What Difference Do CNAs Make?

The world of the certified nurse assistant (CNA) is full of contradictions.

They describe their work as monotonous, stressful and dangerous—but also rewarding.

They provide nearly all the direct care for older adults in long-term care settings, and frequently wind up being the main liaison between family members and licensed care providers. Yet they are usually excluded from decision making and may have difficulty sharing information with nursing staff.

How they perform their regular duties—including feeding, grooming and ambulating residents—directly affects older adults’ quality of life. CNAs constantly adjust to changing conditions and decide between competing priorities, with too little time to accomplish all that they would like to do. Yet they have limited training and often lack access to continuing education and professional development resources.

The vast majority of CNAs works in nursing homes, assisted living facilities or continuing care retirement communities. Their average annual pay is just over $26,000, in Wisconsin and nationally, according to the U.S. Bureau of Labor Statistics. The occupation is growing at double the economy-wide average rate, with 1.8 million CNAs needed by 2022, up from 1.4 million in 2013.

Given the essential role that CNAs play, for older adults and in the long-term care system, there is increasing momentum to improve their work conditions. Extensive research on CNA turnover, which commonly reaches 70 percent or higher annually, has identified positive mentoring and including CNAs in resident care planning as effective ways to retain staff. Last year’s report from the federal Commission on Long-Term Care recommended improving training, creating career pathways and “giving direct care workers integral roles in care teams.”

The direct costs to replace each CNA total at least $2,500, the Better Jobs Better Care (BJBC) initiative of the Robert Wood Johnson Foundation and Atlantic Philanthropies estimated in 2007. Based on their research and demonstration projects, BJBC argues that the cost of retention measures (such as raising wages or increasing training) is generally covered by reduced staff turnover. Moreover, facilities that invest in retention can often add clients, since they have fewer staff vacancies and provide more consistent, higher quality care.

When asked how many people had good continuing education opportunities at their workplaces, fewer than half of those attending a recent one-day conference for CNAs and personal care workers (PCWs) in Madison, Wisconsin, raised their hands.

The conference, which was organized by the Wisconsin Long-Term Care Workforce Alliance, Wisconsin Technical College System and Center for Aging Research and Education, obviously met a real need. Many participants drove hours to attend.

Conference topics included caring for people living with dementia, sustaining mobility, addressing urinary incontinence and supporting resident-resident relationships, as well as reducing stress for the CNAs and PCWs. The presenters were alumni and faculty from the University of Wisconsin–Madison School of Nursing—and, coincidentally, all former CNAs themselves.

Building relationships with residents and fostering relationships among residents are important parts of the job, argued Tonya Roberts, BS’03, MS’08, PhD’12, RN, and the attendees strongly agreed. So what can you do when your supervisor or facility doesn’t value such “invisible” work?

“It improves your efficiency, because you’re preventing some of the delays that might happen because the resident’s combative,” suggests Roberts. “It prevents injury to you and prevents injury to the resident, because you’re preventing the struggle that might otherwise occur. It’s not the only reason why relationship building is important … but it is a reason that might get someone to buy into supporting you to do this work.”

To better understand what people living with dementia may be communicating through problem behaviors, Andrea Gilmore-Bykovskyi, PhD’14, RN encouraged the group to consider the context, behavior and patterns. “Pain is the best first go-to” when figuring out what’s wrong, she says, but wandering may be due to boredom, grabbing to fear, or calling out to loneliness. By addressing underlying causes, you can improve the resident’s quality of life and lessen problematic behaviors, often without medication.

The CNAs and PCWs at the conference appreciated the interactive discussions and useful information, and suggested many topics for possible future events, including nutrition, end of life issues and handling abuse from residents. Everyone who filled out a feedback form said that they would recommend the conference to others.  One participant wrote, “Today made me feel better about myself and what I do.”


With your support, CARE can organize more conferences for CNAs and PCWs in Wisconsin. Click here to make a tax-deductible donation.

–Diane Farsetta (article and photos)