Nursing assistants: a national organization emerges
How Career Nurse Assistants’ Programs is spreading the word about these vital workers
As nurse assistants emerge as important and valued healthcare workers, so is Career Nurse Assistants’ Programs, Inc. (CNAP) emerging as a strong advocate for, by and with them. CNAP, a non-profit educational organization based in Ohio, serves long-term care facilities and organizations nationwide. Although the organization’s name and location have changed several times, the core group of people who came together, many in the early 1970s, is still guiding and directing its current projects.
Today this guidance is provided by a Board of Directors, five National Advisors, a National Advisory Committee comprised of nurse assistants and representatives of nurse assistant groups, organizations, publishers, researchers and others. In addition, a very active Regional LTC Education Committee provides a ready “think tank” and laboratory in which to field test essay questions, planning approaches and other ideas.
While the committee does emphasize nursing homes, representatives also come from a cross-section of long-term care settings, including home care, adult day care, hospital-based SNFs, respite, group homes for the developmentally disabled and family members.
We never planned to create an organization. Indeed, most projects evolved in direct response to a specific need or situation. Particularly significant is the inception of the annual observance of Nurse Assistants’ Week and Career Nurse Assistants’ Day.
The initial thrust for this recognition program actually began in a course about resident abuse. As we talked and worked with nurse assistants on issues of abuse, we began to sense that the curriculum suggested to us by the sponsoring organizations was in itself abusive; the teaching approach was discouraging to anyone who was doing a good job, and the curriculum failed to provide actual assistance in dealing with the myriad of care problems encountered daily by the nurse assistant.
We also heard nurse assistants saying that they perceived their job as “what no one else wants to do.” They did not have a vocabulary for the duties they performed and often felt like outsiders when staff and physicians discussed resident care. They also said they rarely received thanks or recognition for their contributions and the wisdom they brought to their jobs.
The offending curriculum proved to be short-lived and, with the input of a Nurse Assistants’ Representatives Committee (1978), we began to create an identity for the nurse assistant through training, peer development and a variety of recognition programs.
Funding was obtained and data gathering began, first through the Long Term Care Education Center of The University of Akron, and later through Career Nurse Assistants’ Programs, Inc. To further our goals, a number of initiatives and affiliations were established with a variety of organizations on regional, state and national levels. Today, the initiatives are in areas of nurse assistant recognition, education, networking and research.
Recognition and Education
Nurse Assistants’ Week (this year, June 5-12) and Career Nurse Assistants’ Day (June 5) are probably the most visible CNAP initiatives. These nationwide observances provide a framework in which facilities and communities can come together to recognize the important role played by nurse assistants in health care.
Career Nurse Assistants’ Programs provides many educational and promotional materials at little or no cost to facilities desiring to celebrate these observances, including a proclamation ready for signing by the mayor and special event planning. The theme for the ’97 Nurse Assistants’ Week and Career Nurse Assistants’ Day was, “Nurse Assistants: Making Quality Care Happen Through TEAMWORK.” One special project suggested to participants is the annual “Nurse Assistants’ National Classroom” or “Dialogue.” In this project, participants receive a series of topics, tips and discussion questions relating to teamwork. The intent here is to build stronger processes for cooperative planning within the facility.
One of our most rewarding initiatives is the Twenty Year Club, designed to recognize nurse assistants with 20 or more years of service in long-term care. A common misconception held by many is that nurse assistants usually do not stay on the job. Our findings differ – as early as 1975, amid talk about increasing turnover rates, nurse assistants reported service of 15, 20 and as many as 35 years. These same nurse assistants told us they had never been thanked for this loyalty, and some said the administration didn’t even know their names.
This was the impetus for the program, which began in 1978 as The Ten Year Club at The University of Akron. Today, this project has blossomed into the nationwide Twenty Year Club, with more than 700 member nurse assistants who have provided from 20 to as many as 49 years of service, representing 164 facilities in 34 states. As a special commendation to these important heroines and heroes of long-term care, the names of all 700 members of the Twenty Year Club are listed on the official poster of the ’97 Nurse Assistants’ Week.
One networking initiative is the “Network News,” a four- page publication mailed quarterly to up to 10,000 long-term care facilities and organizations across the country. Rather than running full-length articles, we publish brief “flash sessions” on various topics and model programs and provide readers with a contact name and address or phone number for further information. The intent is to foster connections among the nurse assistants and nursing staffs of various facilities across the country with educators, researchers, publishers and each other. The feedback has been extremely positive.
The “Network News” was created at the recommendation of participants in the 1995 National Forum on Nurse Assisting, held in conjunction with the National Citizens’ Coalition for Nursing Home Reform’s Annual Meeting in Alexandria, VA. The purpose of these forums is to identify issues of importance to nurse assistants, give visibility to model programs that begin to address issues of direct care, and develop a national voice and agenda for nurse assisting.
Most of the research conducted by CNAP and our affiliates relates to issues of recruitment, screening, retention and training. Funding for the research project Quality Care and Training (QCTR), currently in progress, is provided by the Ohio Nurses’ Association, The University of Akron, Career Nurse Assistants’ Programs, Inc., the Area Agency on Aging and a number of other sponsoring agencies and organizations.
The purpose of the QCTR project is to examine the relationship of training to the quality of care actually received by the resident. One aspect of this project is to review cost of training and to identify those costs which do not contribute to resident care. A major cost to training, for example, is “in-class turnover” – those nurse assistants who leave before they even begin to work in resident care areas. Unfortunately, many nurse assistants say they are hired directly to class with no interview. The task of determining who will be a good nurse assistant falls to the trainer. This could indicate an inadequacy in the pre-employment screening processes and has implications for further study.
In the 1980s, The University of Akron obtained grants from the Administration on Aging and the Andrus Foundation for the study of nurse assistants with 10 or more years of service. This collection of studies and papers is called the “Stayers Studies.” Their purpose is to identify characteristics of “stayers” that might be useful in the the pre-employment screening process. Several factors have held constant across the entire group. Perhaps the most significant is that each nurse assistant with 10 or more years of service had cared for an older person when she/he was young – a grandparent, a neighbor, someone from church, etc. What’s more, the experience had been perceived as positive.
Another possibly significant factor is that these same nurse assistants reported that family and friends considered them to be the “healthcare expert” and routinely came to them for advice. While we have no data to support the importance of this factor, it suggests that another reason for staying on the job might be to maintain this privileged status within the networks of family and friends.
An additional factor being reported by trainers is the increasing number of nurse assistants coming to class who have not had previous contact with an older person. Many say they have never taken care of anyone – not even to feed a baby. While it is impossible to draw conclusions from such anecdotal findings, it is possible that a “nurturing component,” which has been significant in long-term “stayers,” may be lacking in some nurse assistant applicants today. How this may affect care is not known, but it does signal a concern to identify and train those nurse assistants who have not had previous contact with an older person.
Another factor is that today’s resident might have immigrated to this country in the early 1900s and might retain many cultural influences associated with his or her country of origin. In fact, it is not uncommon that the older woman is a widow living alone, who has never learned to drive a car or manage her own finances. This older woman may become very dependent upon her caregivers in the nursing home. Since it is the nurse assistant who provides most direct care – estimated to be 90% – it follows that the nurse assistant has considerable influence over the resident’s quality of life. For those residents who, either by need or by habit, must rely on others to meet their needs, their quality of life and care depends in large part on having caregivers who know how to nurture.
The characteristic of nurturing has been incorporated into a screening instrument now being field-tested. The purpose of this screening project is to design a tool usable by facilities to determine which prospective nurse assistants are most likely to stay on the job and provide considerate, competent care.
We are also seeking funding for several other research projects. For example, additional empirical data are needed about the nurse assistant with twenty or more years of service. We also plan to study the male nurse assistant, a largely untapped resource and one that brings a number of new variables to the long-term care setting.
Recognizing the impact this will have on the quality of long-term care, Career Nurse Assistants’ Programs, Inc. will continue to advocate for this important worker, to foster connections among nurse assistants and nurse assistant-related groups, organizations, publishers, researchers and others, and to promote a more positive image of the nurse assistant to the facility and to the community.
Genevieve Gipson, RN, is Director of Career Nurse Assistants’ Programs, Inc. For more information write to: Career Nurse Assistants’ Programs, Inc., 3577 Easton Road, Norton, OH 44203-5661; email firstname.lastname@example.org
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