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COACH’S CORNER: Reflecting on the Search for “Meaning”

January 27, 2016

Earlier this month, PHI Organizational Change Consultant Renya Larson wrote a great blog post on the importance of tapping into the intrinsic motivation of employees. After reading that blog post, I got to thinking about each of the three areas of intrinsic motivation she named, and found that it sparked a chain of thoughts about the idea of finding “meaning” in one’s work.

Long-term care relies heavily upon the promise of “meaningful work” — in other words, relationship-focused work that has a genuinely positive impact in someone else’s life — to recruit and retain committed employees. In fact, in our interactions with staff across the long-term care spectrum, employees consistently name this as the primary reason they entered into long-term care. Unfortunately, employees also cite “meaning” as one of their primary sources of frustration. If a CNA or home health aide looks back on their experience at the end of a shift and feels guilt — about having to cut corners, about having to rush, about what didn’t get done — then “meaning” is elusive.

In a recent post in CNA Edge, a blog showcasing the voices and stories of direct-care workers in assisted living and nursing homes settings, Alice describes the reality of life as a CNA:

On the floor, a request for a cup of coffee is trumped by a resident who is a fall risk’s urgent need to use the restroom. A request for an extra pillow will have to come after taking vitals. We are constantly prioritizing the needs that have to be met and something always falls by the wayside.

The fact is, staffing levels in long-term care force employees to make no-win decisions over and over again. It’s a no-win because caregivers have an innate, values-driven desire to find meaning in meeting each client’s individual needs. To consistently have to sacrifice one person’s needs in order to meet another’s is simply antithetical to the idea of experiencing meaning in one’s work.

Nationally, nursing homes average 2.4 hours per resident day of CNA time, and the average CNA manages a caseload of 11 residents each. There are numerous studies linking staffing levels to job satisfaction and quality of care. Researchers such as Charlene Harrington have demonstrated the impact of inadequate staffing levels: good people end up quitting their jobs, which in turn leads to negative outcomes in quality of care.

If you’re not convinced, let’s just analyze the 1:11 ratio as a day shift nursing assistant. If you remove an hour for helping with breakfast, and 15 minutes for a morning break, there are 225 minutes remaining to get the morning report and get each person up and dressed before lunch at noon. This means that each resident could receive 20 minutes of care (outside of breakfast) if they were all treated equally between 7 a.m. and noon. That’s 20 minutes to get a person washed, dressed, to activities, to the bathroom each time they need to go, to a bath or shower, to physical therapy, and so on. Functioning on a daily basis in this reality requires a person to suspend their quest for meaning and replace it with a more robotic, task-driven existence.

Meaning is important not only to workers but to the client as well — and each of their experiences of meaning are linked. Long-term care employees become extended family to their clients, who look forward to seeing them each day. Both the worker and the client find meaning in life through their relationship with each other, but the average CNA workload prioritizes tasks over relationships. In our work supporting clients to implement a “quality care through quality jobs” culture, PHI has been able to help organizations restore balance between task and relationship, creating an environment in which this creation of meaning is genuinely possible.

It can be challenging to restore this balance in the face of fiscal challenges, yet it can be done, and I would argue it has to be done, because organizations in today’s fragile long-term care environment cannot survive the negative impacts of high turnover and poor quality.

— by Susan Misiorski, PHI National Director of Coaching & Consulting Services

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