Gerontological Nursing Interventions Research Center (GNIRC)

Title: Working Conditions of CNAs in Long-Term Care: Iowa

Principal Investigator:  Kennith Culp, PhD, RN, FAAN

Study Site: University of Iowa

Abstract

The certified nursing assistant (CNA) is required to complete 75 hours of training in order to take the CNA exam. Little is known about institutional-based CNAs as many researchers simply do not focus on studying them. There is a tremendous need to recruit and retain CNAs in the long-term care workforce as the number of actively CNAs in the state of Iowa has steadily declined from 31,000 in 1999 to under 29,000 in 2005. This comes at a time when the number of aging Iowans who will need nursing home services will increase dramatically. We simply most begin to study this important care giver in order to better plan for health care services. In this proposal, we intend to ask CNAs about their work environment and their working conditions stratified on facility-based  data on CNA to resident hours. We will develop a better understanding of working conditions using an inductive approach (i.e hazardous work exposures like muscle strain from heaving lifting). This will be completed with EMG recordings and a portable data logger by ergonomics personnel. This proposal also will obtain detailed workplace environmental assessments of the long-term care work environment. These first two activities will be conducted in Phase I of our design using n=10 subjects. In Phase II we will conduct a mailed survey to n=90 CNA respondents in three groups groups: 1) n = 30 of CNAs who work in a facility in the upper quartile of CNA hours per day; 2) n = 30 CNAs employed in a facility in the lower quartile of CNA hours per day; and 3) n = 30 from CNAs who have left the workplace and surrendered their CNA credential in the previous 6 months.  We anticipate a response rate of less than 50%, so we will over-sample each strata for an n=210. The aims of this proposal are three-fold. First of all, we want to pilot test EMG measurements in the nursing home work environment while the CNA performs direct care activities in facilities. This will lead to including EMG instrumentation in a larger-scale study and will contribute to the literature by describing the actual ergonomic challenges to this level of worker in an environment with poor and excellent CNA to resident ratios. Secondly, we will conduct a worksite environmental assessment in facilities with a mean < 1 hour CNA (n=5) and facilities with CNA > 3 hours per day in resident care (n = 5). This will lead to very precise questions in the development of our mailed questionnaire for Phase II.  Lastly, we will pilot test a questionnaire about CNA working conditions across the three groups based on facility quartile cut-offs for CNA to resident contact time and also include CNAs who left the workforce.