Question

Case Study: Retaining Certified Nursing Assistants Certified nursing assistants are the backbone of long-term care. They are tasked with the basic tasks that nurses used to perform, such as toileting, bathing, changing diapers, and other “dirty” jobs. The turnover rate for these direct care workers is more than 70 percent (Bishop et al. 2008). Long-term care administrators spend time and money and lose productivity because of CNA turnover, which has been estimated to cost more than $2,500 per occurrence (Seavey 2004). In addition to direct costs, the turnover negatively affects residents’ quality of life (Bishop et al. 2008). To address these concerns, long-term care administrators must be proactive and develop programs to retain these valuable employees. However, to develop effective programs, administrators first need to understand the underlying factors that help retain CNAs. Bishop and colleagues (2008) found that the quality of CNAs’ relationships with their direct supervisors was a key factor in remaining in their positions. Additionally, turnover became less likely when an organization’s CNAs demonstrated strong commitment to their jobs—in other words, if morale among CNAs was good, CNAs remained in their positions. The Iowa Caregivers Association (2000) found that the main reasons CNAs leave the job are short staffing, poor wages and benefits, lack of respect, and inadequate training and education. Several states have launched initiatives to retain CNAs. One such initiative in Iowa offered focused training on topics such as caring for Alzheimer’s patients. The program was effective in increasing CNA retention because it showed CNAs that the organization valued them enough to invest in their training. Another effective method has been to institute a lead CNA program in which experienced and top-performing CNAs are recognized and rewarded for their knowledge and dedication. Such programs typically involve a small pay increase, but more important, they give CNAs the recognition that is often lacking (Iowa Caregivers Association 2000). Other initiatives, such as including CNAs in decision making, may also be promising. For instance, administrators might consider including CNA supervisors in daily staff meetings and strategic decisions. After all, CNAs spend more time working directly with residents, and much can be gained from their unique insight. Such efforts would help address the perceived lack of respect that causes many CNAs to leave the profession. Better Jobs Better Care, a national initiative to address issues facing the direct care workforce, sponsored a number of demonstration projects, including one that provided CNAs with subsidized housing. In addition, CNAs in the program had access to free transportation to and from the home, healthcare benefits, and a childcare stipend (Better Jobs Better Care 2008). Programs such as these go a long way to showing that CNAs are a valuable part of the long-term care workforce.

Case Study Questions

1. What are the four main reasons CNAs leave their jobs?

2. Using the answer from the previous question, design a program to retain CNAs in your long-term care facility.

3. Remember to provide citations for any sources used. State how your initiative resolves two or more of the four main reasons CNAs leave the profession.

Answer 1

1. The four main reasons CNAs leave their jobs are:

• Short staffing.
• Poor wages and benefits.
• Lack of respect.
• Inadequate training and education.

2. Program to retain CNAs in a long-term care facility:

A CNA rewards program should be instituted in which experienced and top-performing CNAs are recognized and rewarded for their knowledge and dedication with a small pay hike and/or incentives giving them the required recognition. The rewards program should be based on their monthly performance assessments. Their direct supervisors should have a cordial relationship and should include them in decision-making. CNA empowerment practices should be given the utmost importance with a continuous quality improvement process. They should be provided with subsidized housing along with access to free transportation to and from the home, healthcare benefits, and a childcare stipend.

3. Citations for sources used: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5326608/

The above initiative resolves the following three main reasons CNAs leave the profession:

• Poor wages and benefits: Better performing CNAs are given better wages and benefits as part of the rewards program.
• Lack of respect: This is resolved by including the CNAs in decision-making and having a cordial relationship with them.
• Inadequate training and education: This is resolved by CNA-empowerment practices like continuous quality improvement programs.