing or potential hazards for workplace violence
3) TRAINING To make staff aware of security hazards and how to protect themselves through establised policies, procedures and training.
I think a HUGE key to reducing workplace violence is to have Management Commitment to safety and Employee Involvement in the policies, procedures and training.

Whatcha Think? Comment Below and tell me how you feel.

Force the Right Brain to Work

I really think that negativity among the nursing profession is an epidemic. It's not just Nursing Assistants and Home Care Aides. It runs rampant among nurses and doctors as well. There is a reason this happens.

It is our Left Brain. Our left brain HATES stress and wants everything to be comfortable and normal. It's the Right Brain that encourages us to be weird and wonderful.

So when someone around us complains, we have a tendency to go with the complaint because commonality in peer groups is peaceful and comfortable. If we were to disagree, that enters us into conflict (mild to severe) and conflict is uncomfortable.

So we have to be mindful in order to be true to ourselves. We have to tell our Left Brain to SHUT UP and allow our Right Brain do what it does best. Our Right Brain is just aching to debate and discuss and come up with amazing solutions to problems, but we have to shut up the very loud brain and allow our right brains to work.

Right now, I am getting ready to run 42.5 miles in the next 3 days and this is the biggest part of training I have done. I have learned that when I become a bit uncomfortable and stress my body, my Left Brain starts to come up with fake pains and reasons to give up and just starts a whining. I have learned how to shut that off by using a mantra (mine is a bible verse "I can do all things through Christ who gives me strength". Yours might be "Shut it Left Brain" or "It's time to get to work Right Brain") and conscientiously switching gears and then switching your behavior.

This is the 1st of a 5 post series on negativity. I want to talk about and change negativity in 4 main areas:
Negativity towards ourselves
Negativity towards others
Negativity towards your employer
Negativity towards our profession.

I hope you'll come along with me on this ride. If you want more information on how to change your negative thinking, I suggest the following books (The running book will help you in anything because it explains so well why we think the way we do):

The Power of Habit: Why We Do What We Do in Life and Business by Charles Duhigg

Mental Training for Runners: How to Stay Motivated by Jeff Galloway

The Traveler's Gift by Andy Andrews
Look forward to a Book Club worth 4 hours of DSHS Approved Continuing Education in February

Take the Stairs by Rory Vaden
Look forward to a Book Club worth 4 hours of DSHS Approved Continuing Education in April