Primary assisting

Primary Assisting Taking a cue from primary nursing, long-term care facilities switch to primary-NA assignments. BY JUDITH AUKER MOFFETT

IT ensures continuity of care. IT lets caregivers gel to know lhe resident as a person. IT improves family involvement. IThelps nursing assistants manage lheir lime. ITenhances the quality of care. he magical IT is primarycare assignments for nursing assistants (NAs). Above are ust a few bene[fils lhat accrued to nursing facilities off the Lutheran Hospita s and Homes Sociely, a healIh care management company lhal decided to abandon the lradilional assignment method of rotating resident NA staff [from one patient to another. Assigning residenls, instead, to a primary NA has been satisfying for NAs and residenls. The melhod of assignmertt was changed, but the NA duties were not. The registered nurses remained responsible [for clinical assessment, care planning, nursing intervention, and evalualion. The NAs are still responsible for delivering personal care and assisling with activities of daily living. We launched the change by involving the people that would be affecled. A task [force thai included lhe NAs, the director of nursing, and shift supervisors developed a plan for switching lhe assignment method. The lask [force determined how Io divide up the list of residents by carefully matching the NAs with the residents, keeping in mind personalities, levels of care, and personal preferences. The NAs were involved in selecling lheir resident assignments, since they often know more lhan most about lhe personal care needs of lhe residents. To "cover" for days off and vacations, full-lime NAs were paired with parHime NAs when possible, so the resident could depend on a parlicular replacement when the primary NA had time off. Primary-care assignments were used on days and afternoon shifts. NAs who work lhe night shift were not given permanent assignmenls because the higher residenHo-staff ratio means a smaller number of NAs. This makes assigning each NA permanenlly 1o a resident group more difficult. The amount of personal care given on the nighl shift is small enough lhal consislency, lhough important, is less critical.

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Who's Happy Now As one resident explained, "It's so much easier when you don't have to explain everything 1o someone new every day." Plus, eiders have lhe opportunity to [form deeper relationships with staff. Some v,,orry that residents will get too attached to their primary NA. But elders who have a close relalionship with a staff member have someone to share their thoughls, [fears, joys, and wisdom with, which can help keep lhem mentally alert. Now, subtle changes in a residents physical, menial, or

JUDITH AUKER MOFFETT, RN-C, MS, is the director of nursing at the Arlington Good Samaritan Center, Arlington, OH. She was formerly with lutheran Hospitals and Homes Society, Forgo, ND.

emotional status are readily noticed. As one NA pul il, "You know lhem, and when there is something wrong or lhey hurt somewhere different, you know lhat because you work ,,,vilh them everyday." Earlier inlervenlion is possible, perhaps preventing major health problems. Residents" f a m i l i e s are pleased to have a personal "source" to ask about clolhing needs, gift ideas, mail, or visitors. I[f lhey are planning to take their elderly relative out 1o dinner let's say, they can call lhe NA direclly to ask her to help the elder get ready, rather than calling lhe main switchboard and asking that a message be given to whoever is responsible lhat afternoon. The family is able to give appropriate praise, or criticism, to the NA and the administration. This can boost the famit,/s confidence so that their lives are improved too. One [family recently look lheir first vacalion in [five years because lhey could rely on lhe NA who was the primary caregiver. For NAs, primary assignments have meant a greater opporlunity to personalize care: "If Ms. Jones doesn'l feel like a balh tonight I can postpone it until tomorrow evening. Before primary care, I couldn't leave it [for someone else" to do," noted one NA. The NA knows her residents' schedules, so she can plan her day based on their needs. One NA commented, "1 [feel a lot less stressed if I can plan my day before I even come lo work.." Because lhe NAs can [focus on lhe needs of the whole person, not ust lhe physical needs, restorative care can be enhanced. The NAs know their residents capobi ities and can work with them to reach lheir highest levels of independence. Developing personal relationships wilh staff is therapeutic [for residents with "behavior problems." Often, lhey have fewer problems with consistent care by one person. "Youdo get attached, but I don'l think there is ever a time when you get too a~tached. We're just like [family here." "1 lost a resident not long ago, and il felt like I lost afamily member." Most say that dealing wilh the death of a residenl is harder with primary care but that lhey learn to "let go." .Often, lhe NA ak tends the funeral when an assigned resident dies. Those who haven't worked wilh primary care anticipate gelling bored with the sameassignment. Those who have worked with primary assignments insist boredom is not a problem. When there is a genuine commilment to lhe resident, lhe NA goes beyond what must be done, to what can be done with and for lhe resident. From the administrative perspective, primary care helps maintain quahty of care. The primary NA knows that if the residenl shows evidence of poor care, she will be held accountable. Dietary, laundry, activilies, and social services staff can also easily communicate directly with the NA about lhe resident. The resident, [family, and slaff satisfaclion eliminates many of Ihe day-today problems faced by lhe administrator. Produclivity, accounlability, job salisfaclion, and cuslomer satisfaction all lead to more cosheffective care. • Geriatric Nursing September/October 1991 253