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(P13) Leadership Guide: Integrating Nursing Assistants Into Interdisciplinary Teams and Planning

Objective/Aim: Integrating certified nursing assistants (CNAs) into interdisciplinary care teams (IDTs) and resident care planning is essential for improving person-centered care in nursing homes (NHs). CNAs have the most direct contact with residents and are best poised to communicate residents' needs and preferences. However, inadequate staffing and inconsistent CNA assignments along with other barriers often limit their participation in IDT meetings and resident care planning. This study aims to: (1) identify strategies for CNA integration into IDTs and resident care planning processes, and (2) develop a guide for NH leaders that synthesizes these strategies.

Design/Methodology : One-on-one, 30-minute Zoom interviews were conducted with 17 participants, including NH surveyors, social workers, ombudsmen, physicians, directors of nursing, and CNAs from across the US. Interviews focused on the structure and practices of CNA integration into IDTs and resident care planning, as well as outcomes from CNA integration. We used Donabedian’s Quality of Care Model to identify key themes for developing the guide’s components. Two panel meetings were convened with 10 key informants to assess the guide’s relevance through validation testing. The panel provided insights on item relevance, structure, readability, feasibility, and length. Based on their feedback, we refined and finalized the NH executive leadership guide.

Results:

The findings highlight the following strategies for integrating CNAs into IDTs and resident care planning:


  • Schedule IDT meetings around CNA availability, such as at the start/end of CNA shifts, after lunch, or before morning medication rounds.

  • Choose convenient IDT meeting locations, like resident floors, to avoid disrupting care.

  • Cultivate communication by actively seeking CNA input, implementing daily communication logs or 5-minute end-of-day recaps.

  • Designate note-takers for IDT meetings to document discussions.

  • Recognize and incentivize CNA’s active participation in IDT meetings with opportunities for professional growth and potential salary raises.

  • Empower CNAs by educating them on care plan elements and root cause analysis of specific adverse events.

  • Foster a positive culture by having administrators spend time with residents and CNAs.

  • Adjust budget allocations to prioritize staffing and education initiatives.

  • Utilize electronic health records software like "PointClickCare" to allow CNAs to view and contribute to care plans.


The full version of the NH executive leadership guide is available at the following link: https://nyu.box.com/s/a1f3sglzmwqnadb0gyje7rjznmh7y1uq.

 

Conclusion/Discussion : This guide can help members of the leadership team at NHs understand how CNAs can contribute to the IDT meetings and resident care planning. It offers recommendations for how NHs can best integrate CNAs into the IDTs and the resident care planning, aiding NHs in meeting the 2017 CMS §483.21(b)(2) mandate. The recommendations are generalizable to the leadership team at NHs and other residential care settings.