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Teamwork Carries the Day During Pandemic<p>​During the pandemic, it hasn’t been unusual to see a director of nursing (DON) in the kitchen, human resources staff making beds, maintenance staff picking up or dropping off employees, and administrators feeding patients. There’s an “e” in teamwork, and in the past year, that’s stood for “everyone helps everyone else.” <br></p><p><img src="/Monthly-Issue/2021/April/PublishingImages/Oguin.jpg" alt="Jennifer Oguin, RN, DON" class="ms-rteImage-3 ms-rtePosition-1" style="margin&#58;5px;width&#58;144px;height&#58;177px;" />As Jennifer Oguin, RN, DON, at Trinity Care Center in Round Rock, Texas, says, “My title went out the window. When it comes down to it, we are a team that pulls together without even asking. People just jump in and do what needs to be done. It’s embedded in our culture.”<br></p><p>Teamwork has taken on new meaning during the pandemic. Facilities have implemented new strategies for communication,&#160;collaboration, and innovation. Transparency, resilience, and empathy are not buzzwords but essential elements of daily work life.<br></p><p>Getting past the pandemic and the politics of 2021 calls for renewed efforts to focus on the residents and what it takes to keep everyone safe and engaged, as well as building and strengthening cultures that will weather any storm or crisis. </p><h2>Head of the Class&#58; Education Moves Up<br></h2><p>Team education has always been essential in post-acute and long term care. However, during the pandemic, it’s taken on a new level of urgency. It’s also been more challenging, as guidance, recommendations, and clinical evidence regarding COVID-19 have changed constantly. Keeping up with this has been challenging. <br></p><p>How challenging? Well, according to Ohio State University researchers, there have been more than 87,000 scientific papers alone on the coronavirus since the pandemic started. <br></p><p>“You have to communicate frequently and have one-on-one conversations,” says Oguin. “You have to discredit misinformation before it spreads and is embraced as fact.” At first, she says, people were often confused and frightened.<br></p><p>However, she says, “We have kept staff informed as new evidence and information arises. As they saw positive results from guidance and protocols, it lessened their fears and increased their confidence and trust.”<br></p><p>Keeping everyone on the same page when they are getting different information from several sources is “a constant battle,” Oguin says. “As the CDC [Centers for Disease Control and Prevention] put out new guidance, we were regularly updating protocols and recommendations.” <br></p><p><img src="/Monthly-Issue/2021/April/PublishingImages/JBB.jpg" alt="Jeffreys Barrett, RN" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;192px;" />When change is this constant, it is important to acknowledge that it’s frustrating and challenging, she says. “You need to say, ‘We’re doing this, too; we’re there with you. We know this is new and different, but it’s the right thing to do.’ You need to have a team that trusts you, and this helps build trust.”<br></p><p>Jeffreys Barrett, RN, MHA, NHA, executive director of Wellsprings of Gilbert in Arizona, says, “Early on, there were some people who didn’t believe COVID was a real virus, and others who were terrified of it. I would post emails once a week and constantly communicate information we received from the CDC and department of health.”<br></p><p>At some point, he suggests, “You can only educate people until they stop listening. But you can build a level of trust between yourself and others and deal with what is happening without being bombastic or threatening.”<br></p><p>As the pandemic wore on and the holidays approached, team leaders wanted to ensure that staff resisted the urge to attend large parties and family gatherings. “We provided a lot of staff education leading up to the holidays talking about ways to safely celebrate with family and friends,” Barrett says.<br></p><p>Buster Peter, administrator of Park Bend Health Center in Austin, Texas, says, “Then we gave staff take-home kits with PPE [personal protective equipment], hand sanitizer, and other items. We got the most positive response we’ve ever gotten for a staff gift. They appreciated getting something that they needed.”</p><h2>Hiring for Character</h2><p><img src="/Monthly-Issue/2021/April/PublishingImages/Buslovich.jpg" class="ms-rtePosition-1" alt=" Steven Buslovich, MD," style="margin&#58;5px;width&#58;145px;height&#58;186px;" />Hiring during the pandemic was challenging. It was difficult to vet job candidates to determine if they’d be a good fit for the organizational culture. Yet, it’s important to communicate that “if you are devoted to the residents and this patient population, you will do everything possible to protect the resident,” says Steven Buslovich, MD, CMD, MSHCPM, a New York-based geriatrician and chief executive officer of software producer Patient Pattern. “If you’re doing it solely for the paycheck, this isn’t likely the place for you.”<br></p><p>Staffing is always challenging. However, Oguin says, “It is important to have a back-up plan in advance for how you will maintain adequate staffing in a crisis.” Cross-training can help, she says. Training everyone on basic tasks such as feeding, monitoring the dining room, making beds, and basic infection control can make it easier to enable people to fill in when there are shortages on the front lines.</p><h2>Nurse Aide Adaptions<br></h2><p>In many communities, “People stepped up and helped others,” says Alice Bonner, PhD, RN, FAAN, senior advisor for aging, Institute for Healthcare Improvement. “Nursing homes worked with area agencies on aging, senior centers, etc. Administrators and others connected with high schools and community colleges to help fill job openings. Everyone came together, and that made a big difference.”<br></p><p>During the COVID-19 public health emergency, the Centers for Medicare &amp; Medicaid Services (CMS) waived the federal nurse aide training and competency evaluation requirements for newly hired nurse aides, with the exception of requirements that nurse aides be competent to provide needed services. CMS issued this waiver “to assist in potential staffing shortages seen with the COVID-19 pandemic.”<br></p><p>The American Health Care Association/National Center for Assisted Living stepped in to help by offering free eight- and 16-hour online courses for a temporary nurse aide (TNA) able to provide services and supports such as assistance with dining, ambulation, and other activities of daily living. After successfully completing the online training, TNAs then go through a competency evaluation by the provider before beginning work. <br></p><p>Currently, the program is permitted under special waivers, exceptions, or flexibilities for TNA roles in several states. To make the transition to become licensed/certified nurse aides/nurse aides included in state CNA/LNA/NA registries, TNAs need to complete additional certification requirements in accordance with federal and state regulations.<br></p><p>While this solution has filled a need during the pandemic, the National Association for Health Care Assistants (NAHCA) recommends that CMS reinstate the nurse aide training and competency evaluation standards as soon as possible, and no later than the end of March 2021.<br></p><p>NAHCA also suggests that the agency require that temporary nurse aides (those employed under the waiver) complete the training and competency evaluation set forth in federal regulations, since CMS has no authority to extend a waiver beyond a declared emergency period.<br></p><p>Elsewhere, callouts have been an issue. While these were problematic, Peter says, “We always put the safety of our residents and staff at the forefront. We recognize that short-term staffing strategies lead to long-term infection control success. We had nurses covering shifts as CNAs [certified nurse assistants], and we had people working double shifts. But we wouldn’t let people come to work when they didn’t feel good.”</p><h2>From Fear to Firefighters</h2><p>“Some people ran from the fire, but many were firefighters,” Buslovich says. “People with COVID often stop eating and drinking, and they need support and encouragement. We started systematic fluid hydration protocols, and anytime anyone went in the room, they would offer the patient a drink.” Everyone, including therapists, activity staff, administrators, and others helped hydrate and feed patients, he says.<br></p><p>“You might have one or two brave aides on a COVID unit with 20 residents. We don’t have the luxury of relying on them to adequately feed or hydrate everyone,” he says. “It takes a team to enable residents to recover from COVID and, whenever possible, stay out of the hospital.”<br></p><p>These types of efforts were significant, Buslovich says. “We have some of the frailest patients, yet our mortality rate has been remarkably low. Our teams have been a great commodity, and their efforts saved lives.”<br></p><p>Many team members made significant sacrifices to protect residents and co-workers. For instance, Buslovich says, “I moved out of my house and rented an apartment so staff could protect our families and be available 24/7 to the facility. We didn’t know enough about the virus early on, and you had to make a choice to fight the fire or stay back. This way, we could be present and available.”</p><h2>Small Fish, Big Pond</h2><p>One key to reducing turnover is to support staff when they get sick. “For staff who are out, it’s easy to feel like you don’t matter, like you’re a small fish in a big pond,” Peter says.<br></p><p>“When our people call in to staffing coordinators, they get a call from the administrator—not to find out when they’re coming back but to let them know we’re thinking about them and are genuinely concerned about their well-being. They appreciate that,” he says.<br></p><p>“The wheels would fall off without staff. We made sure we expressed appreciation for people’s efforts.”<br>Barrett agrees. “When people were out sick, we sent flowers and food from Door Dash. We made sure we covered people’s wages while they were out. We take caring for our people seriously. It’s not just lip service.”<br></p><p><img src="/Monthly-Issue/2021/April/PublishingImages/JJG.jpg" alt="Jefferson Gerodias, RN" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />Jefferson Gerodias, RN, BSN, director of clinical services at Wellsprings of Gilbert, says, “We took care of employees and their families. We sent them food. Other staff would go grocery shopping and leave them on the doorstep for families.” <br></p><p>Gerodias knows this from experience. He contracted COVID in January and was out sick for two weeks. “Every day I woke up to 50 text messages asking how I was doing. And my floor staff got together and brought me groceries.”<br></p><p>Bonner adds, “When people are out sick, managers can call and check on them. There should be a buddy system where colleagues check on each other. People who are out with COVID shouldn’t feel forgotten or unsupported.”<br></p><p>Moving forward, empathy is key. “You need to understand what everyone is feeling. Everyone has obstacles they are dealing with,” says Oguin. “While everyone is doing their best, you can’t expect them to always drop everything. Managers need to be flexible and understand that their employees are juggling lots of responsibilities and challenges.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.​</em></p>2021-04-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/April/PublishingImages/0421-CS1.jpg" style="BORDER&#58;0px solid;" />COVID-19;WorkforceJoanne KaldyTeamwork has taken on new meaning during the pandemic. Facilities have implemented new strategies for communication, collaboration, and innovation.
How to Improve Administrator and DNS Relationships<p><img src="/Monthly-Issue/2021/April/PublishingImages/AmyStewart.jpg" alt="Amy Stewart" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;157px;height&#58;200px;" />The relationship between the administrator and director of nursing services (DNS) has never been more important. Pandemic stress, coupled with increased regulatory scrutiny, has further strained what was already fraught; often, these stressors lead to turnover in one or both positions. <br></p><p>This critical relationship, often compared to a marriage, drives many aspects of care delivery. It affects facility culture because staff want to work on a cohesive team. It eases certification or complaint surveys by providing support. It generates financial benefits when these two collaborate on budget and census goals. And it improves the environment for residents and staff alike when communication between the two is transparent and truthful. <br></p><p>Achieving these results takes focus on the DNS-administrator relationship itself. When time and skill are invested in cultivating the relationship, it can withstand adversity, but if neglected, there can be far-reaching consequences. </p><h3>Improvement on Both Sides</h3><p>Consider this scenario&#58; Joe, who recently started as the administrator, just told Nancy, the long-time DNS, she will need to cut her nursing budget this month. Nancy immediately became defensive, assuming he was saying she must make staffing changes. But, while Joe said she had to lower expenses, he hadn’t said to cut staff. In fact, Joe had wanted to review options with Nancy, but she jumped to conclusions. <br></p><p>Clearly, this does not create a cohesive team. If Nancy had listened carefully before responding, she would have known Joe wasn’t referring specifically to staffing. If Joe had built trust and established clear expectations, or communicated his wish to weigh options together, he could have avoided Nancy’s overreaction.<br></p><p>This scenario is far too common. When such conflicts occur frequently, they create irreparable damage. Below are five ways to improve the DNS-administrator relationship, regardless of tenure in each role.<br></p><h3 class="ms-rteElement-H3B">1. Teamwork Makes the Dream Work</h3><p>A solid foundation is necessary for a long-lasting, trusting relationship. Commit to working together as a team. Although each role has different responsibilities, the two must work together to meet patient outcomes and budgetary goals. <br></p><p>Yet teamwork goes both ways. Connect daily to discuss challenges, successes, and expectations. Start meetings by sharing what was done well before exploring what needs attention. Use reflective listening to understand what the other is saying before responding.<br></p><p>This takes practice. It is easy to let emotions take over, but reflection on the words used is more productive than reaction. Take time to learn each other’s strengths and weaknesses; use those strengths to improve care delivery and the work environment. A foundation of commitment and collaboration between the administrator and DNS will also reinforce teamwork within other departments and their staff. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>When Liz joined a small facility as the new DNS, tensions were high&#58; The facility had recent survey issues, and census was low. Renee, the administrator, met with Liz daily. Renee discussed expectations and reviewed budget and census goals while Liz shared clinical improvements and concerns. By working to understand one another, Liz and Renee built trust and respected each others’ roles. </p><h3 class="ms-rteElement-H3B">2. Healthy Communication Every Time</h3><p>Learn each other’s preferred communication style and use it when possible. Some people prefer face-to-face communication, while others are perfectly happy with email. Whatever the style, remember that words are very powerful, so choose them wisely. Communicate frequently and honestly. Don’t hide issues to keep the conversations “nice and polite.”<br></p><p>Prioritizing communication requires a safe space to discuss tough situations that inevitably arise. Candid conversations are often necessary to improve care. Being truthful and having respect for each other avoids a negative work environment and supports the other’s efforts. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>When Mrs. Smith’s daughter arrived angry and demanded to speak to the administrator about care delivery concerns, Jen, the administrator, was already aware of the situation. She explained measures that had been initiated to improve care, and Mrs. Smith’s daughter felt reassured about how it was being handled. This confrontation could have gone differently if the DNS and administrator didn’t communicate regularly and transparently. </p><h3 class="ms-rteElement-H3B">3. Conflict Resolution that Works</h3><p>It is unrealistic to think that two people will always agree. Be prepared with a plan to overcome conflicts that will arise. It is best to disagree behind closed doors and work together toward resolution. Brainstorm options and discuss them until an agreement is reached. Sometimes, there isn’t a resolution; when that occurs, agree to disagree and move on.<br></p><p>Because the administrator and DNS are the two top leaders in a facility, staff watch the relationship closely. If staff observe disagreements, they may feel compelled to take sides. Don’t let conflict interfere with the facility’s mission and goals. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>Brenda, the administrator, and Amy, the DNS, discussed changing the uniform policy. Brenda wants nurses to wear one color uniform and nurse assistants another so patients know if the person entering the room is a nurse or assistant. Amy doesn’t agree.<br></p><p>Unhappy staff later question Amy about the change. Although Amy doesn’t like it, she explains the rationale fairly. Staff don’t need to know she disagreed, because it won’t change the policy, but could harm the work environment.</p><h3 class="ms-rteElement-H3B">4. Support Each Other</h3><p>There will be days when the stress level is so high that each person cannot be their normal self. Long term care has many stressful challenges, such as surveys, staffing, census, and regulatory change. When stakes are high, be a support system. Recognize when stressors are taking a toll.<br>Many of these challenges are unique to long term care, and no one can understand like the administrator or DNS. When things get tough, lean on each other. Occasionally, share a small token of gratitude to show you value one another. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>Already stressed about staffing, DNS Mike has just been told the survey team has arrived. Soon after, a surveyor asks Mike about an incident, and the conversation goes poorly. Administrator Tom recognizes that Mike’s stress level is increasing and checks on him, bringing a favorite coffee, moral support, and a sympathetic ear. This leaves Mike feeling heard, valued, and appreciated. </p><h3 class="ms-rteElement-H3B">5. Be Goal-Getters </h3><p>It’s easy to set goals, but the DNS and administrator must collaborate to achieve them. Being goal-getters requires a cohesive team. Offer to help one another with individual and mutual goals. When goals are not aligned, attainment becomes more difficult, and both parties become frustrated. However, when the two work together, goals are more easily achieved. And don’t forget to recognize and celebrate successes. </p><h3 class="ms-rteElement-H3B">• Case in Point</h3><p>Kathy, the DNS, proposes an annual goal of being deficiency-free with no complaint surveys. Bob, the administrator, recognizes that this is an ambitious goal and asks Kathy if she might want to consider a more realistic goal, such as fewer complaint surveys and two fewer deficiencies than last year. <br></p><p>Bob shares his census and budget goals and discusses how Kathy could help meet them. He asks her to include goals that increase the staff’s ability to care for medically complex patients, to help meet budget and census goals.<br></p><p>Cohesiveness in the administrator-DNS relationship has many benefits for a facility. Studies have shown that tenure of the two roles is associated with less staff turnover and lower survey deficiencies. It also enables better patient outcomes, as expectations, goals, and communication remain central to the working relationship. When both parties work together to provide the best care in a transparent manner, they can improve this critical relationship. <br><br><em>Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, is vice president of education and certification strategy at the American Association of Post-Acute Care Nursing (AAPACN). She can be reached at <a href="mailto&#58;astewart@aapacn.org" target="_blank">astewart@aapacn.org</a> ​<br></em></p><p style="text-align&#58;center;"><a href="http&#58;//www.aapacn.org/" target="_blank"><img src="/Monthly-Issue/2021/April/PublishingImages/AAPACN.jpg" class="ms-rtePosition-3" alt="" style="margin&#58;5px;width&#58;200px;height&#58;58px;" /></a>&#160;</p><p><em></em></p>2021-04-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/April/PublishingImages/0421-mgmt.jpg" style="BORDER&#58;0px solid;" />Management;WorkforceAmy Stewart, RNThe relationship between the administrator and director of nursing services has never been more important.
Protecting Our Staff Has Never Been More Critical<p>Our nation’s most vulnerable population has been amongst the hardest hit by the historic COVID-19 pandemic. Since day one, caregivers in nursing homes and assisted living communities have worked tirelessly to ensure the health and safety of their residents and staff, but facilities were forced to fight the virus with limited resources. <br><br>Critical resources, essential in fighting the virus, were hard to come by in almost every facility. Specifically, access to personal protective equipment (PPE) was a challenge for many facilities. Worldwide supply chain issues and soaring demand across every industry left long term care providers scrambling to acquire and afford the masks, gowns, and gloves they needed to help keep staff members safe and prevent further spread of the virus.<br><br>Many suppliers delayed or limited the size of providers’ orders, and many providers got taken by scammers pretending to have legitimate PPE.<br><br>The long term care industry made repeated calls to federal and state officials to prioritize these settings for PPE, but shortages remained. Many facilities were forced to reuse items like N-95 masks or use handmade cloth facemasks, all in accordance with guidance from the Centers for Disease Control and Prevention (CDC) on how to optimize PPE supplies.<br><br>Moreover, early on in the pandemic, public health officials focused on a symptoms-based approach even though we knew the virus was spreading through asymptomatic and pre-symptomatic carriers. The CDC did not revise its guidance to nursing home personnel to wear facemasks at all times throughout the facility until June 2020—five months into the pandemic.<br><br>While access to PPE has improved since last year, long term care providers still struggle to afford the high cost of quality equipment, and suppliers anticipate continued strain on items such as gloves. Some believe facilities should be fined or issued citations by the Occupational Safety and Health Administration (OSHA) or other regulators in an effort to enforce use of PPE. But that approach would only make the situation worse. <br><br>The health and safety of long term care staff and the residents they care for is and always should be the top priority. Facilities have taken historic steps to keep the virus out of facilities and limit its spread if it does make its way in. Their efforts have saved lives. Fining a facility for lack of PPE due to global supply shortages would help no one. We need a public and private partnership so that health care settings, including long term care facilities, have the necessary supplies to protect our health care heroes on the frontlines.<br><br>We should all be working together to ensure facilities have the resources they need, not making matters worse with fines that only draw resources away from where they should be focused&#58; on our residents and staff. <br><br><strong><a href="mailto&#58;dgifford@ahca.org">David Gifford, MD, MPH,</a></strong> is chief medical officer and senior vice president, quality and regulatory affairs, of the American Health Care Association/National Center for Assisted Living.<br>​</p>2021-03-04T05:00:00Z<img alt="" src="/PublishingImages/Headshots/DavidGifford.jpg" style="BORDER&#58;0px solid;" />COVID-19;WorkforceDavid Gifford, MD, MPHOur nation’s most vulnerable population has been amongst the hardest hit by the historic COVID-19 pandemic.
Temporary Nurse Aide Training a Huge Boon During Pandemic<p>Not far into the onslaught of the pandemic, when it became clear that COVID-19 was hitting long term and post-acute care facilities especially hard, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) advocated for special waivers that would help the sector to better meet the needs of its residents and patients.</p><p>One of these waivers allowed for temporary nurse aides (TNAs) to assist with frontline care. The federal government declared a national public health emergency, and on March 30, 2020, the Centers for Medicare &amp; Medicaid Services (CMS) issued <a href="https&#58;//www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf" target="_blank">blanket waivers</a> that allowed for the training and hiring of TNAs.</p><p>AHCA/NCAL immediately launched two free online TNA training courses, one taking eight hours and the other 16 hours. The swift and consequential response to these two courses has surpassed all expectations.</p><h2>A Needed Program</h2><p>More than 182,890 people have registered, and more than 136,300 have completed and passed these courses since their launch in April, numbers that continue to rise every day. Skilled nursing and assisted living communities around the country have hired TNAs, or similarly named positions, to alleviate the staffing challenges that already existed but were made even more significant by COVID-19.</p><p>In addition, while many people around the country were losing their jobs—in retail or the food service industry for example—the TNA program has provided a way for them to receive free training, find work quickly, and begin new careers in long term care while making a significant contribution.</p><p>“The impact of having the TNA program available to use during the public health emergency has been huge,” says Julie Adair, vice president of home care and sector support at the Iowa Health Care Association. More than 1,500 Iowans have completed the TNA course, making it possible for them to gain valuable skills and experience working at a long term care facility. </p><p><a href="/Topics/Guest-Columns/Pages/2021/What-People-are-Saying-About-the-TNA-Program.aspx" target="_blank">What-People-are-Saying-About-the-TNA-Program.aspx</a><br></p><h2>How the Program Works</h2><p>TNAs work side-by-side with and receive supervision from certified nurse assistants (CNAs), registered nurses, and other staff. Tasks include helping with activities of daily living, infection control and prevention, positioning, moving and restorative care, nutrition and elimination, and comfort care </p><p>Students are introduced to the skills and procedures required for the job in the online TNA courses, then gain skills competency training on the job. The videos and other materials used in the online courses are adapted from AHCA’s well-known training curriculum, How To Be a Nurse Assistant. <a href="http&#58;//cnaonline.com/" target="_blank">CNAonline.com</a>, an AHCA partner that offers one of the few hybrid CNA trainings available, sponsored the TNA courses and assisted in getting the material prepared for a quick launch. </p><p>In a <a href="/Topics/Guest-Columns/Pages/2021/Temp-Nurse-Aide-Training-Follow-Up-Survey.aspx" target="_blank">recent survey</a>* of those who completed the TNA course, 54 percent said they had found a job as a TNA, and 48.6 percent said they took the TNA course because they wanted to begin a new career in health care.</p><p>Katherine Midgette completed the online TNA course in November and then began working at a center in Salisbury, Md. She is currently in a CNA training class and will continue her new health career in the years to come. “I plan to be a travelling RN,” she explains.</p><p>James Benson of Michigan felt that the training prepared him and helped him feel more confident on the job. “It really expanded my scope of practice and helped me with proper use of PPE [personal protective equipment] and end-of-life care,” he says. Benson will begin school for a nursing degree this spring.</p><h2>Future Needs</h2><p>Workforce shortages already posed a major challenge to the sector prior to the pandemic, but the added stresses that COVID-19 created brought the workforce crisis to a whole new level. Staffing shortages were so severe over the past several months that states like Minnesota, California, Pennsylvania, and Indiana called in the National Guard for help. </p><p>The question of what will happen when the waivers expire looms large. As of Jan. 21, 2021, the U.S. Department of Health and Human Services extended the public health emergency until April 21, allowing for the continued use of TNAs for 90 more days and giving the long term and post-acute care sector more time to figure out how best to tackle this problem.</p><p>Once the waivers expire, providers could be faced with even more dire staff shortages, and the thousands of people who just joined the health care workforce could lose their jobs, unless they get the additional training needed to become a CNA. </p><p>Making things even more challenging, many in-person training programs and state testing sites remain closed or are operating at reduced capacity due to COVID-19. </p><p>Online nurse assistant training serves as an excellent option, and more and more, providers are stepping up to take advantage of that opportunity. </p><h2>Genesis Takes Next Step</h2><p>Genesis HealthCare, which has post-acute care companies and skilled nursing and assisted living communities in 24 states across the country, has been working with <a href="http&#58;//cnaonline.com/">CNAonline.com</a> to train and certify CNAs for the past two years. Genesis immediately began training newly hired TNAs in its buildings through CNAonline.com so that it would be in a position to hold onto and grow its workforce even after the COVID-19 health crisis has passed. </p><p>“Genesis’ goal from the start was to transition temporary nurse aides that were committed and dedicated to a career pathway toward certification and licensure,” explains Debbie Rowe, vice president of nursing workforce development.</p><p>“CNAonline.com has been very positive. It offers hybrid nurse aide training that complies with state and federal requirements and limits students’ and residents’ exposure in a pandemic environment.”</p><p>Currently, Genesis utilizes CNAonline.com to offer classes in Colorado, Massachusetts, Vermont, and West Virginia and plans to expand to more states.</p><p>TNAs have gotten tremendous clinical practice and hands-on experience while under supervision from more experienced and qualified staff. Having TNAs has also allowed providers to ensure quality of care for residents.</p><p>“Working side by side with a CNA, [TNAs] gave the residents additional attention in meeting their needs,” says Kimberly Gerst, Center nurse executive at the Willows Center in Parkersburg, W.Va. “It really supported the personal touch, which was particularly important during the holidays.” </p><h2>Providers Assess Staffing Needs</h2><p>Many providers have taken an all-hands-on-deck approach and asked their current staff to take the TNA course so they could help out in caring for residents.</p><p>This approach to dealing with staffing shortages may continue even after the current health crisis is over. “We believe that all provider facilities will enhance their professional workforces by adapting a universal caregiver model,” says John Reinhart, president and chief operating officer of CNAonline.com. “By utilizing online technology for CNA training and licensing of their entire team, facilities will have enhanced flexibility for staffing.</p><p>“We work with individual facilities who want to have their own facility-based program,” he says. “This gives them the ability to take more control over their clinical workforce.”</p><p><span><span><img src="/Topics/Guest-Columns/PublishingImages/DanielleLevitan.jpg" alt="Danielle Levitan" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;185px;" /></span></span>The impact that the TNA program has had on the sector during the pandemic offers hope and fresh excitement. People have come together, stepped up, and even found their calling at a critical time, people like Rachael Loretan in Pennsylvania who has loved being a TNA.</p><p><span></span>“This experience really opened my eyes to the nursing field, and I loved working directly with the residents. They made such an impact on me, and it deepened my desire to enter the nursing profession,” she says. “My experience was nothing but amazing!”</p><p><em><a href="mailto&#58;dlevitan@ahca.org" target="_blank">Danielle Levitan</a> is senior director, marketing, with the American Health Care Association.</em></p><p>&#160;</p><p><span class="ms-rteFontSize-1">*Survey of those who have successfully completed the TNA courses with 7,477 respondents. Conducted by AHCA from December 11, 2020 – January 8, 2021.</span></p> 2021-02-10T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/nurse_computers.jpg" width="398" style="BORDER&#58;0px solid;" />Workforce;COVID-19Danielle LevitanTens of thousands of applicants have registered to date, and of those, 75 percent so far have passed their courses.