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On-the-Job “Barriers” Prevent CNAs from Providing Quality Care

September 22, 2014

Certified nursing assistants (CNAs) face numerous “barriers” that prevent them from providing the best-possible care to nursing home residents, argues Penelope Ann Shaw in an editorial published in JAMDA.

Shaw has been a nursing home resident for nearly 12 years, and has depended on care from CNAs since undergoing an acute bout of Guillain-Barre syndrome, a rare neuromuscular disorder.

In her piece, which ran as the lead editorial in JAMDA‘s September issue, Shaw writes that in her experience, CNAs are “usually motivated and caring” individuals who “wish to provide the highest quality of care.”

“But,” she continues, “there are barriers: insufficient knowledge and training, poor wages and benefits, understaffing, a burdensome workload, low morale, and job stress, as well as a lack of respect for what some consider stigmatizing work.”

In an interview with PHI, Shaw, who advises the nursing home division of the Centers for Medicare & Medicaid Services, emphasized the fact that more attention must be paid to the CNA workforce. CNAs “don’t really get paid enough for the difficult work they do,” she said.

She notes that CNAs are among the most injured workforce in the country, with a higher injury rate that firefighters and other jobs that are generally considered to be riskier by the general public. Lifting and transferring residents is not easy and can lead to strains, pulled muscles, and other injuries. (At Shaw’s 145-resident Massachusetts nursing home, units are rewarded with pizza parties for injury-free months.)

Understaffing is also a major issue, Shaw said. When facilities are understaffed, CNAs often rush through their care routines, which lowers the quality of care provided (and can also lead to injury). “Sometimes they’re just in a terrible hurry,” Shaw said.

In her editorial, Shaw cites PHI and the National Consumer Voice for Quality Long-Term Care as two organizations that are working to improve nursing home care quality by focusing on CNA job quality. But, as she notes, it will take more than just those two groups to enact long-term change.

“Collectively, researchers, consumers, advocates, government officials, providers, media, and the general public can work to implement effective solutions,” she writes.

An accompanying editorial by JAMDA editor-in-chief John E. Morley echoes that argument, adding that long-term care stakeholders should take time to acknowledge the hard work and invaluable care provided by the CNA workforce.

“All of us (residents, supervisors, and physicians) need to recognize the heroic task CNAs perform and consistently thank them and recognize their key role on the nursing home team,” he writes.

— by Matthew Ozga

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