LEAP: Learn, Empower, Achieve, Produce

Deciding to LEAP
The largest nursing care facility in the state, Wisconsin Veterans Home at King is like a small town on the shores of Rainbow Lake.

It includes four licensed nursing care buildings, chapels, a a bowling alley, a post office, a theater, a museum and a library. It employs more than 130 licensed staff and management, as well as approximately 300 CNAs, who together provide care for up to 721 resident members.

By 2006, the Wisconsin Veterans Home management was committed to “culture change,” which Nurse Administrator and Chief Nursing Officer Donna Warzynski describes as “the movement from institutionalized care to person-centered care, from an institutionalized feeling to the feeling of home.”

The management knew that any major shift would require buy-in and participation from every staff member and, according to Warzynski, Mather LifeWay’s LEAP program “seemed a good way to lay the groundwork for broader culture change.” In particular, she says, “we knew we needed to work on teamwork, communication, and collaboration,” all of which are emphasized in the LEAP program. Managers also appreciated that LEAP’s multidimensional approach addresses nurse leaders as well as frontline caregivers.

LEAP is designed to develop leadership, mentoring, teamwork, and communication skills for all staff, as well as career mobility for certified nursing assistants. It is based on the belief that training must be implemented at all nursing levels in order to effect change. Specifically, the program’s objectives are to:

• Educate and empower frontline staff and create structures for advancement,
• Reduce turnover and increase staff satisfaction, and
• Create a research-based model, with successful outcomes documented by formal evaluation that can be replicated in other sites.

Initially, four licensed nurses from Wisconsin Veterans Home attended the LEAP train-the-trainer program. Over the course of several subsequent months, these four trained all licensed staff and then all CNAs working at the facility. They also set up a system for training all new incoming employees.

The LEAP Training
Module 1: The Essential Roles of Nurses in LTC. All nurse managers and charge nurses (RNs and LPNs) attend this six-week (18 hours total) program to develop leadership and care role model skills, clinical gerontological expertise, and team-building skills to support the care team. In each session, action steps are role-played in realistic clinical scenarios. The curriculum includes:

• The ten key roles of effective leaders, including communication skills, giving feedback, and mentoring staff.
• The importance of the nurse as a role model in providing “person-centered care,” and how that example can empower residents and frontline staff.
• The importance of gerontological nursing as a specialty. Nurses are encouraged to develop their own knowledge base and assessment skills.
• The need for all nurses to be care team builders who develop relationships with residents, families, and staff in the interest of delivering quality care.

Module 2: Growing the Heart of Care: Career Development for CNAs. This course — 17.5 hours spread over seven weeks — focuses on career and skill development for CNAs. The curriculum, which was developed based on focus groups with CNAs, includes:

• Person-centered care
• Communication skills
• Head-to-toe inspection
• Clinical updates (preventing skin breakdown, incontinence care, and nutrition)
• Building care teams
• Cultural sensitivity
• Working with families, and
• How to mentor new CNAs (a two-part program)

An Expanded Career Ladder

Before starting the LEAP training, Wisconsin Veterans already had a two-tier advancement program in place for CNAs: Level 1 for new CNAs with little or no experience in the field, and Level 2 for those with at least one year of experience who demonstrate an advanced level of competency and receive positive reviews. CNAs who attain Level 2 receive a pay raise.

After the LEAP training, management at Wisconsin Vets decided to enhance this advancement program by adding a Level 3. Level 3 status is a promotion to a leadership position, requiring an exam and interview process. Level 3 CNAs become mentors for new CNAs and oversee documentation and scheduling. They also get training on the use of new equipment and are responsible for training others. In addition, they attend educational sessions on special topics related to caregiving, such as pain management, and take the lead in educating the rest of the staff.

As a result of the LEAP training, management realized that Level 3 CNAs, as mentors to new employees, needed to be held accountable and regularly evaluated by staff as well as management. They revised their previous evaluation tools and posted the responsibilities of Level 3 CNAs in visible places throughout the facility. This has helped other CNAs know what to expect and what they can ask for. As Warzynski says, “the whole idea is to maximize communication and connection with each other.”

Consistent Care Assignment

LEAP laid the groundwork for Wisconsin Vets to implement another aspect of their culture change plans — consistent care assignment. This is a system wherein CNAs regularly care for the same group of resident members. Warzynski notes that good communication, teamwork, and a broader range of care skills are essential to the success of consistent care assignment, and therefore the LEAP training was crucial to preparing staff for this shift.

Consistent care allows members to develop closer relationships with their CNAs, whom they often come to regard as extended family members. “They like having someone who knows them, knows their routines and their little foibles. The CNAs become intertwined with members’ families, too — and the families recognize the value of these relationships,” Warzynski says.

Continuing Education
Mather LifeWays continues to provide support to Wisconsin Veterans, including periodic evaluation and benchmarking services, as well as instruction on working with Alzheimer’s patients and other specific populations. “Every year,” Warzynski says, “they come up with new and timely information.”

Outcomes

Better Communication and Collaboration. Warzynski says the LEAP training was well worth the investment of time and energy. “It was extremely beneficial as we moved toward a focus on person-centered care, especially in terms of our staff’s ability to communicate and collaborate as a team.”

Before the LEAP training, communication among the staff at Wisconsin Veterans was less than optimal, especially communication between licensed and unlicensed staff. Warzynski recalls that CNAs in particular were sometimes frustrated about not being kept “in the loop” after reporting concerns about a resident member’s health or ideas for improving members’ care or environment. They needed to know what follow-up, if any, occurred.

Since the LEAP training, Warzynski sees a marked improvement in communication among staff at all levels. The change to consistent care assignments allows CNAs to notice even the smallest changes in the members they care for, and the LEAP training gives them the skills and confidence to report concerns effectively. Through the training, licensed staff gained better listening skills and learned better systems for prompt follow-up with CNAs.

Better communication has made Warzynski’s job easier, too. “With staff more open, they let me know their concerns in a more positive way, and share their ideas with more confidence. Focusing on communication and teamwork really helps everyone on the healthcare team.”

Better Care. Residents at Wisconsin Veterans also appreciate the more collaborative atmosphere among the staff. According to Warzynski, they consistently report feeling well cared-for and are more comfortable speaking up if something doesn’t go well.

A particularly positive result of the LEAP training at Wisconsin Veterans was the decision to implement a new program called “Final Hours.” Through this program, staff members are educated in how to be with someone at the end of her or his life. Guided by the goal of person-centered care and using the communication skills developed through LEAP, staff work as a team with each resident member, talking through what the resident wants and making sure that each resident’s end-of-life wishes are respected.

Greater Job Satisfaction and Greater Retention Rates. Survey results, as well as anecdotal evidence, show that staff at all levels are enthusiastic about the new emphasis on communication, teamwork, and cooperation. Wisconsin Veterans is still in the process of collecting data about staff turnover rates since implementing LEAP.

Mather Lifeways, however, has collected data at other facilities that have implemented the program. Data from one of the first facilities to use the program show that nurse turnover decreased from 44 percent in 1999 to 16 percent in 2002, while CNA turnover decreased from 76 percent to 4 percent. In another pilot facility, nurse turnover decreased from 72 percent to 50 percent, and CNA turnover from 93 percent to 79 percent, between 1999 and 2001. (These rates were calculated using different formulae.)

A formal evaluation of the program in these two pilot facilities found that nurses’ and CNAs’ perceptions of their work empowerment, job satisfaction, and organizational communication were significantly better six months after they attended the LEAP workshops than they were before.

Lessons Learned

Warzynski is clear that the LEAP program laid essential groundwork for their first successful steps toward culture change. “LEAP helped us — and has continued to help us — shift from the old task-oriented, regimented approach to care to more consideration of what each member wants.”

Any major change at a facility as large as Wisconsin Veterans is daunting for everyone involved, and there was some resistance at first among some of the staff — especially to the idea of consistent care assignment. Several months after the shift, however, a staff survey showed that CNAs were enthusiastic about the change.

Even those who initially resisted the idea are now champions for it, says Warzynski. They see that consistent care means better care for members and a more satisfying work experience for themselves. Warzynski is particularly delighted by how CNAs have internalized their LEAP training and now speak up more confidently, sometimes even referencing their training, as in “Wait a minute — that’s not what we were taught in LEAP.”

Most important to Wisconsin Veterans is LEAP’s emphasis on clear communication and the importance of working together as a team to provide the best possible environment for members as well as for those working to care for them. Without a strong sense of collaboration among the staff, Warzynski says, no effective change could be sustained. LEAP has been the catalyst for culture change that Warzynski hoped it would be: “I would certainly encourage other facilities to look at it and reap the benefits,” she says.

Sponsoring Organization: Wisconsin Veterans Home at King is the largest nursing care facility in the state, serving 720 resident members and employing 130 licensed staff and managers and 300 CNAs.

Best Practice: Wisconsin Veterans has implemented Mather LifeWays’ LEAP program, a career ladder program for nursing assistants that simultaneously focuses on nurse leadership, communication, and collaboration.

Setting: Located on Rainbow Lake, Wisconsin Veterans at King is like a small town, with four licensed nursing care facilities, chapels, a bowling alley, post office, theater, museum, and library.

Start Date: 2006

Costs & Funding: A four-day LEAP train-the-trainer workshop for staff development coordinators or nurse managers costs $2,595 for the first attendee, with discounts available for additional attendees from the same facility who register at the same time. The cost of annual renewals for the LEAP licensing agreement is $500 per facility, which also covers annual evaluation and benchmarking services coordinated by Mather Institute on Aging.

The Armed Forces Foundation sponsored the LEAP training for the initial four nurses from Wisconsin Veterans, and has continued to sponsor the facility’s connection to LEAP.

Contact Information:

Donna Warzynski, Nurse Administrator
N2665 County Road QQ
King, WI 54946-0600
715-258-5586 | dva.state.wi.us/Homes_king.asp