Newly hired certified nursing assistants (CNAs) and culture change: How CNAs integrate into person-centered nursing homes

Nursing homes interested in fostering culture change require a stable CNA staff in order to have time and resources needed to bring about desired change. Turnover among CNAs has been problematic for many years, with turnover rates ranging from 50% to over 100% annually. Approximately 30% of CNA turnover occurs within the first year, yet few studies examine the newly hired CNA's experience. Nursing homes that are able to reduce turnover can devote their training resources to culture change efforts rather than to recruitment and initial training of personnel.

This qualitative study examines the newly hired CNAs experience in five nursing homes in Massachusetts, four of which are in various stages of introducing person-centered culture change practices. Interviews were conducted with CNAs new to the nursing home; their trainers and facility management regarding training, orientation, and workplace practices that create a CNA's early work experiences. During analyses, several themes emerged regarding how important it is for new employees to be accepted by their peers and what factors influence that acceptance. Differences emerge between mangers' and employees' perspectives regarding the impact of specific training programs and work scheduling practices designed to foster good employee relationships.

Understanding what impacts a newly hired CNAs experience has potential to positively impact new employee retention. Studying nursing homes already engaged in culture change efforts focuses attention on the potential of a person centered approach to impact successful workplace integration of new CNAs, and its ultimate impact on resident care.