Browsing "Consistent Assignment"

Consistent Assignment – Entry 2

Dear Diary:

Yesterday we had a meeting on the Rosewood neighborhood to talk about implementing consistent assignment. I wanted to make a case so I came prepared with some great information I found on the Advancing Excellence (AE) and Pioneer Network websites that talked about the benefits of consistent assignment. That information didn’t seem to get staff too excited. However, they did become more engaged when I reminded them of a recent incident with one of the residents on this neighborhood. We had to respond to a family complaint after the resident was given a shower instead of a bath. She’s deathly afraid of showers and it took hours for her to calm down after that experience. All agreed this wouldn’t have happened if the staff member knew the resident well and was familiar with her routine.

As I expected, the conversation quickly went to “Yes, consistent assignment would be nice, but I don’t want to be stuck caring for the same difficult residents every day.” I suggested that implementing consistent assignment will help address these concerns. We need to discuss these
“difficult” residents to find solutions that will make their days and our days better. Not sure if that made any impact, but I assured them that everyone’s concerns would be heard. I also let the nursing assistants know it’s an expectation that consistent assignment will be implemented. The nurses and I will be glad to provide guidance, but it’s up to them to come up with “fair” groups of resident assignments. I shared a rating scale that I found on the AE website called, Dedicated/Consistent Caregivers Tip Sheet. They immediately started talking with each other about which residents should be grouped together. I have given them two weeks to work out the assignments on their shifts and then we will meet again to talk about next steps. We’ll start small and go slowly! I hope that giving the nursing assistants ownership in this project will lead to its success. What other ways can we empower the nursing assistants?

Signed, Donna


  • We have found that the nursing assistants work as “Teams” and in their “Team” they work two to a “Team” this way for the residents who happen to be more difficult they can work together and this does not seem to be as heavy for the staff.
    Residents negative behaviors may decrease as the same staff work with them most days as they get used to a routine.
    When one regular caregiver has a day off the other is there to be more consistent and the residents don’t feel totally abandoned. Some residents like to know when their regular caregiver will be gone for a day but that is totally up to the caregiver as it is their persoanl time.

  • At my facility we have a wonderful group of CNAs and nurses who do work as a team. But we also have one or two that are constantly feeling they do “more than their share” and do not have the teamwork mindset. They have “their” residents and refuse to assist with residents who are not on their group assignment. I’m hoping that having the CNAs actually collaborate and come to an agreement on what residents should be grouped together will at least make the groups fair. I forgot to mention in my last comment that by changing the groups this also changes residents’ bath days which has been an issue in the past. I might have to sell them also on the changes.

Share your nursing home perspective on this quality improvement issue.

Consistent Assignment – Entry 1

Dear Diary:

Last week I was cleaning out my office and found handouts from a presentation on consistent assignment I heard about six months ago. I have heard over and over that consistent assignment improve the quality of care and the quality of life for residents. Earlier this year I brought it up at one of our staff meetings and I was completely shot down. The nursing assistants were just not interested. I think they’re too afraid that they’ll be stuck with the same “difficult” residents everyday and that they’ll burn out. I put that idea on the bottom of my list, but I think it’s time to bring it back to the top.

I’ve been trying to figure out how I can get the staff excited about this. We’ve been hearing a lot about quality lately as we prepare for the new QAPI regulation. I know that I’m supposed to be creating a culture to support quality improvement efforts by fostering the participation of every caregiver. So, I think this project will be a great way to practice my leadership skills!

I know we will have more success if the nursing assistants take ownership of this change. How can we empower the nursing assistants to take this on?

Signed, Donna


  • When I first met with my staff to discuss consistent assignment, we also had some of the same issues come up. Staff were afraid of “burnout”. I tried to keep the focus on how easy the nursing assistants day goes when they know the residents routine…especially the residents that have a very specific routine. A few of my long term nursing assistants got behind the idea and that really helped.

    One struggle I am having is trying to get “consistent” staffing when I have an “in-house” pool. The pool is great offering flexibility for staff and I have sufficient staff numbers…I know I am very lucky:)…but, it is really challenging to consistently assign staff that have an inconsistent schedule.

  • I have not even addressed the issue with staff at this point. We have a large population of (mostly) CNAs that either work 2 jobs and need to stay on their current schedules or both husband and wife work and need to work opposite days for child care issues. One other difficult obstacle is that our staffing person left (he was GREAT at figuring schedule blocks out) and we now have a lady who is new at the job and is very unsure of herself and absolutely no good at using the excel program. I, myself, am no good at it but will become an expert by the time this is done.

  • Just when I think we have our CNA staffing in good order, now one of our top CNAs has put his notice in because he has been accepted at a hospital. We barely got our new aids through orientation. Now we have another gap to fill. I have faith that at some point things will stabilize.

  • We do work with consistant staff and have for years. Our residents have thoroughly enjoyed it. It is not unusual for a resident to say they miss their “regular” caregiver when they have a day off. But one thing we are trying to implement now is for the staff to “manage up” this is where they tell their resident “I am going home for the day,____is here to replace me and they have worked with you before and know that you like to get ready for bed early so you can watch TV in bed”. Or, ________, will be here tomorrow and she knows you have a bath scheduled and will make sure you get to the beauty shop right after your bath”. Reassuring the resident someone else will be able to assist them, this will get rid of some anxieties they may have.

Share your nursing home perspective on this quality improvement issue.