STEPS - Systems to Enrich Professional Staff

The Need
Quality patient/resident care is the primary goal of every long term and health care provider. Nursing assistants play a major role in the provision of quality care, delivering over 90% of the direct patient/resident care in most settings. Two related factors influence the nursing assistants’ chances of giving quality care: consistent, stable CNA staffing and training and education.

There is a great demand for nursing assistants and it is likely that many providers find the supply does not meet the demand. There are many reasons for this including high CNA turnover rates, more employment opportunities for nursing assistants, a shrinking labor pool, and fewer facilities providing a nurse aide training program. It is very difficult to provide quality patient/resident care without a stable and consistent staff of CNAs.

Numerous studies cite a direct correlation between CNA turnover rates and quality indicators such as prevalence of pressure ulcers, unplanned weight loss, accidents, etc. Inversely, there is a connection between CNA retention and the same quality indicators.

Training and education returns both direct and indirect benefits. The direct benefits are obvious, a more knowledgeable and skilled nursing assistant staff. The indirect benefits are most likely to occur when training and education is formatted and presented as a career ladder. A career ladder is training and education provided in an organized format that is challenging, yet attainable, offering an opportunity for the nursing assistants to elevate their status within that organized format based upon completion of educational courses.

"It is very difficult to provide quality patient/resident care without a stable and consistent staff of CNAs."

According to a June, 2000 study of nurse aide turnover by the Florida Policy Exchange Center on Aging, when nursing assistant career ladders were implemented significant improvement was found in general knowledge, self-direction, job satisfaction, confidence with challenges, motivation to perform at higher level, overall value to facility, resident view of quality of care, supervisor view of quality of care, and desire for further education. It also found that staff development and in-service training are critical to morale, job satisfaction, stress reduction and turnover. The 2001 United States GAO report/testimony on Recruitment and Retention of Nurses and Nurse Aides Is a Growing Concern identifies the development of additional training and opportunities for career advancement as one of three initiatives to improve nurse aide recruitment and retention.

When training and education is provided as an opportunity in the form of a career ladder the nursing assistants will gain a greater job satisfaction which leads to increased retention and reduced turnover, thereby contributing to a more stable and consistent staff all of which positively impact the delivery of quality care.

ACHP has developed a career ladder, STEPS, especially for nursing assistants based upon thousands of hours working with CNAs across the country, surveys and direct input from CNAs. STEPS is complete with levels or plateaus of accomplishment and incentives/awards for completion.