Editor's Note: Readers with access to the Internet and, more specifically, to our Web site, http://www.ltlmagazine.com, may have noticed a rather interesting outbreak of conversation over the latter part of May in a “blog” initiated by Paul Willging. Yes, that Paul Willging—one of long-term care's most prominent leaders, spokespeople, and analysts for the past 25 years, a professor at Johns Hopkins University, and the author of numerous highly provocative commentaries for this magazine over the past several years. Paul almost always generates response, and he didn't disappoint this time, either—even though this was his first venture into the exotic “world of online.” Paul started with a simple comment and question about long-term care staffing and, within days, had sparked an outpouring of eloquent and telling observations from readers throughout the field. The so-called “blogosphere” allows anonymous contributions, which perhaps in this context was a good thing—the comments were pointed and personal. Read them and see what you think, perhaps even add your own two cents, if you'd like, at the Web site. And, oh yes, welcome to the new world of long-term care communication.
Posted on: Tuesday, May 13, 2008 11:26:35 AM by Paul Willging
Recently the Institute of Medicine produced a prepublication copy of its long-awaited report on the healthcare workforce. It confirmed what we already know: “We've got trouble right here in River City.” Nurse aide turnover, for example, is running at 72% per year (and other studies have it closer to 85 and even 100%).
Some might argue—so what else is new? With the pressures of the job and with reimbursement essentially capped by Medicaid at only slightly over minimum wage, what else can one expect? Others might say: That's nothing but a lame excuse. We know that, with the right atmosphere and management style in a nursing facility, average turnover can be cut at least in half.
I really want to know what those of you on the front lines think. Is the issue one of management? Or reimbursement? Or a combination of the two? Let's talk (or argue?) about it.
Wednesday, May 14, 2008 1:17:06 PM by Laura
We have 40% turnover with our CNAs calculated from 10/07 through 4/08. This is down from 75% 18 months ago. We are moving deep into culture change and are educating, using Eden as well as LEAP in the nursing areas.
Wednesday, May 14, 2008 3:42:13 PM by Anonymous
I have worked in long-term care (same facility) as an LPN for 28 years. I have seen CNA turnover increase greatly since I first started in 1980. Pay is a factor, but I truly believe that education is one of the areas that is the most different now than then. We had a higher retention rate when the pay was $3.50 per hour than we do now at $8.00 or more per hour. Back when I first started, even though the CNAs weren't licensed, they were trained for weeks and weeks, one-to-one, until they were comfortable enough to be given an assignment on their own, or they took a class in their senior year of high school (or enrolled as adults in the class) that lasted an entire school year. Those CNAs stayed much longer on the job than the ones we have now. We were fortunate to have one wonderful lady who worked for 50+ years as a CNA before she finally retired, and all our long-term CNAs come from that time period when they received more training before they were “turned loose.” Nowadays, the CNA classes last 2 weeks, they have classroom time in the morning and floor time in the afternoon, and when the class is over they are put to work on “orientation” with an experienced CNA, but expected to complete their own workload. The experienced CNA also has her own assignment and often does not have or take the time to “train” the new CNA. The “new” CNAs sometimes don't really have any idea of what is required to take care of this population after this short a training period and are expected to complete full assignments much too soon, which is probably the reason we don't have anyone left out of the classes in six months time. We also have quite a few displaced workers from factory shutdowns and layoffs who come into this field without a real expectation of what all is involved in caring for sometimes very sick and often very cantankerous but loveable older folks. We are thankful for the good CNAs we have and for the ones we can get to stay who, with time, become very good CNAs. I believe that if more time were spent on education it would result in people who, first, know what they are getting into as a CNA, second, people who are thoroughly trained in all aspects of the job performance and, third, people who aren't well suited for or do not like to do this kind of work leaving it before they got to the actual job. The CNAs are the backbone of the facilities—we would not be able to provide care to the residents or operate the facilities without them, so why would we not give our “backbones” all the strength (education) we could to make them stronger?
Thursday, May 15, 2008 7:46:13 AM by Kim
As the above commenter mentioned, the training is not good enough. It's common nowadays to see these CNA mills push students through in a week or two. Little to no actual preparation for the real day-to-day work is provided. Yes, the skills are taught, but barely so.
Supervision is an issue. Our charge nurses are overworked and we're left to fend for ourselves. This is OK for some things but not everything. Nothing is more demoralizing than watching your peers deliver poor, inadequate care, and when you speak up about it nothing is done. Names on the schedule hold more value than the care given by the names.