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CNAs: Opening the career door. (cover story). By: Breedlove, Janis.
Nursing Homes: Long Term Care Management. Jun93, Vol. 42 Issue 5,
p8. 3p. 1 Color Photograph. Abstract: Suggests ways of recruiting and
retaining certified nursing assistant (CNA) for long-term care facility.
Reasons for decrease in supply of CNAs; Ways to empower CNAs;
Change of title to Nurse Technician. Reading Level (Lexile): 1050. (AN:
9308266674)
MasterFILE Premier
CNAS: OPENING THE CAREER DOOR
Recruitment, retention and training of these vital workers relies on one thing: motivation. Is it there?
The nursing home industry has experienced rapid change in the last few years, particularly with the
implementation of OBRA. One thing that remains the same is most of the care provided in a long-term
care facility is delivered by a certified nursing assistant (CNA). And, although CNAs were plentiful in
years past, many facilities report that they are now experiencing difficulty in recruiting and retaining them.
Although the nursing assistant population differs around the country, CNAs have many characteristics in
common. They are entry level with minimal education, often living below the poverty line and dependent
on public assistance. Many have not been taught nor do they feel they have the ability to learn how to do
anything other than personal care. This "poor self-esteem trap" may have ensured recruitment and
retention in the past, but will no longer guarantee a staff in the future or do anything to promote job
satisfaction.
Many factors have changed the playing field. With the shrinkage of the skilled workforce, many service
industries are targeting minorities. Funding for job training is available. And, as if the physical demands of
long-term care were not enough (the average nursing assistant lifts 2,000 lbs. a day), the job is equally
taxing on the nerves and receives little praise.
Facilities experiencing recruitment and retention problems with both nurses and nursing assistants often
feel helpless to change the situation. With tight limitations on salary and benefits, they feel they are
unable to compete with other health care settings. Unfortunately, they are unaware of other factors, aside
from salary and benefits, which make employees unhappy.
Not that some individuals are not tempted to leave for the $.50/hr. more that the facility down the street is
offering, and fail to see that the loss of sick time and vacation time alone during a new probationary
period will quickly eat up any small salary increase. This may be irrelevant, in any event: Most CNAs
leave their place of employment because they are unhappy with work conditions but find that their
concerns fall on deaf ears. They recognize that they are powerless and have no voice, and feel the only
way they can get attention is to remove themselves from the ranks. Unfortunately, their action is seldom
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seen as simply a request for better communication and their resignations are accepted as a matter of
course.
In an attempt to identify staff concerns, facilities required exit interviews asking "why are you leaving?"
This is not very effective. Most people are smart enough to realize they need a good reference from their
soon-to-be ax-employer and will not give an honest response. Others are so angry they blame specific
individuals for the facility's shortcomings. Instead of asking why people leave, the facility should focus on
employees who stay and ask, "why do you work here?"
Many facilities know they have a morale problem but honestly believe they have made an effort to
improve the working conditions of CNAs. The problem may not, however, be only working conditions.
Most CNAs complain about work relationships, particularly with the nurses.
If you are unsure if you have an atmosphere that recognizes the CNAs as contributing members of the
health care team, you might ask the following questions:
Do CNAs "cover the floor" during staff meetings and facility inservices?
Are CNAs involved in decision-making at any level? Do they have input into team make-up or
assignments, facility policies and procedures, topics for inservices, etc.?
Is there a career ladder?
Are there merit increases or does everyone get the same raise on annual review?
Are there are awards programs other than "employee of the month"?
How individualized is orientation?
Ways to Empower CNAs
Review your system of evaluation. Is it objective? Give a copy to each employee on hire so they know
what to expect. Tell them how they can achieve the best evaluation, what is expected and what they can
receive for good performance.
Example: How do you evaluate initiative? Tell the employee that you have a monthly mandatory staff
meeting and that if she attends every month during the probationary period, she will receive an excellent
score for initiative. If she attends only two meetings, her score will be "good" and for attendance at only
one meeting, she will be scored "poor." This enables the individual to understand and control his/her
destiny.
Identify the strengths of each CNA. Everyone is good at something! Utilize this "strength" during
orientation and inservice training. Example: If Mary Smith is good at body mechanics during resident
lifting and transfers, have her assist the physical therapist during the facility inservice program on resident
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transfers and utilize her as a preceptor for new employees (including LPNs and RNs).
Identify one CNA on each shift to serve as a preceptor of orientation. Most facilities utilize some sort of
skills checklist, but no one really takes responsibility to ensure that the new employees are actually
proficient at reach skill. Make this the responsibility of the CNA preceptor.
Consider primary assignments. Select a task force of CNAs and have them select the resident-oriented
teams. Assign permanent teams to your tenured CNAs. They will have the same group of residents every
day they work. On their days off, other CNAs will be assigned to their teams. The primary concept allows
the CNA to have a vested interest in her job. Her residents are a reflection of her work. She will not only
be responsible for the daily care of the residents assigned to her team, but will be accountable for their
closets, bedside tables, nail care, weight-taking, and achievement of their care plan goals.
Evaluate the relationship between the nurses and the CNAs. Do your nurses pass medications and then
take a cigarette break until the next medication pass? Since we use "functional nursing" as the delivery
model in LTC, many nurses see their role as task-oriented. "My job is to pass medication and give
treatments, not transfer residents or pass out lunch trays." Although functional nursing delegates tasks
and ensures that everything gets done, it does not promote teamwork.
The facility may have to take a strong stand regarding everyone's role to assist with a variety of functions,
and may wish to start by having a meeting of CNAs and asking nurses to answer call lights and "watch
the floor." Don't allow "functional nursing" to set up a class system in your facility.
Change the name. "Nursing assistant" somehow conjures up the thought that they are there to assist
nurses. Yet our CNAs work independently of nurses. Perhaps Nurse Technician is a title they would
prefer. Better yet, put out a suggestion box and ask the CNAs to suggest a new title.
Understanding what nursing assistants want really isn't that difficult. It's the same thing we all want:
someone to value their opinion, recognize their contribution and to say thank you. They want to be
perceived as an important member of the health care team, and not simply stuck at the bottom of the
totem pole.
~~~~~~~~
by Janis Breedlove, RN, MA
Janis Breedlove, R.N., M.A., is a Nurse Specialist for RehabWorks, Clearwater, Florida.
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