Press Q & A with Linda Leekley

1. How did In the Know begin?
   During the mid 1990's, changes in health care reimbursement caused many health care organizations to slash their operating costs. Unfortunately, many staff development and clinical education departments took the hardest hits because they were not "directly" related to client care. 
   As a nurse, with experience in acute care, home health and clinical education, I knew that these budget cuts would put the responsibility for clinical education on the already overburdened shoulders of nursing supervisors. It became my mission to come up with a realistic way to help. In 1998, I conceived a plan and put it into motion by founding In the Know, a publishing company focused on the ongoing educational needs of certified nursing assistants.

2. What made you focus on certified nursing assistants only?
   The answer to that is simple. There was a tremendous need for nursing assistant inservice materials that was not being met. (To maintain their certification, all CNAs are required to complete a certain number of inservice hours per year. While this number varies per state, the average is twelve hours.) Unfortunately, because there tends to be a high turnover rate among nursing assistants, many health care organizations consider continuing education for their aides a low priority. 
   Early in my nursing career, I came to understand the vital role that nursing assistants play in the health care team. Today, in many health care organizations, CNA's deliver up to 80% of the hands-on client care! When you consider that aides have the least amount of pre-employment education of any clinical employees, it's clear that their ongoing on-the-job training is crucial. In fact, I believe that consistent, quality inservice education is key to retaining good CNAs and keeping turnover rates low. Good inservice education spurs critical thinking, enhances the quality of client care, and encourages professionalism on the part of aides. 

3. How did you come up with your initial topics, and how do you choose topics now?
   From the start, I wanted to offer a wide variety of inservices, including topics that are mandated by OSHA and JCAHO, topics that serve to enhance skills and topics that address some of the most common conditions—such as diabetes and hypertension—that aides are likely to encounter. In addition, our inservice topics are chosen based on suggestions from our customers as well as the current "hot issues" in Medicare, JCAHO and medicine.

4. How are the inservices written?
   All of our inservices are written by registered nurses who have experience in home care, hospice, long term care, hospital nursing, health care management and staff development. They perform extensive research to make sure that each inservice contains the most recent information. We combine lots of factual information with practical tips for effective client care and add graphics and some fun stuff, like jokes and funny stories, to make the inservices appealing to the aides who are using them.

5. How do customers order and receive their inservices?
   Customers can order by calling our toll-free number, (877)-809-5515, or by faxing us at (919) -490-4808.  Our inservices are sold online and through mail order. We have a website (knowingmore.com), and we ship all over the world. Ultimately our inservices are all paper format, but our customers can choose to have their inservices delivered in paper or CD-ROM format. (We also email topics when our customers need an inservice quickly, but due to the size of the files we limit emailing to three or fewer topics.)

6. How much do the inservices cost?
   Individually, each inservice is $48. However, we have created four different plans: Platinum, Gold, Silver and the "PRN" Plan. Each plan has something special to offer. For example, the Platinum Plan offers the most free perks--more than $500 worth. Our Gold Plan balances topic choice with budget. The Silver Plan is the most convenient. And, the PRN Plan offers the most flexibility. For customers who want to use In the Know as the foundation for their CNA continuing education, our Gold and Platinum Plans are the best bet. They are designed around a year of inservice training; customers receive the 12 inservice topics of their choice--plus a 13th for free. And, for first time customers, we offer a 25% discount on both the Gold and Platinum Plans. Whatever your budget, we encourage you to discuss your needs with us so that we can provide the most cost-effective way for you to develop top-notch CNAs!

7. How do your customers actually use these materials?
   We have a variety of customer types, and we know from their feedback that the majority of them use our inservices for self study, because many of their CNAs are working in clients' homes, or during hours that prevent them from attending the group presentation. They just fold up a copy of the learner section and tuck it into the CNA's paycheck, and the aide reads through the material, takes the quiz at the end of it, and turns it into their supervisor for grading and inservice credit.  When our customers use our inservices for group presentations, they usually have a nurse supervisor present the inservices, which contain a section for the supervisor (sort of a "here's how to teach this topic" section), and a learner section with a quiz at the end that is copied and given to each CNA. We also include some "extras" with each inservice, such as discussion questions, teaching tips and a game or two. These help, in a fun way, to reinforce the concepts that are taught during the inservice presentation.

8. Do you also produce training videos?  
   No, we don't...and with good reason. As a former clinical educator, I can tell you that the fastest way to put a group of people to sleep is by turning the lights down and popping a video in the VCR. While videos can provide some great visuals that assist with learning, in general, they give no opportunity for group interaction and offer no way for the learner to review the information later, at his or her own pace. And, in my experience, by the time a video is produced and ready for sale, the information it contains is often at least a year old. Our newsletter-style format allows us to offer current information and our suggested activities create a stimulating learning environment in which everyone stays awake!

9. Are CNA training materials subject to any state or federal "approval"?
   Unfortunately, no. I really think that this is a huge oversight that, in many cases, can lead to less than adequate inservice education for nursing assistants. Nursing supervisors are notoriously overburdened. Busy nursing supervisors or staff educators may not take the time to prepare quality materials for their aides. That's where we come in...

10. What kinds of comments do you get from your customers about your inservices?
   Oh, we love to hear from our customers! And we try to solicit as much information from them as possible. Of course, we love to hear that they think our inservices are the best they've ever used! But we also enjoy hearing how they're using them, what topics they'd like to see added to our library, how they think their aides are responding to the inservices, and, of course, how their client care improves as they use our materials for their CNA education. Better client outcomes is a major objective for us.  Here are a few comments we've gotten back from some of our customers:

"Very well done. We like all your inservices! Our state surveyors were impressed that we had found an organization like yours."
Deborah F., RN
Hickory Estates
Sumner, Illinois

"In the Know inservices have ensured that my home health aides get the required training they need without taking nonexistent hours from my schedule to plan it."
Sonjia H.
Hospice Southwest
Vancouver, Washington

"My thanks to you for putting out such interesting and informative programs for our home health aides. You do a great job and make my job as educator easier and less time-consuming. Your discussion questions are thought-provoking and generate lots of interesting input from our aides. Keep up the good work!"
Marlene G.
Community Home Services
Naples, Florida