Nursing home goals

We have received a ton of request on this topic, so we have found several people who said this is what they are using, much dates back a deacde. If you have more to add please send it to jeff . cline at me.com ad we will share it with the community.

Goal 1 – Staff Turnover: Nursing homes will take steps to minimize staff turnover in order to maintain a stable workforce to care for residents.

Goal 2 – Consistent Assignment: Being regularly cared for by the same caregiver is essential to quality of care and quality of life. To maximize quality, as well as resident and staff relationships, the majority of nursing homes will employ “consistent assignment” of CNAs.

Goal 3 – Restraints: Nursing home residents are independent to the best of their ability and rarely experience daily physical restraints.

Goal 4 – Pressure Ulcers: Nursing home residents receive appropriate care to prevent and appropriately treat pressure ulcers when they develop.

Goal 5 – Pain: Nursing home residents will receive appropriate care to prevent and minimize episodes of moderate or severe pain. Objectives for long stay and short stay are slightly different.

• Goal 5A: Long stay (longer than 90 days) nursing home residents will receive appropriate care to prevent and minimize episodes of moderate or severe pain.
• GOAL 5B: People who come from a hospital to a nursing homes for a short stay will receive appropriate care to prevent and minimize episodes of moderate or severe pain.

Goal 6 – Advance Care Planning: Following admission and prior to completing or updating the plan of care, all nursing home residents will have the opportunity to discuss their goals for care including their preferences for advance care planning with an appropriate member of the healthcare team. Those preferences should be recorded in their medical record and used in the development of their plan of care.

Goal 7 – Resident/Family Satisfaction: Nursing home staff will assess resident and family experience of care and incorporate this information into their quality improvement activities.

Goal 8 – Staff Satisfaction: Nursing home administrators will assess staff satisfaction with their work environment at least annually and upon separation and incorporate this information into their quality improvement activities.

Why is staff retention important?

Staff who are familiar with a nursing home’s resident’s routines and practices are likely to
provide better care and are more likely to develop bonds with residents and with other staff.
Improved staff retention also means that caregivers will likely spend less time teaching
temporary staff about residents’ care needs, likes and dislikes or nursing home routines. The
Advancing Excellence Campaign seeks to make sure “nursing homes will take steps to minimize
staff turnover in order to maintain a stable workforce to care for residents.”

How nursing assistants can help retain good staff:
• Become a member of or help create a staff retention committee.
• Advocate for a “buddy program” to welcome and orient new employees.
• Check with new staff to see if they have any questions.
• Help new staff understand policies and procedures.
• Help new staff respond to each resident’s needs and preferences.
• Be willing to work with/partner with new employees in their first weeks of work.
• Be willing to trade shifts with new employees if emergencies arise.
• Be willing to include new employees in your carpool.
• Be willing to share your meal times or breaks with new employees.
• Be patient, have fun, and be flexible.
How staff can help the nursing home attract good employees:
• Assist with recruiting and hiring of quality staff.
• Assist with training.
• Speak up about things that are both working and not working in the nursing.
• Create an employee council.
• Commit to improving communication between and among all staff.
• Learn about and participate in the nurse’s quality improvement (QI) program.
• Answer any staff surveys the nursing home sends to you.
• Have staff social events and do your job the way you want others to do theirs.

Increasing Use of Consistent Assignment

What is consistent assignment and why is it important?
Consistent assignment means a resident receives care from the same nursing assistants 85% of
the time. Consistent assignment allows staff to develop closer relationships with residents in
their care and with co-workers. Advancing Excellence chose this goal because consistent
assignment results in the following benefits:
• Residents receive better care because staff are more knowledgeable about their needs
and preferences.
• Residents feel more secure knowing that they will receive care from someone who they
know.
• Staff see how their skill, experience and knowledge of the residents makes a difference
in residents’ lives.
• Staff are better able to implement care plans and are more likely to notice changes in
residents’ health, which can prevent larger health problems.
• Work becomes easier because staff are more accustomed to the residents’ schedule,
needs and wishes.
Consistent assignment provides a strong foundation for resident-centered care because it
fosters the strong development of relationships, which is central to quality care.
The Advancing Excellence Campaign believes that “Being regularly cared for by the same
caregiver is essential to quality of care and quality of life. To maximize quality, as well as
resident and staff relationships, the majority of nursing homes will employ consistent assignment
of CNAs.”
How can staff help implement consistent assignment?
• Work with your nursing home’s leadership in developing an educational program on the
benefits of consistent assignment.
• Participate in meetings with other staff about consistent assignment.
• Collaborate with your nursing home’s leadership to develop a process that will ensure
that nursing assistants have input when assignments are given. The goal is to have
everyone feel that their assignment is fair.
• Meet regularly to discuss how consistent assignment is working, including reviewing
assignments to ensure that relationships with the residents are going well.
• Talk to leadership if you have a suggestion that you think might work better.

Reducing Restraint Use

Why is reducing the use of physical restraints important?
While physical restraints were once regarded as necessary for the safety of some residents,
research has proven that restraints increase the likelihood of injury and may cause serious
health problems such as poor circulation, constipation, incontinence, weak muscles and bones,
pressure sores, poor appetite and infections. Advancing Excellence’s goal is to make sure all
“nursing home residents are independent to the best of their ability and rarely experience daily
physical restraints.”
How can nursing assistants help reduce the use of restraints?
• Abide by the philosophy that restraints are rarely used and are reserved for extreme
circumstances.
• Learn the difference between a restraint and an enabler.
• Look for patterns of behavior that lead to falls.
o Keep water close to a resident and take residents to the bathroom often to
prevent falls.
o Look for restless behavior, agitation and pain that can lead to residents
wandering unsafely.
• Recognize that resident behaviors may reflect emotions or physical conditions such as
pain or infection.
• Determine the triggers for agitated behaviors in each resident, and learn how to prevent
them.
• Learn what calms a resident, and use that as an intervention to prevent and minimize
restless behaviors, such as:
o Doing an activity that he or she enjoys; ask activity staff for ideas to keep
restless residents engaged;
o Sit with a resident for a few minutes holding his or her hand and visit;
o Offer a resident a snack or something to drink; or
o Redirect or distract a resident with Alzheimer’s.
• Check the care plans for specific interventions that calm residents.
• Be aware that the resident might be in pain, and discuss this with the charge nurse.
• Volunteer to be a part of the facility restraint-free committee.
• If a restraint must be used, be on the lookout for pressure areas, urinary tract infections,
decrease in other functional abilities, and behavioral changes of your resident that may
occur during the use of a restraint.
• Follow your nursing home’s protocols for restraint use.
• Participate in in-services related to restraints.
• Talk to the charge nurse if you have a suggestion that you think would work better for a
resident and prevent use of a restraint.

Reducing Pressure Ulcers

Why is reducing pressure ulcers important?
A pressure ulcer or bed sore is an injury to the skin caused by constant pressure over a bony area
which reduces the blood supply to the area. Nursing home residents who cannot easily reposition
themselves are often susceptible to this condition and need special care. Pressure ulcers can be
dangerous and painful for a resident, in part because broken skin can allow infection into the body.
If untreated, pressure ulcers can deepen and even expose the bone. Deeper ulcers may be hard to
heal or may not heal at all. Sometimes, pressure ulcers can lead to death.
The presence of pressure ulcers limits the quality of life for a resident as evidenced by:
• Decrease in bowel and bladder function
• More incontinence
• Decrease in ability to move without help
• Decrease in mental capacity
• Increase in pain
• Increased risk for infection
• Less participation in activities
Proven techniques can reduce and almost eliminate this uncomfortable and potentially dangerous
condition. Advancing Excellence believes that “Nursing home residents receive appropriate care to
prevent and minimize pressure ulcers.”
How can nursing assistants help reduce pressure ulcers?
• Read residents’ care plans to learn who is at risk of developing pressure ulcers.
• Change the position of residents who are immobilized when in bed or when up in a chair.
• Provide frequent incontinence care. Remove urine and/or feces from the skin as soon as
possible.
• Provide water to the resident frequently because well-hydrated skin will not break down
easily.
• Check the resident’s skin each time you provide care. Note and report redness — especially
over a bony area — that does not disappear or a new open skin area.
• If the resident’s care plan requires a dressing, make sure it is there.
• Note the resident’s eating habits. Make sure they have nutritious meals. If residents aren’t
eating, notify the charge nurse.
• Look for opportunities to increase residents’ mobility through activities and/or socialization.
• Observe residents for pain, and notify the charge nurse if a resident complains of pain or if
you observe the signs of pain in non-communicative residents.
• Follow your nursing home’s facility’s protocols for pressure ulcer prevention and treatment.
• Participate in in-services related to pain.
• Talk to the charge nurse if you have a suggestion that you think might work better for a
resident.
• Share what you learn and know with other staff.

Reducing Moderate to Severe Pain

Why is reducing residents’ pain so important?
Pain can affect residents’ daily activities and quality of life and can cause depression,
sleeplessness or restlessness, or cause residents to become distressed or lose their
appetites. The Advancing Excellence Campaign believes “Nursing home residents will
receive appropriate care to prevent and minimize episodes of moderate or severe pain.”
How can nursing assistants help prevent or minimize residents’ pain?
• Recognize that the resident’s pain is subjective; pain is different for different people;
what may be mild pain to one may be excruciating to another person.
• Learn which residents have chronic pain.
• Ask residents about their pain, or observe residents for pain; notify the charge nurse if a
resident says she has pain or if you observe the signs of pain in residents who cannot
communicate.
• A resident with dementia may not be able to verbally tell you he has pain; observe for
signs of pain in facial expressions – gritted teeth, frowning, grimacing, etc. or other
behavior, such as pacing, aggression or agitation.
• Ask residents who are unable to sleep if they are in pain.
• Read the care plans of residents to learn resident-specific interventions for pain.
• Monitor residents who have pain for nutritional intake and weight loss.
• Learn how to engage residents with pain in activities to prevent isolation.
• Recognize that residents may not want to admit they are in pain because they think they
are not being a “good patient.” Sometimes they may describe being “uncomfortable”
rather than being in “pain.”
• Follow your nursing home’s protocols to identify and manage resident pain.
• Participate in in-services related to pain management.
• Talk to the charge nurse if you have questions.
• Talk to the charge nurse if you have a suggestion that you think might work better for a
resident.

Documenting Conversations about Advance Care
Planning

Why is advance care planning important?
Advance care planning helps to ensure that family, friends and caregivers are all familiar with a
resident’s wishes about the care they wish to receive, especially related to end of life care.
Because each resident will have different preferences based on personal values and beliefs, it’s
important for caregivers to know as much as possible about their wishes before important
decisions need to be made.
The Campaign goal is “Following admission and prior to completing or updating the plan of care,
all nursing home residents will have the opportunity to discuss their goals for care, including their
preferences for advance care planning, with an appropriate member of the healthcare team.
Those preferences should be recorded in their medical record and used in the development of
their plan of care.”
How nursing assistants can help residents participate in advance care
planning:
• Learn about advance care planning documents specific to your state (i.e., living wills,
medical powers of attorney, documents for those who are cognitively impaired, and
others).
• Learn who in your nursing home can help residents with advance care planning and
refer questions to that person.
• Recognize that not all residents and families will want to talk about advance care
planning.
• Listen to residents when they want to talk about end of life care, and report these
conversations to the charge nurse.
• Accept that a resident has the right to make his or her own choices, even if you do not
agree with them.
• Understand that the advance care planning process and decisions are affected by the
disease the resident has, gender, age, religious beliefs and culture.
• Learn about the cultural differences that impact advance care planning.
• Learn what decisions residents under your care have made, and respect and honor their
decisions, including those related to physical, psychosocial and spiritual needs.
• Help family members to accept their loved one’s decisions.
• Expect that emotions may be strong when discussing end of life care with residents and
family members.

Improving Resident/Family Satisfaction

Why is resident/family satisfaction important?
Assessing resident satisfaction is the first step in making changes or improvements to meet
residents’ needs and expectations and improve quality of care or the daily life of residents. The
Advancing Excellence Campaign believes that “Nursing homes should assess resident and
family experience of care and incorporate this information into their quality improvement
activities.”
How can nursing assistants help improve resident/family satisfaction?
• Know the needs, preferences and expectations of residents and families.
• Recognize that feelings of guilt, grief, uncertainty and stress affect how residents
and families express their concerns.
• Listen to and encourage residents and families to share ideas, recommendations
and concerns. Report concerns and problems as soon as they arise to the
appropriate staff and/or leadership.
• Follow through on what you say you will do.
• Follow up with residents and families to see if their problems were resolved.
• Find ways for residents/families to participate in planning his or her care or
treatment.
• Build relationships by orientating new staff to the residents and families they will be
working with.
• If residents or families express that they are not happy with how a problem was
solved, refer them to the local ombudsman.
• Encourage residents and families to attend resident and family councils.
• Promote a sense of community within your nursing home

Improving Staff Satisfaction

Why is staff satisfaction important?
Employee satisfaction has been proven to improve the quality of care within your facility and
decreases employee turnover. Advancing Excellence’s goal is that “Almost all nursing homes
will assess staff satisfaction with their work environment at least annually and upon separation
and incorporate this information into their quality improvement activities.”
How can nursing assistants help improve staff satisfaction?
• Show respect for other employees.
• Facilitate good communications between all departments.
• Show appreciation to other staff for a job well done.
• Encourage interdepartmental functions such as picnics so employees can meet other
employees’ families and learn more about one another away from the workplace.
• Encourage fun functions involving staff, residents and families.
• Check with new staff regularly to see if they have any questions.
• Advocate for a peer mentoring program to welcome and orient new employees.
• Help new staff to understand policies and procedures specific to your facility.
• Help new staff become familiar with the work environment.
• Help new staff learn individual resident needs and preferences.
• Be willing to work with/partner with new employees in their first weeks of work.
• Help your nursing home become involved with community projects.
• Remember that there is more than one way to do things.
Help the nursing home become the employer of choice:
• Assist with recruiting and hiring of quality staff.
• Assist with providing quality training and in-services.
• Speak up about things that are working in your facility and things that need
improvement.
• Develop an employee council.
• Commit to improving communication, recognizing that it is a two way street, to and from
staff.
• Learn about and participate in the facility’s quality improvement (QI) program.
• Answer any staff surveys the nursing home sends to you.
• Have staff social events.
• Treat co-workers as you treat residents.
• Do your job the way you want others to do theirs.