Lack of Certified Nurse Assistants: Why Do You Want to Be a Cna

The Situation/Challenge: 

Currently at the skilled nursing facility (SNF) where I work at, recruiting, hiring, and retaining registered nurses (RN), licensed vocational/ practical nurses (LVN/LPN), and certified nurse assistants (CNA) is difficult. The organizational challenge of high turnover affects quality of care for the residents as well as stress and increased workload for the staff. This is not unusual in SNFs, in fact, inadequate staffing and increased workload has been reported by facilities (DSHS, 2016).

Who, What, Where, When, Why: 

Lack of nurses and CNAs continue to be a daily concern as more highly acute residents are being admitted in the SNF. The nonprofit organization’s vision is to serve more post-acute short-term residents as the industry continues to shift towards this model. The effects of quality of care has been the result of the nursing workforce trends for over thirty years (Choi, 2011). RNs, LVNs/LPNs, and CNAs need to be on staff and available to provide care to residents. However, in general, SNFs are considered undesirable workplaces due to resident needs, documentation, on the job inquiries, salary and wages, and staffing levels. Poor ethical climate and moral conflict cause to higher turnover rate as well (Filipova, 2010).

The 3 theories that will be applied: Alderfer’s ERG Theory, Satisfaction- Performance Theory, and General Adaptation Syndrome are the three theories that will be applied and evaluated for the above situation.

Theory/ Approach 1: Alderfer’s ERG Theory

Background: 

Alderfer’s ERG Theory was developed to address gaps in Maslow’s Hierarchy of Needs in the late 1960s. Proposed by Clayton Alderfer, Existence, Relatedness and Growth are the three need levels. Food, air, water, wage and benefits, and working conditions are the lower-order needs. Interpersonal and social needs are satisfied when significant interpersonal relationships are developed according to the relatedness needs. Lastly, When something is created and established, growth needs are gratified. A greater sense of wholeness is the outcome of significant contribution.

ii. Application: As part of a large organization with communities in multiple states, benefits offered are comparable to other large organizations. The pay, on the other hand, is slightly lower because 1) the organization is nonprofit and 2) wages offered by other health care organizations, such as hospitals, are more competitive (Avenue, 2019). In the hiring process when wage is discussed, it is common for hiring managers in the SNF to promote fringe benefits, i.e. health benefits, education tuition assistance, employee discounts. Free meals usually excite potential employees, though, the wage determines whether someone accepts the job offer or not. Existence is not fully met. Relatedness is commonly met as the strong bond among employees and supervisors is apparent. The mission and values are shared among staff from managers to front-line staff. The final category, growth, needs some improvement. In-services are provided regularly for the nursing department by nurse leaders as well as through online training, however, these trainings become stale overtime. Newly RN graduates are interested in working at the SNF in their first few years to gain experience; their next move is then to shift to being in an acute setting. Valuable resources and training provide support to employees feeling more committed to the organization’s vision and goals (Filipova, 2010). Making decisions on culture change and developing resident care plans, are two examples that could empower CNAs to be part of the team (Berridge, 2016).