HCM 4060 Module 4 Training and Performance Case Study Example

Twelve Hours a Year Is the Floor, Not the Plan: Training Aides for Dementia Care and Coaching a Nurse Through Documentation Errors

Student Name

B.S. in Healthcare Management, Thomas Edison State University

HCM-4060: Human Resources Management for Healthcare Organizations

Mentor Name

Month Day, Year

Twelve Hours a Year Is the Floor, Not the Plan: Training Aides for Dementia Care and Coaching a Nurse Through Documentation Errors

Situation

Two related problems face Cape Shore, the composite Cape May County skilled nursing facility in these cases. First, more than half of its long-term residents have dementia, yet new nurse aides receive a one-day orientation focused on paperwork and a video on abuse reporting; incident reports show that most resident-to-staff aggression occurs during bathing and dressing with aides in their first three months. Second, Dana, a licensed practical nurse with eleven years at the center and excellent relationships with residents, has had four medication administration records with missing or late entries in two months, and the director of nursing wants to terminate her. The HR director has been asked to recommend a training plan and a fair way to handle Dana's performance.

Question 1: What Training Do Aides Need, and Is the Minimum Enough?

Federal rules for nursing homes paid by Medicare and Medicaid set a floor. Nurse aides must complete at least twelve hours of in-service education each year, and that education must include dementia management and abuse prevention training (42 C.F.R. § 483.95). Cape Shore meets the letter of the rule with annual modules, but its incident data show that the training is not preventing the problem.

Flynn et al. (2022) describe training as beginning with a needs assessment that compares what employees must do with what they can do. Here the assessment is clear: new aides do not know how to approach a frightened resident with dementia, how to break care into small steps or how to step back and return when a resident resists. The plan adds a full day of hands-on dementia care training in the first week, using role play with experienced aides, followed by four weeks of paired shifts on the dementia unit and a skills check by a nurse educator before an aide works alone there. Annual in-service hours then build on that base rather than replacing it.

Question 2: How Should the Training Be Evaluated?

Kirkpatrick's four levels, summarized in the textbook, offer a structure: reaction, learning, behavior and results. Cape Shore would measure reaction with a short survey after the training day, learning with the educator's skills check, behavior with observed care during the paired shifts and a follow-up observation at ninety days, and results with incident reports of aggression during care, injuries to staff and early turnover among new aides. Arthur et al. (2003) pooled many evaluations and reported sizeable improvements from organizational training in what employees learned, what they did and what the organization achieved, and that the method and evaluation criteria affected how effective training appeared. Measuring only reactions would tell the center little about whether residents and aides are safer.

Question 3: How Should Dana's Performance Be Managed?

The director of nursing's instinct to terminate is understandable, since medication documentation errors can harm residents and draw citations. But the textbook frames performance management as a continuing process of setting expectations, observing performance, giving feedback and helping employees improve, with discipline used progressively and consistently (Flynn et al., 2022). Dana's record shows eleven years of good performance and a recent change, which suggests a cause worth finding before a decision.

The HR director recommends four steps. First, gather facts: review the four records, the times of the entries, the staffing on those shifts and any system changes. In this case the review finds that the errors began when the center switched to a new electronic medication record and that three occurred on shifts when Dana covered two units. Second, meet with Dana, describe the specific errors and ask for her account; she reports difficulty with the new system's scanning steps under time pressure. Third, put a written performance improvement plan in place for sixty days with clear expectations, retraining on the system with the vendor's trainer, a weekly audit of her records and a meeting every two weeks. Fourth, state the consequence: if errors continue despite support, progressive discipline will follow under the center's policy.

This approach reflects just-culture principles, which distinguish human error and at-risk behavior caused by system design from reckless conduct. It also protects the center legally. A long-serving employee terminated without documented feedback or a chance to improve may claim that the stated reason was a pretext, and consistent, documented steps applied to everyone are the best defense.

Question 4: What Does the Case Show About Appraisal?

The case also exposes the center's annual appraisal. Dana's last review was a checklist rating her as meeting expectations in every category, with no mention of documentation. DeNisi and Murphy (2017) reviewed a century of research and concluded that the field has moved from perfecting rating forms toward managing performance through ongoing feedback and goals. Cape Shore should replace its checklist with brief quarterly conversations for licensed nurses, focused on a few measurable expectations, including documentation accuracy drawn from routine audits, so that problems surface early.

Conclusion

Training aides to the federal minimum has not prevented injuries during dementia care; a needs-based program evaluated at all four levels should. Dana's documentation errors call for fact-finding, a supported improvement plan and consistent discipline if needed, not immediate termination, and the case shows why ongoing performance conversations should replace a yearly checklist.

References

Arthur, W., Jr., Bennett, W., Jr., Edens, P. S., & Bell, S. T. (2003). Effectiveness of training in organizations: A meta-analysis of design and evaluation features. Journal of Applied Psychology, 88(2), 234-245. https://doi.org/10.1037/0021-9010.88.2.234

42 C.F.R. § 483.95 (2025). Training requirements. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.95

DeNisi, A. S., & Murphy, K. R. (2017). Performance appraisal and performance management: 100 years of progress? Journal of Applied Psychology, 102(3), 421-433. https://doi.org/10.1037/apl0000085

Flynn, W. J., Mathis, R. L., Jackson, J. H., & Valentine, S. R. (2022). Healthcare human resource management (4th ed.). Cengage Learning.