Everyone knows that it’s crucial to be properly staffed to provide quality care. But these days, things aren’t so easy. Certified nurse assistant (CNA) turnover is at the top of the list of problems in long term and post-acute care (LT/PAC). Trying times call for a different way of thinking and managing. 

Feelings are contagious, especially those of staff. Every CNA that leaves the building feeling unhappy at the end of the day is telling others that the facility is not a good place to work and not a good place for their family member to be. But keep in mind that the backbone of quality care is the CNA staff. Below are a few suggestions for recruiting and retaining CNAs differently.

Give Recruitment Bonu​ses

Never use “sign on” bonuses to attract new talent. The facility is open and able to provide quality care because of a solid core of CNAs. They get there in the snow. They never call out. They can do the work of many and pick up the slack when needed. Giving someone who has not worked a second for the company’s mission a large amount of cash up front just to join the team sends a mixed message, especially when veteran CNAs were never offered it. 

It is a far better option to provide a “recruitment bonus.” This is a bonus paid to members of the team (those who are presently employed) that find and recruit others to come to work for the center. It’s a different way to reward current staff for doing the work of bringing in talent. 

An organization might pay “X” dollars for bringing in an application, “X” more dollars for a hire of that applicant, and a final amount if the new hire stays 90 days. 

Incorporate Fu​n 

Make the facility a fun place to work. Even though this sounds easy, it requires some serious thinking. Rather than driving or pressing staff in what could be a negative way to meet goals, make the accomplishment of those same goals fun. Tap into the competitive energy of the staff. Have two units compete against each other to see which can meet a certain goal. Then, give everyone (both sides) a pizza party, but have some fun with the losing team having to serve the pizza to the winners. 

Another idea is to hold a contest, with regular family members and resident council members as judges. The contest can be about almost anything, but something special happens when staff and others get engaged and connected while focusing on a common goal. If staff enjoy coming to work every day, and they are managed positively rather than negatively, they are much less likely to leave over 25 cents an hour.

Focus on the St​ars

Every building has those “special” (the solid core) CNAs mentioned earlier. Most people in the building know who they are. Everyone agrees that turnover is bad, but losing the center’s star players can really affect quality of care in a very short time, like in a New York minute. One way to keep the best and brightest is by giving them an opportunity to grow. Set up a career ladder, with raises associated with each step. 

Step one might get the staff member out of the entry level CNA position and pay rate. This would require them to have a good attitude, spirit, and good attendance (use the company’s evaluation system). Another requirement would be working for 90 days at the center. Once at this level, which could be named something that fits the center’s culture, such as geriatric CNA, the CNA can look forward to another opportunity and will be more likely to find it.

Ready for Leader​ship 

Step two has various options, with leadership always an obvious choice. It can be amazing how often CNAs aren’t even allowed to set up a bath schedule or handle assignments. Nurses are struggling to get meds and treatments done, yet managers often expect them to do all these other things as well.

Speaking from experience, veteran trained CNAs will make others proud when given this opportunity. Even a director of nursing of CNAs can be used as the top of the career ladder (and it has in the past). The levels in between are where the real fun happens. 

Here is how to make leadership tasks accessible for the center’s star CNAs. Sit down and make a list of the things the organization needs most. Then call those things “CNA Advancement Specialties.” These steps would pay more money, and each CNA reaching that level would become the facility/shift/unit leader for that role. 

In addition to “lead” spots, other leadership options might include a specialty related to the handling of difficult residents—those residents that hit others. Some CNAs have natural gifts for calmly handling such residents. Provide those gifted CNAs with extra training to supplement their natural skills, and let them be a mentor and consultant for the rest of the building in their area of expertise.

Assistance with wounds is another area of potential. CNAs are perfectly positioned to help make early identification of at-risk areas on residents. Those in this specialty position could help mentor or train others on positioning and other wound-prevention techniques.

One can think of multiple options for CNA advancement. Personally, the chief operating officer at American HealthCare in Roanoke, Va., has come up with over 50 options for these levels; obviously it’s probably best to not use that many. 

Passion Leads to Specialtie​s

So how do these “levels” help with retention? It has a lot to do with that CNA’s passion. The CNA must have good fundamentals (attendance, spirit, and so on) in place to advance to the first level above. Then, it’s up to leadership to get them additional in-house or outside training for the specialty.

For example, CNA Deborah would be the specialist or expert on the subject matter of wound prevention, and other CNAs would come to her for guidance and help with this issue. CNA Sara, working just down the hall, might be the specialist in handling difficult residents; she would be called on for help related to that subject. The most important thing is that these items are chosen to match the appropriate CNA’s passion. 

That means that leadership is aware of who has what passion, and they are ready to recognize and cultivate it with the right opportunities.

All About Gratit​ude

Gratitude is foolproof: It works. Thank staff every day for what they do every single day. Ask their opinion on problems and issues the organization faces. Let them serve on, and sometimes even run, committees related to the holiday party or National Skilled Nursing Care Week. 

Treat every staff member as an equal partner in this business every day. Tell each one how the organization is doing—how can they help everyone get ready for survey? This has several career ladder options on that subject alone.

Does all this work overnight? Well, no miracles there. But following these ideas will start to prevent a few resignations. Most of these will be in that “core” CNA group the center simply cannot afford to lose. Each loss hurts the organization dearly, so every single one prevented will help quality of care. There will be one less person out there saying the building is a bad place to work and a bad place to bring a loved one. The war against CNA turnover is won one CNA at a time. 

Greg Dowdy is chief operating officer for American HealthCare, Roanoke, Va. He has been doing this job for 35 years, in which time he may have learned a thing or two. Reach him at gdowdy@ahc.cc​.​