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.