Do Training Regulations for Certified Nursing Assistants Influence Job Satisfaction?

Transcription

1 NCSBN scientific symposium 2014 (April 10, 2014) Do Training Regulations for Certified Nursing Assistants Influence Job Satisfaction? Kihye Han, Alison M. Trinkoff, Carla L. Storr, Nancy Lerner, Meg Johantgen, & Kyungsook Gartrell, This study was funded by the National Council of State Boards of Nursing (Grant R40009; PI, A Trinkoff)

2 Outline Outline 1. Background CNAs in the NHs CNA training and regulation Research findings supporting additional training 2. Study purpose 3. Study design & data source 4. Measures State regulation Initial training quality and focus Job satisfaction 5. Data analysis 6. Results 7. Discussion & Implications for policy & regulations 2

3 NHs and CNAs in the US CNAs in NHs Nursing homes (NHs): one of the largest he alth care providers in the United States ser ving the aging US population (House et al., 2009) Certified/Geriatric Nursing Assistants provide the vast majority of care (referred to as certified nursing assistants, CNAs) (Konetzka et al., 2008) 3

4 Challenges CNAs in NHs: Challenges Entry level providers with limited training & education High turnover rate Job dissatisfaction Unrealistic expectations/ lack of satisfactory performance 4

5 Regulations Regulations of CNA training Federal requirements: (Subpart D of Title 42 of the Code of Federal Regulations for Public Health) at least 75 hours of initial training at least 12 hours of continuing education annu ally In addition to federal requirements, each st ate has the authority to require additional tr aining and continuing education hours. 5

6 Previous research Evidence supports additional training Increase job satisfaction (Castle, 2010) Reduce turnover (Noel et al., 2000) Promote improved care for residents ( Horn et al., 2010; Zheng & Temkin-Greener, 2010). Better trained CNAs who are more capable of performing assigned tasks could provide better care. 6

7 Study purpose Study purpose To investigate the associations among state level r egulations, initial training quality and focus, and jo b satisfaction in CNAs Hypotheses (1) more stringent training regulations are related to bett er CNA perception of initial training quality, (2) CNAs reporting better initial training quality are more satisfied with their jobs. (3) training focus, or topical content of the initial training, is associated with job satisfaction. 7

8 Design Study design & data source A cross-sectional secondary data analysis using the following data the National Nursing Home Survey (NNHS) the National Nursing Assistant Survey (NNAS) linked to data on state regulations of CNA train ing 8

9 NNAS National Nursing Assistant Survey Random sub-sample of 790 NHs was selected from 1,174 participating in the NNHS 592 NHs of those initially selected responded ( 75%) Of the 4,274 eligible CNAs in these NHs, 3,01 7 CNAs (71%) completed a computer-assisted telephone interview. 9

10 State regulations State regulations of CNA training Whether states required more hours than t he federal requirements (75 hours) for initi al training (yes/no) Whether states required more hours than t he federal requirements (12 hours annuall y) for continuing education (yes/no) 10

11 Initial training quality Initial training quality After summing the values and finding that the scores were skewed, scores were dichotomized using the 75th percentile to define initial training quality: 11

12 Initial training focus Initial training focus: basic care vs work life skills Basic care skills: a,b,d,g, i, j Work life skills: c,e,f,h,k The count total was dichotomized to reflect the amount of focus paid to each skill taught such that a high count reflected a strong emphasis in the content 12

13 Job satisfaction Job satisfaction Satisfied with job Dissatisfied with job missing This single item job satisfaction measure has been shown to highly correlate with multiple item measures (Wanous et al., 1997). Previous research using the National Nursing Assistant Survey has also successfully used this question (Choi & Johantgen, 2012). 13

14 Covariates Other covariates CNA characteristics: age, race, education, and years of CNA experience Age and years of CNA experience were not str ongly correlated (r=0.56) so both were include d. NH characteristics: number of beds, type o f ownership, and total nurse staffing 14

15 Data analysis Data analysis National Center for Health Statistics Research Data Center (NCHS-RDC) remote access sys tem SAS-callable SUDAAN version was us ed to correct for complex sampling design effe cts in the NNHS and NNAS. Descriptive analysis, Chi square tests, Binomi al logistic regression models 15

16 Personal characteristics by initial training quality, weighted proportion (%) Study Initial Training Quality sample High low p-value unweighted n 2, ,160 weighted n 680, , ,754 Age (years) Race White <0.01 Black Other Education high school more than high school Years of CNA experience < > Note. p-values based on chi square tests by initial training quality 16

17 Facility characteristics by initial training quality, weighted proportion (%) Study sample Initial Training Quality High low p-value Bed size < <0.01 Ownership for profit not for-profit Nurse staffing 5 hours per resident day < 5 hours per resident day Note. p-values based on chi square tests by initial training quality 17

18 Bivariate association between state regulation and initia l training quality and focus among CNAs, weighted proport ion (%) Training Focus: Basic care skills Training Focus: Work life skills Initial Training Quality high low p-value high Low p-value High low p-value Initial training requirements > 75 hours hours (federal requirement) Continuing education requirements > 12 hours annually < hours annually (federal requirement) Initial training location nursing facility educational facility others How much of training costs certified nursing assistants paid all part none How much valued their work by society very much < < <0.01 somewhat not at all Note. p-values based on chi square tests by initial training quality and training topic focus 18

19 Associations of initial training quality and topic f ocus with job satisfaction among CNAs Model 1 Model 2 Model 3 Model 4 OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Initial training quality, high vs low 1.51 ( ) Training focus: basic care skills, high vs low 1.80 ( ) 1.36 ( ) Training focus: work life skills, high vs low 2.19 ( ) 1.91 ( ) Model fit: -2 Log-Likelihood Ratio (p-value) (p<0.01) (p<0.01) (p<0.01) (p<0.01) Note. training quality: high (>75%-ile for each score) and low ( 75%-ile) training focus: high (answered good/excellent for all the items in each area) and low (all the other) Models were adjusted for age, race, education, years of certified nursing assistant experience, bed size, owners hip, and nurse staffing 19

20 Initial training focus on work life skill topics by job satisfaction, weighted proportion (%) Satisfied with job Dissatisfied with job P-value Work life skills Working with co-workers Excellent <0.01 Good Fair Poor not offered Working with supervisors Excellent <0.01 Good Straightening out or dealing with problems at work Excellent <0.01 Good Organizing your work tasks so that everything gets done on time excellent <0.01 good Preventing injuries at work excellent good

21 Initial training focus on basic care skill topics by jo b satisfaction, weighted proportion (%) Satisfied with job Dissatisfied with job p-value Basic care skills Discussing resident care with residents family members Excellent Good Dementia care Excellent <0.01 Good Working with residents that act out or are abusive Excellent <0.01 Good Recording residents information 0.09 Resident care skills such as helping with bathing, eating, dressing, and moving 0.17 Talking with residents

22 Discussion 1 Discussion CNAs with more than 75 hours initial training were more likely to report that their initial training was of high quality, and this was related to job satisfaction. Minimum federal requirements for 75 hours inadequate for new CNAs in NHs as resident acuity increases (OIG Nurse Aid e Training Report, 2002). US federal requirements for CNA initial training much lowe r than in several countries: months for health service helpers/assistants in Denmark 2-3 years for care-workers in the Netherlands (Fujisawa & Colombo, 2009) 22

23 Discussion 2 Discussion Additional training hours may have provided more information and knowledge that could help CNAs feel more competent in and satisfied with their work. Additional CNA didactic (i.e., in-class) training improved quality (Fitzpatrick & Roberts, 2004; Smith et al., 2005) Insufficient clinical experiences high CNA turnover (OIG, 2 002) The training focus on practical experience in Denmark and the Netherlands help match CNA expectations to actual job experience and to increase retention (Fujisawa R, Colombo, 200 9; Korczyk, 2004) 23

24 Discussion 3 Discussion CNAs with high focus of training on work life skills (e.g., problem solving, task organization and working with others) were significantly more likely to be satisfied with their current job. Work life topics are not federally required in US CNA trainin g, but in Europe training typically includes communication, conflict management and team work (Fujisawa & Colombo, 2009). Additional attention to work life topics could help to increas e CNA job satisfaction and thus their retention. 24

25 Limitations Limitations Cross-sectional data Self-report National Nursing Home Survey an d National Nursing Assistant Survey Confidentiality of the data collection, use of compu ter-assisted interviewing for NNHS & NNAS shoul d have decreased this problem Measures - are they valid? Age of data still applicable today 25

26 Implications Implications for policy & regulations Re-consider Federal minimum requirements as they have not changed in more than 20 years (Sengupta et al., 20 10) The Institute of Medicine recommended (IOM, 2008) 1) the minimum training hours increase to at least 120 hours, 2) the CNA certification exam directly assess competence in the care of older people. Consider adding initial training hours and continuing education that focuses on work life skills, given the r elation to job satisfaction or competency, as well as t he ultimate goal of regulation, to promote quality resi dent care. 26

27 Questions Suggestions Comments Thoughts Contact: Kihye Han