SHOP FOR

How to Implement a Senior Carer Role: Lessons I Learned

  • By Ben Miller, Registered Manager of Castleford House Nursing Home
  • •  Dec 07, 2021

Reading time:5 minutes

This article gives you my ‘warts and all’ experience first of creating a new role of Senior Carer and then how I came to realise that for this new role to succeed there needed to be a formal Senior Carer Induction process.

Read on for my top tips to make a success of implementing a change like this in your care service, and to download my Senior Carer Induction Plan Booklet. I hope this will help you make a success of the Senior Carer role in your service because – after a rocky start – I can honestly say it has transformed the care we provide to residents and the work opportunities for our staff.

A nurse-led service

In June 2016 when I was promoted up to manager of Castleford House, at the time a 42-bedded nursing home, there were no Senior Carers. We were entirely nurse-led and there was little need on offer for Carers’ career progression beyond the Health and Social care level 2 & 3 qualifications. Carers did their roles and if they wanted more then leaving was the only option.

90 nursing hours short per week

My promotion, coupled with a member of staff retiring and another moving away meant that I began my management career 90 nursing hours short per week. Recruiting nurses back then was the problem it still is today. The nurses had to work many shifts on their own when safe staffing numbers would have been to have two during the day. Whilst the care standards weren’t suffering, the nurses were stretched thin, tired and an accident was waiting to happen.

The idea of a Senior Carer

The idea of creating a Senior Care role didn’t come from me – it came from one of my nurses. She came to me after a morning medication round, frustrated because she kept getting distracted by care staff asking her things like when their breaks were due to start, who should help this person back to bed, what should they do now, can they do this etc.

Nurses felt managing Care Staff was a distraction

“They should be able to organise themselves, they’re grownups,” she said. “They need someone senior to direct them, so they don’t keep stopping me from doing medications.”

This was a common issue that the nurses had – the care staff often distracted them from important matters for routine things. This wasn’t so much of an issue when we had two nurses on shift, but at this point we were working with only one nurse on most shifts - and that one nurse needed to give their full attention to their tasks.

Talent in the team

Some members of the team actually already had the makings of leaders. I had a carer who had been a nurse in her home country, a carer who had many years of experience and was incredibly reliable, two carers who were young but ambitious, loyal and reliable – they just needed to be given the opportunity.

We needed to recruit nurses and creating a new role in the home for care staff would not stop that need. But if I was going to create a new role it couldn’t be a temporary thing – it wouldn’t be fair to “promote” people into a new role only to demote them again when our recruitment campaigns finally bore fruit. Whatever plan I came up with would need to fit into our future plans and be able to work alongside the nurses.

A mixed reaction to the idea!

I internally advertised a “Senior Carer” position and prompted certain people who I felt would suit the role to apply. Only the people I prompted applied for the position because others were resistant to the idea of change. I was told by carers and some more resistant nurses that “we’ve never had Senior Carers before, we don’t need them now”.

But I stuck to my guns and went ahead with the development and in October 2016 the role was rolled out. I did my best to ensure that things went smoothly, that the transition from care staff being nurse-led to Senior Carer-led was an easy one, but the resistance that I was met with was quite fierce.

In my presence it worked, but without me….

When I was in the building things worked well. But when my back was turned nurses would interfere, put down the Senior Carers, go behind their back and change things or, worse, change allocations right in front of them. Care staff would deliberately go slow, would ignore instructions or, if they didn’t like what they were asked to do, would go to the nurses and play the nurses against the Senior Carers.

The theory was ridiculously easy, but in practice it was hell

The role of the Senior Carer was simple – act as the go-between for nurses and carers. If the nurses wanted something done, they would ask the Senior Carer to arrange it. The Senior Carers allocated the care staff on shift to their roles, ensured they had breaks (and stuck to the times), liaised with the nurses for anything and made sure that everything went smoothly. When new staff started, they worked with them and trained and supervised them during their induction. The theory was ridiculously easy, but in practice there was so much resistance that it became a constant source of frustration.

The key to make this stick was to persevere, and to give massive credit to the team who stepped into the Senior Carer role they absolutely stuck to their guns and did not get too disheartened. They were also doing this at their “usual” pay rates, because the role was a trial and so they did not get a pay rise for doing it, which made their determination even more admirable and commendable. As time went on people saw the support the role got from management and started to defer to it. Complaining was deflected but constructive criticism was welcomed, and adjustments were made where appropriate.

3 months in, the case for change was made

The biggest leap in ensuring the role became an established part of the home was a shift where no Senior Carer was available. It went catastrophically wrong – care staff did not know what they needed to do, the nurses did not know where the team were or who was doing what and, sadly, standards suffered because of that. It was the clearest signal that, approximately three months after implementing the role, it was now a necessity and the team had evolved to accommodate the new role.

Acceptance didn’t make for plain sailing

There were still stumbling blocks. One of the original Senior Carers stepped down, feeling overwhelmed by the role and the only person who could potentially fill the void had been employed for only a month, so as well as learning about the home and residents and team and other important aspects she also had to learn how to fill a role that was still in its infancy.

Senior Carers need to be promoted from within

That was when I learned that I wanted the Senior Carers of the future to be developed from the current team and not recruited into the role – it simplified the induction process and also ensured that people who took on the role already had the respect and regard of their peers and the nurses. That new recruit who stepped up not long after starting did really well, but it took a lot of extra time and effort to ensure that she was “up to standard” and even longer for the nurses and carers to trust her in the position.

CcarestockroomHQ

More responsibility but no extra pay to start with

For the first year of fulfilling a Senior Carer position, the postholders did it for no extra money. When it was firmly established, they were given a pay rise for their efforts, which cemented the “trial” as a success and ensured that the role would be one that continued indefinitely.

New starters helped to cement the change

Time was fantastic for embedding the role; as new staff started, having a Senior Carer to defer to was automatic, it was part of their induction. After a while, even the more experienced staff had no choice but to get on board if they hadn’t already, because more of the team were now appreciative of the role than not.

Dealing with someone failing in the role

In 2020, in the throes of the pandemic, one of our Senior Carers left to move back home and at that point in time only one member of the team wanted to step up. She had the characteristics of being a good Senior Carer – level 3 health and social care, experience of doing the role in other care settings, respected by peers, wanted to do the role… but it went really wrong.

A loss of confidence

Once in the role she lost her confidence and become overwhelmed with the responsibility. She struggled to accept any constructive feedback and saw anything negative as an assault on her character. Eventually shifts she was Senior Carer on would end with her publicly threatening to resign from the role, only for her to apologise the following morning and saying she would do better.

More needed to prepare for success

She eventually stepped down, but this showed me that we needed to make improvements to the induction of Senior Carers to appropriately prepare them for the position. Up until this point, the induction of Senior Carers had been a case of pairing the potential Senior Carers with a suitable Senior Carer and have them “show them the ropes” until both thought the new senior was ready and then they were let loose. This needed to change.

But you need the right candidate

Not only that, but I realised that I had stepped this person up into the role because I felt that there were no better options available from the team at that time and so I was effectively shoehorning her into the position, rather than considering whether she would have been the best person for the role.

The job looks easier than it is

The main problem with our Senior Carer induction was that care staff saw the Senior Carers doing their role and thought it was easier than it actually is. They saw them allocating, saw them directing the team and thought that the role was simple. They didn’t understand the nuances behind the role – getting the timings right, checking staff had done things and chasing them if they hadn’t, managing problems within the team on that day, changing plans when unexpected events occurred, having some of the highest care standards within the team so that they led by example and lots more.

CcarestockroomHQ

Shadowing is not enough

There were things that, even by shadowing another Senior Carer, they might not be able to learn and, likewise, the Senior Carer they were shadowing was unable to get an appropriate measure of whether they had what it took to take on the role – it almost felt that it was “a given” that the person was going to get the role and so the learning and development was a formality.

Training someone for promotion costs money

I didn’t want to fit square pegs into round holes. It took a lot of work, time, effort and manpower to go through the Senior Carer induction process and it’s a waste if the person who is inducted is not able to fulfil the role after a few months. Onboarding a brand-new staff member apparently costs, on average, £3000 per new staff member and I would estimate that onboarding a new Senior Carer could cost maybe more than half of that because of the supernumerary aspect of the induction - your time, the time of the person inducting them and their own time.

Formalising Senior Carer Induction

I decided to create a Senior Carer induction booklet that outlined their roles and responsibilities. The first port of call was the Senior Carers themselves, to ask them what needed to go in the booklet. All of them had individual input and then I asked the nurses if there was anything they felt needed to be added – this was one of the most important parts, because the nurses needed to feel involved in the process and not excluded. They would be working alongside the postholder and so needed to know that the right person was going to be selected.

Make the requirements of the Senior Carer role clear

The booklet listed what was required to be a Senior Carer. It made it clear, in no uncertain terms, that this role was more than just allocating a team. The potential Senior Carer would need to read through this booklet and if they felt that this was too much, they could stop the induction before it got started and no real time was wasted.

Use role-play if you need to

In the booklet we included areas that were likely to come up as a Senior Carer, but maybe they would not experience them during their induction, such as conflict resolution. If, during their induction, they did not experience any situations that required managing conflict then I would get some of the team to role-play having a conflict that they would need to mediate – this usually involved one carer “going slow” and another “complaining” about them, which can be a common occurrence in a nursing home. The team usually enjoy acting out these scenarios and it can really lighten the atmosphere on shift when we do this – of course, we try not to tell the Senior Carer in training that we’re going to do it and it’s great to see how they respond to the challenge.

Frequent review points are essential

An extra requirement that I made as part of the induction process was a “touch base” review at the end of every induction shift, where the potential senior and the Senior Carer who worked with them would message me their feedback about how they felt things were going and look at where else they needed to develop.

This was important because it meant that I could see not only how the potential Senior Carer was developing, but I could also find out how the current senior staff were performing in their inductions through feedback from the person who was inducting them. This was done when the team were usually at home, having recovered from the shift and had time to reflect. It was also useful to gauge how committed the person was to the role, because whilst home time is their safe space, the role does not necessarily stop at home time. Most of the Senior Carers would prepare their allocations the night before – for a Senior Carer in training to be available for a few minutes at home after a shift to give feedback, it showed commitment to the induction and to the role.

Why didn't I think of it before?!

In fact, the changes to the Senior Carer induction were so simple that I had to wonder why I hadn’t done something like this from the start. It didn’t take long to instigate a trial of this, as we had to replace the Senior Carer who stepped down and the success was fantastic – the Senior Carers who she would be working with were confident working with her because she did so well and they were able to evidence this with the completed paperwork and she was, likewise, extremely confident and felt that she knew as much about the role as possible from completing the paperwork and just having that physical evidence that she was ready and able to fulfil the role. There was also no risk of “but I didn’t know that” or “I wasn’t shown how to do that” weeks after the induction, because everything needed to be signed off before they could attain the role.

Ongoing assessment and development

This Senior Carer induction process can also be used to test/assess the capabilities and competencies of the current Senior Carers – to review their competencies and skills and make recommendations for any improvements. This helps the nurses feel more involved with the Senior Carers and can foster a greater sense of teamwork, as well as also help identify and address any issues that might arise and manage those accordingly. This also reduces complacency in the Senior Carers, as they are aware that they need to maintain high standards or this will reflect poorly when they are being assessed.

A blueprint for New Carer induction

The huge success of the Senior Carer induction was the catalyst for a change in the way that all new care staff are inducted, as the Senior Carers and I then sat down and devised a “care staff induction booklet”, which was based on the same principle, but for new care staff instead. The success of this was also incredible and, again, it gave people such a sense of accomplishment to have that evidence that they had achieved everything that they needed to be a care assistant.

Go for it – it's easy if you know how

If anyone was looking at implementing this Senior Carer induction process – it’s easy. You just need a Senior Carer that you trust to induct somebody (if you don’t trust your Senior Carers then they shouldn’t be in that position, frankly) and a potential new Senior Carer to be inducted. Show them the paperwork, explain what is involved and let them loose, with periodic reviews/meetings to check on their progress.

A final word of advice

One of the biggest challenges you might face is the Senior Carer who is doing the induction not wanting to be the “bad guy” and fail someone in their induction. This is why it is important to meet with the person leading the induction and pick up on any concerns they have. They should be raising any concerns they have with the inductee, anyway, but if they’re not it’s important to encourage and support them to do this. The more frequently they are supported to have ‘difficult conversations’, the easier it will become for them and the better a Senior Carer they will develop into.

CcarestockroomHQ

11 lessons for implementing the Senior Carer role in your care service:

  1. Don’t take it personally when people resist (even people you believe you had a good relationship with)
  2. Be 100% consistent in getting things done via the new role. Don’t be tempted to go back to the old ways under time pressure because you’ll put your change in jeopardy
  3. With a new role, don’t compromise on the candidate – if they fail, the role will be seen to be failing as well
  4. Praise and support the people who take on new roles and responsibilities publicly and privately
  5. Expect the first 3 months to be hell! It will feel like people are going behind your back – even undermining you. but really, it's not personal! Change can be uncomfortable so people don’t always behave as they usually would
  6. Use role-play to make sure the candidate is well prepared even for those less usual scenarios
  7. Change is never ‘finished’. For us the new role was just the start – new processes were then needed
  8. New staff can help cement the process – for them, the new way of working is just how things get done round here
  9. Involve stakeholders – potential postholders, the people they will manage and the nurses they’ll work alongside
  10. Make it easy for people to tell you about concerns – no one wants to be the ‘bad guy’ but it’s important you hear the truth about performance. Informal and frequent is the way to go
  11. Stick with it!


0 Comment


Leave a Comment