potential conflicts may arise. Being a supervisor to other nursing assistants creates another layer of reporting to the already very hierarchical

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1 The Why s and How s of a Nursing Assistant Career Ladder Reprinted from Lqe Services Network Week News Nursing assistant career ladders have been developed in some long term care settings to allow for vertical advancement within the clinical CNA position. If you are considering a career ladder as an employee development option there are some key issues to consider. The Goals of a Career Ladder First what do you want to accomplish with the career ladder? Several possible outcomes an organization may be striving for may include: 1) A tool to increase leadership skills for high achieving CNAs. 2)A program to develop trained mentors for new employees. 3)An educational initiative to develop specialized clinical skills, e.g. dementia care specialists, restorative specialists for selected nursing assistants. 4)A program to decrease staff turnover. 5)A reward/incentive program for high achieving nursing assistants. Or other organizationally determined goals. It is crucial to consider what you hope to accomplish and also what the goals and needs of the nursing assistants are before embarking on a career ladder program. The Organization Structure How will the advanced CNAs fit into the structure of your organization? Job title and salary increases need to be considered early and discussed with human resources. Budgetary changes may need to be approved for the next fiscal year and this may necessitate implementing the program in the future. The reporting structure for the advanced nursing assistants and performance evaluation changes are just two important things to redesign. Include nursing assistants in the planning process for the career ladder for maximum buy-in. What do they want to learn and what skills are important to them to do their job well? Another key issue to consider is whether the advanced nursing assistants will have staff reporting to them or if they will be in a pure staff position. If they are in a lead CNA position they may have responsibilities for assignments and work delivery of other nursing assistants. Some organizations have had success with this model. But many

2 potential conflicts may arise. Being a supervisor to other nursing assistants creates another layer of reporting to the already very hierarchical organizational structure of nursing facilities. It can also cause increased staff stress and territory issues between nursing assistants that will hardly facilitate increased teamwork. Again, involve nursing assistants in these discussions to determine their comfort with the changes in reporting and roles. Involve Nurses A career ladder will not work without the buy-in of all nurses! What will be their responsibilities and roles in working with the advanced nursing assistants? Are they partners with the advanced nursing assistants in creating and nurturing the care teams on each unit? Are they to be involved in the performance evaluation process? The educational program? And, if the advanced CNA is a mentor to new staff, how is the charge nurse a partner in this process? Nurses need to feel a commitment to these nursing assistants and support them in this new role or the career ladder will be less successful and may be functioning outside of the structure of the nursing care team. These considerations need to be thought through before creating a new organizational structure as important as a nursing assistant career ladder. Take the time to conceptualize how best to create and implement a career ladder in your organization.

3 Retaining Certified Nursing Assistants Reprinted with permission fvom Mark Darby, RN. * Once you have the person hired, only half the battle is done. In some facilities, turnover rates with CNAs are in the triple digits. This creates a revolving door syndrome where an organization can become very good at hiring but do very poorly at retaining employees. The US Chamber of Commerce points out that replacing a worker can cost times their weekly salary. If you lose 100 CNAs in a year, this revolving door may cost you over $500,000. While important, staffing and pay are not the only factors that deter-mine a CNA s decision to leave a job. Feeling like you make a difference in people s lives, effective relationships with a direct super-visor, and working on a capable team are significant contributors to high feelings of job satisfaction, which have been shown to increase retention. Improving these areas may provide greater return on investment than increases in pay. Feeling Like You Make A DifSerence CNAs, like many staff, want to make a difference. They are not always told how important they are to the care of residents. A word of thanks from a resident or a family member is a strong motivator for staff. Such comments could be encouraged by: Making customer satisfaction cards readily available Posting favorable comments on a bulletin board Highlighting positive comments in staff meetings and other gather-ings Supervisors and administrators can also add with words of encourage-ment that are specific, detailed and given in a timely manner. Relationship with Supervisor Good relationships with a supervisor also contribute to job satisfaction. Oftentimes, supervisors may have the technical skills but lack adequate supervisory training. CNAs want and need supervision that will help them do a good job well. Without proper training, well-meaning super-visors may actually increase job dissatisfaction in CNAs. Topics for training include communication skills, problem solving, giving effective feedback and mentoring. Investment in training super-visors can also increase the job satisfaction of these nurse supervisors. Multiple avenues of training are available including audio and printed training programs, onsite training, and Internet based interactive training.

4 Teamwork Having someone you can count on during those long shifts not only makes the job easier but also motivates workers to do their job better. Paying attention to teamwork skills during times of change can de-crease feelings of stress. Teamwork can be encouraged through: e Actively listening to the concerns of a CNA and showing their input is valued. 0 Modeling teamwork at all levels of the organization e Showing appreciation to all staff members 0 Allowing time for CNAs to solve problems themselves when appropriate e Teaching and training about teamwork Long term care has undergone drastic changes in the last several years. Often we spend so much time putting out fires, we forget that we can actually prevent them from occurring. Paying attention to job satisfaction now, can stop the revolving door syndrome later on.

5 nnouncing the Caregiver Job Clearinghouse: A Free Web Site for Posting Long Term Care Job Openings The American Association of Homes and Services for the Aging (AAHSA) is pleased to team up with the U.S. Department of Labor, the American Health Care Association (AHCA) and organizations representing some of America s most affected industries to present this new employee recruitment resource. The goal is to offer recently displaced workers from the food service, hospitality and related industries rewarding career opportunities in the field of senior living and long term care. Attract qualified candidates by posting positions in:.administration.direct Care *Finance.Food Service.Housekeeping *Human Resources 0 Maintenance.Management Follow these simple steps to begin posting positions: 1.Visit ( 2.Click on the Employer tab on the left side of the page 3.Create a free employer account by registering through the here prompt 4.Provide your company name and contact information 5.Create a user name and password Once you submit the form, the Department of Labor will verify your organization with the state labor department. You will be notified by within 72 hours that you are cleared to start posting jobs. For questions, (cjhelp@ajb.dni.us).

6 HOW YOU Gonna Keep ekn Down on the Farm? In a recent article featured in Contemporary Long Term Care magazine, Grace Rudolph, LSW, Director of Social Service at Sippican Healthcare Center in Marion, Massachussetts, offers the 10 Commandments of retaining staff. They are as follows: 1. Treat all employees with respect. 2. Honor differences and be open to suggestions. 3. Never lie. Don t offer a benefit unless you can produce it. 4. Be fair in giving honest wages. 5. Give bonuses (movie tickets and a gift certificate for dinner for two, for example) for performance above and beyond the call of duty. 6. Encourage the feeling of we re all in this together among staff members, residents, and families. 7. Offer more benefits for time accrued, beginning with a benefit after one year s employment. 8. Make an example of good behavior and employee loyalty. 9. Encourage staff autonomy. 10. Listen - really listen - to employee concerns and respond to them in a timely fashion. For a complete reprint of the article, contact Contemporary Long Term Care at (847) * Grace Rudolph, LSW, (January 2001, How you gonna keep em down on the farm? Contemporary Long Term Care, Vol. 24, No. 1, p. 43