Creative Strategies for CNA Retention


  Arete Rehab is redefining successful aging.

Arete Rehab is redefining successful aging.

Is your facility doing weekly orientation for new staff due to low retention numbers? Is this because of growth or is it because of turnover? Does everyone want to work for you or are people jumping ship for reasons you don’t understand or know how to fix? You are not alone….the struggle is real!

Staff retention in Skilled Nursing Facilities is an issue all over the US. Turnover impacts care, profit, reputation, and safety, but there are few who have cracked the code of long term staff retention. Certified Nursing Assistants (CNA’s) are typically the group with the highest turnover. Reasons for this include low pay, limited opportunity for advancement, inadequate orientation/training, minimal decision making power, unbalanced or unrealistic workload, injury, and lack of respect. Dating back to the 1970’s, some facilities report CNA turnover rates ranging from 55% to 75% and in some cases even 100%.

Industry surveys, research, and exit interviews have identified reasons people are leaving, but as far as strategies to prevent it, the literature is lacking. The bottom line is this: these are the people that are tasked with maintaining the quality of life of your residents, and with quality standards increasing they are tasked with keeping your patients alive and well.

Have you, as a leader, ever worked a whole shift as a CNA or shadowed one to get a realistic view of what the challenges of the role? It may be an eye-opening experience and allow you to generate ideas to increase staff retention. In general, it seems there needs to be a new approach and finding something successful would be coveted and sought out by other leaders all over the globe.

It seems that while the decision makers are making the decisions, and the caregivers are providing the care, communication and collaboration between the two is indirect and ineffective. How do you bring everyone together? Here are some ideas to consider:

  • Executive Directors don’t often share budget information with CNAs. Imagine if you did. Discuss the realities of running a building and having to pay for its function. First, it provides a simple human connection over the realities of paying bills. Second, the CNAs feel included and that their input is respected.

  • Educate all staff on the current and upcoming quality standards and how they can impact the bottom line: use actual numbers to be as clear as possible. Then utilize a system of recognition for high quality care. Track things such as early identification of skin breakdown, assistance with discharge planning/family training, reduced number of falls while on shift, and patient reports to reward high quality care. Increase responsibility for those that deserve it.

  • Implement incentives for problem solving and process improvement. Regardless of level of education if one does a job over and over, they will have ideas of how to make a process better. Explore this and reward it. Simple suggestions of moving a clean linen closet may cut down on time and distance to walk, which increases productivity. No suggestion should be dismissed without consideration.

  • Task nursing leadership and therapy to develop skills training that provide a mode of advancement for CNA’s. For example, a CNA with advanced skin assessment skills or hip precaution training could train new staff and mentor them. Levels of achievement could correspond to incentives.

These are just a few ideas. Someone has to be the first, the one to try something different. What do you have to lose??