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April, 2001

An Iowa-Based Nursing Assistant Retention Project

In December 2000, the Iowa CareGivers Association published the results of a 2-year Certified Nursing Assistant Recruitment and Retention Project. Due to the physical, emotional, and mental demands of the work, poor wages and benefits, inadequate orientations and levels of training, and other work environment factors, about 80% of those who enter the field in Iowa, leave within the first year and most often within the first three months of employment. The project, funded by the Iowa Department of Human Services, looked at interventions for retaining direct care workers longer.

The goal of the pilot project was to demonstrate a reduction of Certified Nurse Assistant (CNA) turnover by assessing the needs of direct care workers in nursing facilities, and by providing programs and services that were responsive to the needs identified. In the assessment phases of the project, both CNAs and Nurse Supervisors identified short staffing, poor wages and benefits, lack of respect or appreciation, and inadequate levels of education, training and orientation to the chief reasons why CNAs leave the field.

Of eight nursing facilities that participated in the study, three rural and two urban centers received interventions and tracked CNA employment. The three remaining facilities served as a control group for which CNA employment was tracked with no interventions.

The project�s retention-based interventions included:

	CNA needs assessment survey
	Nurse supervisor survey
	Job satisfaction survey
	Conflict resolution training
	Team building/communication training
	Recognition programs (facility and community)
	Training on caring for the Alzheimer�s client
	Community education and recognition programs
	CNA support group meetings
	Communicating with dying residents and their families
	CNA Mentor training programs
	CNA Mentor quarterly meetings
	Direct care forums
	Ways to retain CNAs (for management)
	Exit interviews

Project evaluators found that those facilities receiving interventions experienced a CNA retention rate of approximately twice as long as those facilities that did not receive the intentions. The overall average length of CNA service for treatment versus comparison facilities during the study period was 18.96 months and 10.01 months, respectively.

The study produced a list of recommendations for reducing turnover rates. Here are just a few considerations for facility administrators and nurse supervisors:

	Be visible to the CNA staff.
	Meet with each CNA individually on a regular basis.
	Embrace a facility culture that promotes professionalism among all staff, including CNAs.
	Place a high priority on training for nursing staff who supervise CNAs.
	Give supervisors the authority and resources necessary to provide the training needed by CNA staff.
	Implement a CNA Mentorship Training Program whereby CNAs mentor and orient new CNAs [as an advancement with a pay increase]. CNA support through participation in the planning and implementation of such a program is very important to its success.

A full report of the study can be obtained from the Iowa CareGivers Association web site at https://members.aol.com/iowacga.

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