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WIN A STEP UP: Improving job quality and increasing retention |
Description |
This project, whose name stands for Workforce Improvement for Nursing Assistants: Supporting Training, Education, and Payment for Upgrading Performance, works to increase job satisfaction and retention rates by giving nursing assistants financial incentives in exchange for completing training modules and staying with an employer for a specified period. Nursing homes are also paid incentives for their participation. |
Sponsoring Organization |
The project is a partnership between the North Carolina Department of Health and Human Services and the Institute on Aging of the University of North Carolina at Chapel Hill. |
Setting |
As of November 2003, the program was active in 38 North Carolina nursing homes. By July 2005, 80 nursing homes are expected to be involved. While several home care agencies and adult care homes were involved in the pilot, the program operates solely in nursing homes, largely because it is funded by civil monetary penalty (CMP) fines collected from nursing homes, which the state has earmarked for use in improving nursing home quality. |
Target Group |
At present, the program involves only nursing assistants in nursing homes. |
Start Date |
The pilot program began in March 1998 with a comprehensive study of the nursing assistant workforce in North Carolina. The pilot education and incentive program was implemented and evaluated by January 2002. Planning began that year on Phase Two, a rollout version developed from the pilot. In 2003 planning began on Phase Three, in which licensed nurses responsible for managing CNAs will receive help in becoming better supervisors. |
Objectives |
- Upgrade nursing assistants' skills
- Increase nursing assistants' career commitment and job satisfaction
- Reward nursing assistants for their dedication and commitment to the job
- Increase retention rates for nursing assistants
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Key Components |
Selection. Any nursing home in North Carolina may choose to participate. Homes may participate as many times and for as long as they choose. Each home designs its own method of selecting nursing assistants and decides how many will participate, although they are encouraged to keep classes small (usually 10 members) and to select participants by drawing names from a lottery.
Educational Program. This consists of 27 hours of education divided into 7 modules, which are supported by detailed participant and instructor training manuals and overheads for the trainer, all supplied free of charge by WIN A STEP UP. Instructor manuals include lesson plans, teaching strategies, and evaluation tools for each topic. Facilities may choose to provide their own qualified instructor. Those who cannot or who opt not to are provided an instructor free of charge. In addition, the program offers a course on the principles of adult education for facility-based instructors, since modules must be taught through a variety of methods including mental imagery, simulation and class discussion. Nursing assistants are evaluated for their participation based on attendance, participation and passing a 'closed book' written test with a minimum grade of 80.
The modules cover a mix of clinical and interpersonal/communication skills:
- Infection control (1 session). Participants study an infection control vocabulary, complete a crossword puzzle, and conduct a confidential self-assessment of their infection control practices.
- Fecal impaction and hydration (1 session). This covers how to identify and prevent fecal impaction and poor hydration, including causes and risk factors for both.
- Pressure ulcers (1 session). This module reviews the causes, identification, risk factors, prevention and treatment of pressure ulcers, using clinical photographs, clinical practice sheets and a crossword puzzle to help memory.
- A more empathetic you (2 sessions). This fosters the development of empathetic skills to help nursing assistants better understand the feelings and fears experienced by most nursing home residents. It also covers beliefs and myths about aging. Teaching methods include mental imagery and role plays.
- Me, myself and I (1 session). The focus of this module is coping with challenges faced both on and off the job, including stress, self-image, conflict, and differing needs and values.
- Being part of a team (1 session). This module uses role play and class discussion in addition to lectures to convey the knowledge, skills, and effort required to create effective teams.
- Advanced communication (2 sessions). This addresses both verbal and non-verbal communication, including listening skills and sensitivity to cultural differences. It also explores ways of communicating with residents who face problems such as anxiety and depression.
Incentives. Participating nursing assistants and facilities are given financial rewards. These include:
- Training session incentives. Nursing assistants receive $70 for each session they attend.
- Retention incentives. Nursing assistants who compete at least 70 percent of the sessions and stay at their facility for at least three months after completing the sessions receive a one-time bonus of $75 from WIN A STEP UP. In addition, they receive an incentive from the facility. The facility incentive may be a one-time bonus of at least $75, a wage increase of at least 25 cents an hour, or both.
- Facility incentives. WIN A STEP UP provides an incentive to the facility of $250 (to those who offer participants a bonus), $1,000 (to those that offer a pay raise), or $1,250 (to those that offer both).
In addition, facilities are encouraged to provide graduation ceremonies and provide pins for graduates of the educational program.
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Results, Outcomes, Evaluation |
Pilot Phase Evaluation. A formal evaluation of the pilot program was conducted by the University of North Carolina's Institute of Aging. More than 80 percent of the participants reported that they applied the skills and ideas they learned in their daily work, and annual turnover rates were lower (15 percent) for nursing assistants who participated in the program than for those in matched comparison groups (32 percent.) In addition, 60 percent of the participants reported increases in job satisfaction, although that increase may have been due at least partly to other factors, since 44 percent of those in the comparison groups also reported increased satisfaction.
Phase Two Evaluation. The University of North Carolina has received a research grant from the Better Jobs Better Care program to evaluate the program's performance.
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Lessons Learned |
According to program administrator Leigh-Anne Royster, WIN A STEP UP cannot succeed in facilities whose administrators don't understand the link between investing in a facility's nursing assistants and investing in its quality of care.
The educational program should not be stretched over too much time or squeezed into too short a period. Facilities that have completed the classes in as little as two weeks have found that the classes failed to create a lasting impression. Others have found that taking as long as 18 months causes the monetary reward to lose its appeal and turnover to take its toll. The ideal time period, says Royster, is about six months.
Some facilities enroll only nursing assistants who have already demonstrated outstanding dedication to the profession, using the program to reward their dedication, but WIN A STEP UP works best when groups combine some outstanding workers with some who are not as highly motivated or who are struggling with certain aspects of the job. Royster recommends drawing names of prospective participants from a lottery to keep a balance in the group, and to avoid the appearance of favoritism.
Royster believes that raises, either alone or in combination with one-time bonuses, work better than bonuses alone as retention incentives, although there is no data to prove or disprove that belief. In addition, she says, giving raises in recognition of this special achievement encourages facility administrators to think of CNA work as a career and to consider giving systematic raises to those who demonstrate a commitment to it.
The positive response to the pilot led to recommendations that the program be expanded to all nursing homes in the state, that it be expanded to other long-term care settings as well, and that a more explicit career ladder be developed for nursing assistants. |
Costs and Funding |
WIN A STEP UP supplies all training materials - and trainers, if requested - at no charge, so the only cost to facilities is the bonus and/or wage increase they provide to participants. That expense is partially covered by the incentives they receive from the program.
For WIN A STEP UP, the program costs about $10,000 for each class of 10, including the $70 per participant per module, the $75 for each graduate who stays through the end of the retention period, and the incentive paid to the facility.
The cost of developing the pilot program was funded by a grant from the Kate B. Reynolds Charitable Trust. Phase Two is funded by the State of North Carolina's CMP fines.
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Contact Information |
Ally Woodside
WIN A STEP UP
UNC Institute on Aging
720 Airport Road, CB# 1030
Chapel Hill, NC 27599-1030
t: (919) 218-1192
e: awoodside@schsr.unc.edu
Website: www.aging.unc.edu/research/winastepup
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Other Resources |
Konrad, Thomas R. and Jennifer Craft Morgan Workforce Improvement for Nursing Assistants: Supporting Training, Education, and Payment for Upgrading Performance
http://www.aging.unc.edu/research/winastepup/pilot.html
State of North Carolina Department of Health and Human Services (2000): Continuing Education Modules for Nurse Aides http://facility-services.state.nc.us/hcprcd.htm
*These training materials were developed by the North Carolina Division of Facility Services. As such, these materials are in the public domain and may not be altered without approval from the Division of Facility Services nor may these materials be reproduced for sale.
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