“NAs know where the quality gaps lie.”

I loved working in a skilled nursing facility—the long-term relationships with residents and their families, the chance to really hone in on nursing basics, the opportunity to learn about life from people who had seen it all.

But what finally drove me away from this work was the mediocre quality of care in two different “homes” where I was on staff. I was angry and frustrated, and even after several years in nursing, still too inexperienced to understand what I could have done to make things better.

Including nursing assistants in QI projects: ‘crucial to success.’

Today, care is slowly changing. Nursing homes are now required to post on the web certain data about their patient outcomes (https://www.medicare.gov/nursinghomecompare/search.html), and to implement quality improvement (QI) initiatives. But have we regarded QI projects as the province of RNs and administrators only? In this month’s AJN, Kathleen Abrahamson and colleagues make the following observation:

“…nearly all changes driven by QI in work processes, schedules, approaches to care, or documentation will either affect or be carried out by nursing assistants. Thus, including NAs in QI efforts is crucial to their success.”

The truth of this statement is so clear, it might be called a “no-brainer.” As the authors point out, NAs have the most frequent contact with residents and their families. Yet the culture of nursing homes tends to be even more hierarchical and resistant to change than hospital culture. So what needs to be done in order to make use of the expertise of nursing assistants when QI initiatives are designed?

Respecting NAs for what they know.

In this month’s Viewpoint, “Involving Nursing Assistants in Nursing Home QI,” Abrahamson and her colleagues share several practical ideas for welcoming NAs into the QI process. This kind of shared QI effort can transform the care that we provide. And it will work best when NAs are respected for what they know about each resident and about the daily routines in their facility. As the authors write:

“NAs know where the quality gaps lie. If given the opportunity to contribute, they can have valuable input into areas most in need of improvement.”