Long-Term Care

Tip of the week: Retain CNAs to save money

Contemporary Long-Term Care Weekly, November 13, 2008

Certified nursing assistants (CNA) make up a large portion of your staff, and the money spent on recruiting and orienting them to your nursing home can add up fast.

“Many nursing homes use agencies to staff these high-turnover positions,” said Kelly Smith-Papa, RN, associate professor at the University of Hartford (CT) and staff educator at McLean in Simsbury, CT. “If facilities didn’t use agencies, they could save hundreds of thousands of dollars a year.”

Smith-Papa has worked on CNA retention for quite a while and—with the help of professional educators—has developed successful techniques to reduce turnover. In addition, Bonnie Maxwell, MS, RN, administrator of Cardinal Home Care, Inc., has worked with various facilities to keep CNAs happy and satisfied with their jobs.

Read on for tips you can implement in your own nursing home.

Educate current staff

Nursing homes spend a lot of time educating new staff on how their processes work and making sure that the clinical staff are competent and can perform necessary duties. How much time do they spend educating veteran staff on how to work with and treat the newbies? Chances are, not a lot.

CNAs in particular do difficult work for many hours each day for small salaries. Veteran staff need to do their part to treat CNAs well and appreciate their value to the organization, Smith-Papa says.

“Like most healthcare employees, CNAs took the job to help people, not to get hazed by colleagues who’ve worked at a facility longer,” she says.

This means that managers should take time to remind experienced personnel why it’s important to keep qualified CNAs on staff and how they can play a part in that retention.

One way to do this is by hosting team-building workshops for old and new employees, Smith-Papa suggests. Assign veteran and novice staff to work on a project together so they can get to know one another and understand each other’s personalities and strengths.

For example, Smith-Papa’s facility enlists a team of new and old staff to put together gift bags for postacute residents. Staff with various years of experience work together to stuff goody bags with calendars, pens, and notebooks for residents’ welcome packets. This task allows a chore to be completed while offering an outlet for staff to become acquainted. “Aides often feel dumped on,” Maxwell adds.

Give veteran staff tips on making new staff feel welcome and appreciated. For example, if a novice CNA has been working with a difficult resident for several days, tell that staffer that he or she has done a good job, and then transfer the difficult resident to a seasoned professional for a while. Explain to staff that “good residents” aren’t reserved for nurses who’ve put in their time at the facility, Maxwell says.

Educate new staff

Orientation may last anywhere from a day to a week in most nursing homes, but Maxwell suggests that it become a long-term priority for new staff, especially CNAs.

Hiring personnel will often check that incoming CNAs have the proper state certification to work in this post, but they neglect to follow up on competencies during their first few months of work.

Try on-boarding instead of traditional orientation for new CNAs, Maxwell suggests. On-boarding helps people operate fully in a specific facility. The process may take up to a year. This method includes the following tasks:

 

  • Evaluation of the progress of the CNA
  • Setting up a success plan for the CNA

    “We often set up success plans for managers, but we don’t do it at a lower level,” Maxwell says.

    She suggests separating the on-boarding process into the following two sections:

  • Technical skills: These include whatever skills the CNA was hired to perform. Write them in detail, much like a job description.
  • Interpersonal skills: These include how the CNA interacts with the residents.

    To make sure that the CNA can perform the technical skills, set up a time for the manager to demonstrate the skill and have the employee demonstrate it back to the manager. This ensures that the CNA is able to work with the residents.

    Find the right educators

    Hiring outside educational resources can also be taxing on a nursing home’s budget. Whenever possible, tap into the skill sets that you have in-house.

    If you know that one of your employees is a good educator, find ways to use him or her in on-boarding and other CNA training. For example, if your new employees need help in certain areas, find veteran staff who excel in these areas and set up mentoring or shadowing programs, Maxwell says.

    Smith-Papa agrees. “Nursing in long-term care is more than a job,” she says. “Nurses never give themselves enough credit. They are role models and geriatric experts.”

    The research-based LEAP program was used in Smith-Papa’s facility to educate the work force about becoming empowered and building relationships to achieve positive outcomes and increase staff retention (see “LEAP for success” below more information about LEAP).

    Measure and reward for success

    Measuring your processes with real scenarios and statistics makes problems and solutions quite real for all staff. When problems seem more real and relevant to employees’ daily jobs, they may feel a responsibility to become part of the solution.

    To test this, find an area that needs improvement. For example, survey residents and determine whether they are satisfied with the outcome of using call lights, Maxwell says. Ask them questions such as the following:

  • How long does it typically take for someone to respond to your call light?
  • Are you satisfied with the length of time that it takes?
  • If not, why not?

    To implement a program to improve response time for call lights, notify all CNAs of the plan’s goals. Offer incentives and rewards for successful outcomes, Maxwell says. This may mean something such as a pizza party for the unit with the best response time, or a gift certificate or movie passes for individual achievement. Don’t forget that verbal rewards often mean just as much as tangible ones. “A heart-felt ‘thank you’ nurtures the spirit and can’t be bought,” Maxwell says.

     

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