Is a Career Ladder the Answer to CNA Staffing?

A podcast from the Leonard Davis Institute at the University of Pennsylvania called“Tradeoffs” identifies health policy issues that impact the delivery of care in all aspects of the system. The January 5, 2023 episode specifically addressed the impact of COVID-19 and the increase in pay rates for the service industry on the acute-on-chronic shortage of certified nursing assistants (CNAs) in long-term care.

The focus of this episode was to identify programs and providers who established career ladders to provide opportunities to professionalize employees in an attempt to improve retention of staff to prevent the closure of units or entire facilities. 

The current lack of sufficient direct care employees in both long-term care and home health care is expected to reach 8 million by 2030 while the amount of people over the age of 65 years will grow by 30%. The gap between the supply and the demand of the direct care work force will likely get much worse before it improves.

Career pathways may provide an opportunity for employers to improve retention. In addition to wage compensation, the primary focus is on finding ways to improve the professionalism of the staff which is accomplished by addressing the value of experience and providing formal pathways for growth. 

Career ladders provide a basic level of education, then add another tier of skills in mental health/behavioral interventions. A third level includes clinical skills, which may be limited by state Nurse Practice Acts or facility policies. 

The key is to listen to staff to determine what they need. Staff need to be seen as individuals who may want education or money or autonomy or flexibility or a host of other issues that may not be readily identified. 

The old way of educating and disciplining staff may no longer work. The lack of staff has already impacted our ability to admit new residents and to care for those who are already our residents.