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.