Career Ladder for CNAs

In the late 1990s, administrators at St. Peter Villa Rehabilitation and Nursing Center, a long-term care facility in Memphis, Tennessee, decided they needed to do something about the sky-high turnover rate among their staff of certified nursing assistants (CNAs). At the time, St. Peter Villa’s CNA turnover rate was over 100 percent, says Kathryn Werkhoven, then an administrator at St. Peter. (Today, she is the facility’s executive director, but will begin to scale down her role starting in late 2010.)

Prior to joining St. Peter Villa, Werkhoven had worked at a hospital that used a career ladder to improve retention and quality of care. “I knew a career ladder could work well — it could help with our turnover,” she said. Along with the rest of the St. Peter administration, Werkhoven began designing a career ladder structure for St. Peter Villa. The career ladder debuted in 1999.

St. Peter’s administrators had several goals in mind when developing the career ladder, Werkhoven says. For example, they wanted to give CNAs a greater sense of ownership within the facility by allowing them to make positive, tangible changes to the way St. Peter Villa administers care.

It was also important to broaden the range of tasks that CNAs would be expected to complete as they advance up the career ladder; this would increase their sense of responsibility. And the career ladder would also have to include wage raises at each step, to help reward the facility’s most-committed CNAs.

Level Two CNA

St. Peter Villa’s career ladder has been in place for more than a decade. Today, out of approximately 80 total CNAs currently employed at the facility, roughly 25 have advanced to at least Level Two of the ladder — a relatively strong percentage, but still, “I’m surprised that there haven’t been more people” joining the program, Werkhoven said.

Eligibility and Requirements

All CNAs are eligible to apply for the career ladder program after six months of employment, as long as they have not received any written warnings from a supervisor. As part of the application process, CNAs must think of a way to change St. Peter Villa for the better; they then present their proposal in a written letter to the St. Peter administration, as well as during an in-person meeting with the director of nursing. The proposed change can be relatively minor — for example, one CNA proposed adding water coolers to common areas to encourage residents to stay hydrated. Administrators say they just want to see career-ladder applicants demonstrate an ability to think critically about St. Peter Villa in a way that fosters positive growth.

Implementing their proposed change is one of several requirements that CNAs must complete in order to advance to Level Two of the career ladder — and receive a 50 cent increase in their hourly wage. CNAs must also:

• Attend 18 hours of in-service training sessions. These are supplementary trainings, focused on a variety of competencies, including dementia care, lifting, and dealing with difficult residents.
• Teach two in-service training sessions. Usually, these training sessions are based on St. Peter Villa’s own training curricula, but CNAs have also developed their own trainings, either of their own devising or based on a care seminar they may have attended outside the facility.
• Mentor new CNAs. Although new-CNA mentorship is officially a requirement in order to advance to Level Two, Werkhoven says that there is a degree of flexibility regarding this step: organizationally, “we recognize that some people aren’t good teachers,” she said.
• Serve on at least one employee committee. This can include one of St. Peter’s permanent committees, which focus on subjects such as infection control and falls prevention, or one of the ad hoc committees that is formed when the need arises. (For example, residents began complaining that they did not have enough activities available to them, so the St. Peter staff formed an ad hoc committee on resident activities.)

Level Three CNA

After reaching Level Two of the career ladder, CNAs have the option of ascending to Level Three by undergoing an additional 24 hours of in-service training. Level Three CNAs help St. Peter’s nurse managers check documentation for other CNAs, craft a weekly schedule for CNAs to follow, and perform other tasks supporting their nurse manager. Indeed, Werkhoven says that Level Three CNAs are, essentially, assistant nurse managers. CNAs who reach Level Three of the career ladder are rewarded with a raise of one dollar an hour.

Outcomes

Reduced Turnover. The primary reason that St. Peter Villa created its career ladder was to reduce worker turnover, which had spiraled out of control by the late 1990s. In that respect, the program has been a huge success, Werkhoven says. Turnover has decreased steadily since the career ladder debuted; today, the year-to-year turnover rate at St. Peter hovers around 25 percent.

Workplace Culture. The career ladder has improved St. Peter is less tangible ways as well, Werkhoven says. CNAs who go through the career ladder feel a greater sense of purpose and ownership over their jobs. Overall, Werkhoven says, they are a “happier group of people” because of the opportunities the career ladder provides — and that translates to better care. Additionally, the career ladder gives St. Peter’s administrators an easy way to recognize which employees are the most valuable. “It rewards those who want to work hard and are committed,” Werkhoven said. “You want those people to stay.”

Lessons Learned

Many CNAs initially took a dim view toward the career ladder shortly after it was introduced in 1999, Werkhoven recalls. Some felt that it was simply a way for St. Peter administrators to dump more work on CNAs.

Indeed, administrators had to knock some participants off the ladder in the early going, a consequence of not meeting their additional responsibilities to a satisfactory degree. “Those people weren’t really committed,” Werkhoven said.

Over time, however, Werkhoven and the rest of the St. Peter administration have learned that CNAs “need to have people cheering them on,” encouraging them to pursue the opportunity to advance their careers. Consequently, nurse managers are today much more actively involved in promoting the program; and Werkhoven says that, going forward, that involvement will only increase.

In fact, Werkhoven recommends that other facilities with career ladders ensure that all of their nurses and nurse managers are on board with the idea, so that they can encourage CNAs to embark on the career-ladder journey.

Sponsoring Organization: St. Peter Villa Rehabilitation and Nursing Center is a 180-bed, nonprofit facility providing skilled and intermediate care to elders and people with disabilities.

Best Practice: St. Peter Villa runs a three-tiered career ladder for its staff of around 80 certified nursing assistants (CNAs). CNAs take on greater responsibilities — and earn higher wages — as they advance up the ladder.

Setting: Located in the heart of Memphis, Tennessee, St. Peter Villa is an adherent of the Eden Alternative; its stated mission is to provide long-term and rehabilitative care while maintaining “the inherent dignity of each resident.”

Start Date: The career ladder program began in 1999.

Costs & Funding: St. Peter Villa administrators say that the small financial cost of running the career ladder is more than offset by the financial benefits of maintaining a stable, high-quality staff of CNAs.

Contact Information:

Kathryn Werkhoven, Executive Director
141 North McLean Boulevard
Memphis, TN 38104-2693
(901) 276-2021 | www.stpetervilla.org