Geriatric Nursing Assistant Specialist (GNAS) Program

Career ladders are a crucial component in ensuring quality direct-care jobs. They give workers the opportunity to develop more sophisticated skills, create more value for their employers, and, ideally, earn more money. For the last 21 years, Genesis HealthCare has offered certified nursing assistants (CNAs) the opportunity to take a big step in their professional development by joining its Geriatric Nursing Assistant Specialist (GNAS) training program.

Selection

The program features a selective admission process. Only CNAs who have been employed at Genesis for at least six months and have received a satisfactory job performance evaluation from their supervisor are considered. Candidates are then asked to submit a letter of intent and take an examination dealing with how they confront difficult residents.

Training

The GNAS program is comprised of 10 weekly eight-hour training sessions; CNAs must clear space in their own schedules to attend the classes. At the five-week point of the program, they receive a 50-cent increase in their wages. Upon completing the entire training, they earn an additional 75-cent raise.

The training session is divided into six modules, each addressing a different component of the GNAS job description:

• Introduction to Communications: This module teaches basic communication skills. Trainees learn what personality category they fall under — defined here as a porpoise, a fox, or an eagle — and how their personality may be perceived by co-workers and residents.
• Advanced Communications: Trainees learn about how to deal with uncommunicative coworkers, miscommunications, and numerous other “minefields” inherent in communications.
• Anatomy and Physiology: During this module, trainers review body parts and all the organ systems.
• Disease Processes of the Elderly: This module goes over the diseases that are most likely to occur among long-term care residents, including diabetes, heart failure, respiratory disorders, and urinary disorders.
• Cognition, Death, and Dying: Trainees review major cognitive disorders, such as depression, delirium, and dementia. They also go over the dying process and learn to identify the different stages of death.
• Care Delivery Processes: In this module, trainees learn how to perform the specific tasks that they will have to perform regularly after graduating from the GNAS program. Those tasks include: preventing pressure ulcers, dealing with weight issues, preventing falls, and handling incontinence.

Graduation

Upon the successful completion of the GNAS training program, a graduation ceremony is held for the trainees. The ceremonies are held in the facility where the GNAS works; in fact, residents often attend the ceremonies to support their graduating CNAs. Graduates receive pins, a diploma, flowers, and are treated to a meal. “It’s a big deal,” said Donna Babineau, a clinical education specialist who has been training CNAs in the GNAS program for the last 13 years.

“When you see them graduate,” Babineau said, “and when they hear their name called and they get their diploma and handed their pin, there is a totally different look in their eyes from when they started [the GNAS training program]. Always. I’ve never not seen that look.”

After graduation, GNASs take on additional responsibilities within their residencies. Typically, Babineau said, GNASs take an active role in interviewing potential new CNA hires, as well as mentoring existing CNAs. They also participate more in the various care delivery services they learned about during their training (such as preventing pressure ulcers and falls). Finally, GNASs often serve as a liaison between registered nurses and other CNAs on staff.

Outcomes

Value added. After graduation, GNAS educators make scheduled visits to their former students in their work environments to assess their progress. (The visits occur after 30 days, 90 days, six months, and one year.) During the visits, educators observe how the GNASs have incorporated their training into their job routines. For example: Are they involved in peer mentoring and interviewing CNA candidates? Are they attending care planning meetings with nurses? Do they participate in complicated care processes such as pressure-ulcer prevention? Babineau says that, in her experience, the vast majority of GNASs exhibit greater value as employees than they did before their training.

Career development. Babineau estimates that there are roughly 100 GNAS graduates currently employed within the Genesis system. In 2002 — the last year for which data are available — the 10-year retention rate for GNAS graduates was 65 percent. Babineau says that this figure is probably slightly higher today, but it is misleading nevertheless. GNASs aren’t leaving Genesis because they are discouraged with their work and quit, she says. Rather, many GNASs use their tenure at Genesis as a stepping stone to nursing school, or they leave to pursue some other career advancement. According to Babineau, GNAS graduates realize that “if I can pass Anatomy and Physiology after being out of a classroom setting for so long, I can do anything!” The GNAS program fosters the confidence to allow CNAs “to explore avenues in long-term care they would have never thought of pursuing before,” Babineau said.

Confidence. Susan Goyner, a graduate of the GNAS training program, says that her self-confidence has received a huge boost after she successfully completed her training. (Goyner was the valedictorian of her graduating class.) She has wanted to become a nurse since she was a child, but she never felt she had the self-esteem to go to nursing school. After completing her GNAS training, Goyner says she now feels secure enough in her abilities to pursue nursing in earnest.

Babineau says that the development of CNAs’ self-assurance might be the single most important outcome of the entire GNAS program. After the training, GNASs are far more likely “to go to the nurse with confidence and say, ‘Mrs. Jones has a temp’ using the medical words or the clinical words. It makes a big difference to them,” said Babineau — who was herself a CNA for six years in the 1980s. “I know how hard that [job] can be sometimes,” she said.

Lessons Learned

Follow up and encouragement. GNAS educators have learned that GNASs are best able to use their training if their long-term care centers actively encourage, understand, and “buy into” their expanded roles. Center administrators who truly understand the role of the GNAS — and communicate that role to the rest of their staff — are the ones who get the most value out of their GNASs, Babineau says. During the educators’ regular post-graduation visits to GNASs, they evaluate the extent to which nurses in the facilities understand what the specific role of the GNAS is. If GNASs are being underused or simply misused, educators will determine the root of the problem and try to correct it, Babineau said.

Communication. Another important lesson learned from the GNAS program is how crucial the two communications modules have been to ensure effective GNAS training. Babineau said that, in the past, Genesis has employed CNAs who were “really good, but maybe they didn’t know how to communicate too well, and would come across as boisterous or sometimes problematic.” Then they graduate the GNAS program “and they’ve learned how to get what they need for their residents [while] speaking in a productive way, instead of blaming.” Sometimes all that stands between a good but flawed CNA and a model GNAS is a small dose of communications training.

Sponsoring Organization: Genesis HealthCare is a for-profit provider of long-term care and services. It comprises more than 200 skilled nursing centers and assisted living communities throughout 13 Eastern states. Genesis provides care to more than 26,000 people every day. Headquartered in Kennett Square, PA, Genesis also maintains regional headquarters in Towson, MD; Andover, MA; and Morgantown, WV.

Best Practice: The Geriatric Nursing Assistant Specialist (GNAS) program gives certified nursing assistants the opportunity to move up in their careers by undergoing a 10-week training. Graduates of the program are given more responsibilities, a new job title, and a raise in their hourly wages.

Setting: The GNAS program runs only in Genesis’s New England centers.

Start Date: Initiated in 1989, the GNAS program has since undergone two major revisions — in 1996 and 2007. The most recent update focused on updating care delivery processes that have grown stale over the years. The 2007 update also streamlined the curriculum by eliminating rarely seen disease processes while bolstering coverage of more common maladies such as heart disease and diabetes.

Costs and Funding: The program costs several hundred dollars per student (for publishing the course materials), plus the additional money added onto GNAS graduates’ wages. CNAs attend the training courses on their days off, and are not paid for their time.

Additional Resources:

• Salamon, Lisa, and Debi Sita. “The ‘Genesis’ of Super CNAs.” Provider, September 2001, pp. 55-58.

Contact Information:

Donna Babineau, Clinical Education Specialist
200 Brickstone Square
Andover, MA 01810-1429
(978) 247-5026 | website