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  1. Pennington, Karen MS, RN
  2. Scott, Jill PhD, RN
  3. Magilvy, Kathy PhD, RN


Objective: Pilot study to examine the experiences of the certified nursing assistants (CNAs) in Colorado nursing homes.


Background Data: CNAs provide 80% to 90% of the care to residents in nursing homes. Their reported turnover rate is as high as 400% in some studies, and the potential pool of CNAs is dwindling. As the demand for CNAs increases, their experiences must be understood to effectively address recruitment and retention issues.


Methods: Minimally structured interviews of 12 CNAs in 6 Colorado nursing homes and observations of care provided were conducted. Atlas/Ti software was used as a data management tool for analyzing and coding data.


Results: The overriding theme that emerged from the interviews was "we love our jobs." Three patterns of thought and behavior emerged: attributes of the CNA, working conditions of the CNA, and future success of the CNA and the nursing home.


Conclusions: Issues important to CNAs revolved around basic motivational factors, such as job enrichment opportunities, personal growth opportunities, recognition, responsibility, and sense of achievement. Leadership must become creative and build on that base, providing CNAs with job mobility, job enrichment opportunities, recognition, and increased job responsibility, producing positive outcomes not only for the CNA but also for the resident and the facility.


It is estimated that 1.6 million older Americans reside in 23,000 US nursing homes. 1,2 Since 1963, when the number of nursing home beds totaled approximately 500,000, the number has grown to more than 1.8 million. 3 Certified nursing assistants (CNAs) provide 80% to 90% of nursing home care. 4 As the foundation of the nursing home workforce, CNAs are critical to the care of the elderly. The role of providing care to the elderly should provide meaningful work, yet CNAs' turnover rates are as high as 400%. 4 As the aging of the population and the need for nursing home care increases, the experiences of the most prevalent caregivers must be understood.


In the midst of a healthcare provider shortage, nursing homes are not the healthcare employer of choice. 5,6 Yet, the need for CNA jobs is expected to increase 36% by 2008. 7 The potential CNA workforce is shrinking. Alexander et al examined the workplace and found that turnover was directly related to 6 dimensions of work: work hazards, professional growth opportunities, role clarity, workload, autonomy, and relationship with coworkers, 8 all prevalent dimensions of the CNA workplace.


CNAs must also deal with an increasing number of residents who are cognitively impaired for which they have little formal training. In some nursing homes, the percentage of residents who are cognitively impaired is reaching close to 94%, 9 causing CNAs to report significantly higher psychological job demands. These demands affect workplace retention.


When asked about quality in nursing homes, residents valued good staff and care over all other industry definers of quality. 10,11 Studies also suggest that consumers' perceived good care as the result of adequate, educated, and supervised staff. 10 Sufficient well-oriented CNA staff members are essential to deliver quality care and to meet residents' individualized needs. It is imperative that the value of CNAs is understood and appreciated.


After instructing CNAs at a local community college for several years, it became apparent to the lead author that findings in the literature and the values of CNAs were incongruent. Additionally, work as a research assistant in nursing homes introduced the lead author to many CNAs who did not hold the same values and experiences described in the literature. Desiring to investigate this incongruence, the purpose of this phenomenologic study informed by ethnography was to explore the work lives of CNAs in the nursing home setting. The goal of the study was to explore CNA perceptions and values. Current research demonstrates minimal explanation for who the CNA is, what the CNA does, and how the CNA carries out his or her role.


By exploring what is valued by the CNA, it was believed that hiring practices, orientation strategies, and working conditions could be improved, leading to greater stability in the workforce with accompanying lower orientation and personnel costs. New strategies must reflect the group values and norms of this important component of nursing home caregivers. Facility administrators will have new information to improve retention of a valued healthcare provider through CNAs' perceptions of work.