Retraining support staff has its ups and downs
Roller coaster ride is worth the thrill of better care
When administrators at Stanford (CA) Health Services restructured their materials management processes, they created a new position: one cross-trained in housekeeping, patient transportation, and supply distribution.
Unlike the specialized staff who used to perform these duties, this person, called a support services assistant, (SSA) is stationed on the unit and is a member of the care team as part of Stanford’s goal to bring services closer to the patient, says Suzanne Taylor, RN, MS, nurse specialist for program development and the nurse educator who developed the SSA training curriculum.
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 have also pleased patients. For example, patients used to complain about the time it took clinicians to answer call lights. Now, the SSA also responds to call lights, reducing the wait.
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. The 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 cannot 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 2 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," Taylor 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 SSA learning process, Taylor offers these tips:
• Clear communication.
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 potluck dinners 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 to continue the program.
"We took a long hard look at the program, and we decided that patient satisfaction had improved so much, we kept it," Taylor explains. "If you were to ask people today if they were to do it over again, they would. It’s not easy, but it’s worth it."
Here, Taylor shares some common problems of launching a new position and Stanford’s attempts to minimize them.
• Turnover.
Administrators learned some SSAs were leaving because they disliked the amount of housekeeping tasks required of them. Now, Stanford screens applicants more carefully, making sure they thoroughly understand the duties of the job. Also, administrators created two levels of SSAs to allow for promotions.
• Poor performance.
SSAs are required to take quarterly inservice training in all areas to keep skills and performance up to standards. Also, representatives from each of the speciality areas, such as housekeeping, now review the quality of the SSAs’ work. Taylor says the nurses did not have the in-depth knowledge of housekeeping duties to know whether or not the performances met hospital standards. Stanford also appointed a lead SSA position to supervise the evening and night shifts.
• Injury prevention.
Taylor brought in a physical therapist to teach an intense body mechanics course during the orientation to prevent SSAs from injuring themselves when performing such tasks as transporting patients in wheelchairs or on gurneys.
• Cultural differences.
Some cultures fear death and dying, an issue that came up when an SSA had to help transport a body to the holding room. To address these differences, Taylor added a session on death and dying and a tour of the holding room to the orientation. Also, the managers now attend a course on cultural diversity.
"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 dying patients. We were used to staff already trained to deal with it, but 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 says the hospital now receives letters from patients praising and thanking the SSAs.
"They will take pride in their work," Taylor says. "You may have to spend the time with them, but they’re worth it."
[For more information, contact Suzanne Taylor, Stanford Health Services, 300 Pasteur Drive, Stanford, CA 94305. Telephone: (415) 725-0249.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content