The September 2020 American Nurse Journal article “Implementation of evidence-based practice in long-term care” addresses high turnover and job dissatisfaction.

First, seeing this need for more training and respect for long-term care (LTC) staff, including certified nursing assistants (CNAs), demonstrates an awareness of direct-patient care often lost in our love of drama and youth. Thank you.

Second, the discussion of CNA turnover misses at least one critical consideration. My CNA team members often work multiple jobs to support their families because their hourly pay is abominable. These are the healthcare workers with the most impact on the quality of life and therefore the health of our elderly and disabled. (My comments are aimed at LTC and homecare.) CNAs do the majority of back-breaking, everything-is-urgent, hand-holding work. With eight to ten residents per CNA, there is no time to rest, and there is no easy day or part of a shift to look forward to. Then, they have to run to a second 8-hour shift! And they have to be on time for their first shift the next day. They are not working doubles at one facility. They are not picking up “extra” time. They are traveling to their second job. This for a person who needs to be aware and present for fragile people, for families visiting, for people with cognitive deficits—people whose golden years are spent in a people warehouse. The families don’t understand how at $8,000 per month the facility can have a skeleton staff. They don’t understand why the CNAs are tired, irritated, or miss something. They’re unable to be in two to three places at one time.

If we want our families’ golden years to be a little more golden instead of leaden, then our CNAs need more help than just evidence-based practice training. They need the time and space to learn, they need respect for their growth—including training and support to move on and some kind of promotion if they want—and they need the time to practice this knowledge. Brain power only goes so far when one CNA needs to help three people transfer to the toilet all at the same time.

Barry Parnas, MS, RN
St. Paul, Minnesota