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proper training - support from management - direct care staff input
Finding the solutions and
working to fix the problems
adequate coverage - ability to take leave time - general work climate

Problem #1: Workers are not properly trained to deal with residents who have violent behaviors - this often puts both staff and other clients at risk. False allegations against staff made by these clients or others can arise when enforcing particularly challenging BSP’s (behavior support plan). As a result, BSP’s are being enforced inconsistently because workers feel they are not receiving support for doing their job as well as being afraid of what a (false) allegation can mean to their career.

Solution: We must hire more staff at better wages (a legislative issue). They must be properly trained in dealing with severe behaviors. Give staff support and backup in enforcement of BSP’s. Recognize staff for good work with employee of the month awards or an extra day off when needed. Make staff a part of the treatment team so their observations of behavior are heard and solutions found for each client.

Problem #2: There are too many reassigned staff - we need to get them back faster. Investigations and decisions take too long which often leaves us short-staffed. When false allegations are made repeatedly by the same clients, or in some cases, when staff is falsely accused by other staff, this results in reassignment to kitchen duty, sometimes for months, as we are told: “this is not punishment”.

Solution: Speed up the decision making process. Also, until decisions are made, move people to another home when allegations are class II or less instead of taking them out of coverage. When clients have a repeated record of false allegations, this should be noted and responded to by their treatment team. Punishing workers for months for things they have not done drags morale down and causes good workers to quit.

Problem #3: There is a lack of communication between management, treatment teams and direct care staff.

Solution: Increase communication through meetings or other initiatives where direct care staff input could be heard. We are the ones working with the residents; although, we are rarely given a chance for input and we are often the last to know anything.

Problem #4: When we call for help, we often don’t get a timely response to the page because the professional staff are stretched too thin. Sometimes, this puts patient and staff at risk because of the lack of support.

Solution: We need more professional staff on duty with assignments that make it possible for them to respond in a timely manner.

Problem #5: Retaliation can sometimes result from asking questions or issuing complaints.

Solution: Unit directors through supervisors need to be better trained in how to listen and respond to employees. The entire staff should be treated as professionals.

Problem #6: The system sometimes seems to be based on a “scapegoat” program. When there are problems, the reaction is “find someone to blame”.

Solution: The system should be based on problem solving; really looking at the problem and figuring out how to get the work done as a team.

Problem #7: Holdovers are excessive, often resulting in double shifts. Workers receive discipline as a result of problems that come from being fatigued. This creates an unsafe situation for everyone.

Solution: Voluntary overtime should be truly voluntary and not forced. No one should ever work more than 16 hours at a time. Overtime should be allocated based on a voluntary sign-up sheet. In disciplinary situations, fatigue and number of hours worked should be a relevant part of the investigation.

Problem #8: There are frequent pulls to homes where staff have no experience with those particular clients. In-service and training often consists of signing your initials to papers you are not given time to read or to attendance forms without being given an actual in-service. If mistakes are made, the employee is disciplined and then told they should have known because they were trained or in-serviced.

Solution: All on-the-job training and in-service requirements should be fully met with real training. Workers must be given time to review BSP’s or special considerations (diets, etc.) for the clients they will be dealing with. Additionally, a survey should be conducted of the number of mistakes and accidents that happen as a result of poorly trained pulled staff and then act on the information.

Problem #9: Hospital and infirmary pulls can result in sitting 16 hours or more with a client without any provision for bathroom or meal breaks.

Solution: Extended hospital and infirmary pulls must have provisions for relief to go to the bathroom and eat a meal.

Problem #10: Central coverage has been abolished, creating numerous problems in securing adequate coverage.

Solution: Re-establish central coverage and hire staff as floaters so there is a pool to pull from to make coverage. Allow time at start of shift for float to review BSP

Problem #11: Employee rights are often trampled in the name of client rights. Being treated like criminals results in employees just trying to get through the day without getting into trouble.

Solution: Client rights are of primary importance; however, employee rights must be respected as well. Clients’ rights can best be protected by a well-trained and motivated staff. Morale is destroyed in a climate where staff feel they are guilty until proven innocent and good work and extra effort goes un-rewarded. Employees need to have a clear understanding of their rights as well as their duties. Real use of the positive performance program to reward and encourage would be a good starting point.

Problem #12: Staff feel like it’s nearly impossible to get time off. Requests are not responded to and then are often denied at the last minute making it impossible to plan ahead. Vacation is granted then pulled back or split up.

Solution: Don’t rescind previously granted time. It is up to the facility to find coverage. Adhere to HHSC policy on taking compensatory leave time: “A supervisor must allow employees to use state compensatory leave if requested 90 days in advance of the date it is to be taken.” (Chapter 6, Section E, HHSC Policy manual). Don’t deny time off because the home “might” be short on the requested date.