Nursing Assistant Training and Education: recommendations for change; contributors to a recent government-sponsored report on minimum staffing ratios suggest improvements for staff training - Feature Article

Nursing Homes, August, 2002 by Elise Nakhnikian, Mary Ann Wilner, Donna Hurd

For Nursing Facilities

Create strong connections with community-based training providers, such as community colleges and the Red Gross. Facility representatives who supervise CNAs should help design and monitor training programs to ensure that what is taught is consistent with "real life" situations in the facility.

Foster a caring relationship between nursing assistants and residents. The emphasis should be less on performing tasks and more on getting to know residents as individuals, learning their habits and preferences, and incorporating that information whenever possible into their care. In part, that means allowing each nursing assistant to care for the same group of residents over time.

Invest in workers for the long term. A key ingredient to a decent job is having a clearly defined framework for advancement. This includes:

* A clearly defined job ladder. It gives nursing assistants who want to stay in the profession a way of earning more money and enhancing their skills without having to abandon the field.

* Leadership roles for experienced CNAs. This might involve using nursing assistants as associate trainers or as peer mentors, or giving them special roles on the caregiving team.

* Access to a variety of educational opportunities. These might include GED programs, ESL courses, community college programs, or regional or national conferences for nursing assistants.

Ensure that the nurse managers are trained in supervisory skills. Nurses who supervise CNAs need training in how to set consistent standards and hold workers accountable while respecting employees as individuals. Training should cover cultural sensitivity, since nursing home managers often come from a different ethnic group, class or country of origin than the people they supervise, and those differences can lead to misunderstandings.

Develop effective and substantive orientation programs. Such programs should last for the first three months a new worker is on the job and may include mentoring by an experienced peer. Mentors should be trained, supervised and compensated for these responsibilities.

For Course Content, Teaching Methods and Testing

One of the key changes PHI recommends is to use adult education methods. Many CNAs have not had good experiences in the traditional school system and find it difficult to learn from lectures, videos and books. Adult education is, or should be, dynamic and interactive. It might include role playing, small group discussions, case-study reviews and hands-on practice of clinical skills.

Other recommendations for course content and teaching methods include:

* Foster staff skills in problem solving, critical thinking and conflict resolution.

* Incorporate extensive field experience from the nursing home into precertification training.

* Design in-service training to respond to CNAs' specific learning needs.

* Teach communication and other "soft" skills, as well as technical skills and tasks.

Elise Nakhnikian is a long-term care specialist at the Paraprofessional Healthcare Institute (PHI), elise@paraprofessional.org. Mary Ann Wilner, PhD, is director of health policy for PHI, maryann@paraprofessional.org. Donna Hurd, RN, MSN, is a senior analyst at Abt Associates, Inc., don donna_hurd@abtassoc.com. To read Phase I of the federal nursing home staffing report, Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, go to www.hcfa.gov/medicaid/reports.>

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