THE IMPORTANCE OF CNAs TO ENSURING HIGH QUALITY PALLIATIVE CARE IN NURSING HOMES
Anyone who spends time in a nursing home soon becomes aware of the important work done by certified nursing assistants (CNAs). The role of a CNA includes providing personal care, observing and reporting symptoms, and assisting with activities of daily living. However, these tasks don't fully describe the special relationships that CNAs have with residents. CNAs are like family to residents, tending to the unglamorous but essential tasks of everyday living. Although entertainment and media often focus on the dramatic elements of health care, such as emergency or high tech care, families and patients commonly remember the "little things." They appreciate having a clean bed, getting their teeth brushed, and having their hair brushed. In other words, when the day is done, nursing assistant care matters very much.
Unfortunately, as a society, we often don't appreciate and recognize these important elements of care. That results in a lack of respect, compensation, and adequate education for many CNAs. Several groups are taking steps to change this situation. The Hospice and Palliative Nurses Association (www.hpna.org) recently published a position statement entitled, The Value of the Nursing Assistant in End of Life Care (available at: http://www.hpna.org/positions.asp). This paper summarizes the Association's commitment to nursing assistants providing end-of-life care in all clinical settings, including nursing homes. This brief but assertive statement is a good reminder of the need to teach nursing assistants about all aspects of care—including palliative care—and to include them in care planning. In our own research, CNAs have told us that while they liked their jobs, they often felt as though other health care team members failed to listen to their input. These CNAs knew that they had important contributions to make in planning and delivering care, emphasizing that they often "knew the resident best." Another research group (Pennington, Scott, and Magilvy, 2003) found a high level of commitment among CNAs working in nursing homes, as well as similar frustrations. Based on their study, these investigators identified strategies to increase job satisfaction among CNAs.
We urge licensed staff and administrators to examine their own beliefs and practices about the CNAs with whom they work. Log onto the HPNA website and print out the position statement. Post it in your facility and discuss ways to acknowledge and reward CNAs. Contact us if you need copies of the studies we mention or would like to get creative ideas about increasing job satisfaction.
One important way to increase CNA job satisfaction is to encourage continuing education. In our March 2004 Tip of the Month, we discuss resources for CNA training in palliative care and opportunities for nursing assistant certification in hospice and palliative care. And, of course, use the PERT Curriculum materials to review with CNAs the important concepts in palliative care!
References
- Ersek M, (Editor). Core Curriculum for the Hospice and Palliative Nursing Assistant. Dubuque, IA: Kendall-Hunt; 2003.
- Ersek, M., Kraybill, B.M., & Hansberry, J. (2000). Assessing the educational needs and concerns of nursing home staff regarding end-of-life care. Journal of Gerontological Nursing, 26(10),16-26.
- Hospice and Palliative Nurses Association. The Value of the Nursing Assistant in End of Life Care, 2005, (Available at: http://www.hpna.org/pdf/Position_ValueOfNA.pdf)
- Pennington K, Scott J, Magilvy K. The role of certified nursing assistants in nursing homes. Journal of Nursing Administration, 2003;33(11):578-584.