Diversity, shortages, the lack of physician-nurse communication, and poor self-development opportunities are just some of the many issues facing certified assistant nurses (CNAs). The goal of this paper is to reconsider the most salient HRM issues affecting the nursing profession. Certified Nursing Assistants (CNAs) are at the center of this discussion. Issues to consider include EEO and affirmative action, HR planning, selection, and recruitment, Human Resource Development (HRD), safety and health, compensation and benefits, and employee relations. Implications for the future of the nursing profession are included.
Keywords: Certified Nursing Assistant, CNA, human resource, nursing aide.
Certified Nursing Assistant
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Being a Certified Nursing Assistant (CNA) is not an easy task. Nursing aides must meet a whole range of professional and education requirements. Much has been written and said about the problems experienced by students in their way to becoming CNAs. No less serious are the difficulties facing the entire nursing profession. Diversity, shortages, and poor physician-nurse communication are just some of the many issues affecting today’s nursing profession. Not surprisingly, HRM is gradually turning into the major factor of professional and financial success in the nursing profession and health care, in general. Through affirmative action policies, proper human resource planning and selection, appropriate human resource development programs, as well as solid compensations and effective employee relations, health care organizations can change the face of the nursing profession, making it more attractive for nursing students. CNA is an entry-level specialization, and it is difficult to imagine that certified nursing assistants will have power or legitimate authority to influence HRM decisions in health care organizations. However, in the nearest future, CNAs will have to assume more power and strength in their decisions regarding the nursing career and be prepared to operate in the tough conditions of nursing shortages, low diversity, and the changing nature of physician-nurse relations.
Certified Nursing Assistant (CNA): A Brief Insight
In order to understand how the major elements of Human Resource Management (HRM) affect the nursing profession, the basic premises and requirements to being a Certified Nursing Assistant (CNA) need to be specified. The U.S. Bureau of Labor Statistics is, probably, the most reliable source of professional information for nurses. It should be noted that BLS (2012) does not provide any specific information regarding CNAs. Rather, CNAs are included in the list of nursing aides, attendants, and orderlies (BLS, 2012). This means that CNAs are actually nursing aides; they represent an entry-level position in the nursing career, and only some states call their nursing aids CNAs. According to BLS (2012), “nursing aides, orderlies, and attendants help provide basic care for patients in hospitals and residents of long-term care facilities, such as nursing homes.” Nursing assistants are expected to provide basic care and assist patients in their living activities (BLS, 2012). For example, nursing assistants clean patients, bathe them, help them dress and use toilet, record their complaints and health concerns, measure their vital signs, and help them eat (BLS, 2012). To a large extent, a CNA is an essential link between the patient and his/her physician, as it is through the nursing assistant that physicians learn about their patients’ health needs and concerns.
It is not surprising that the quality of HRM and HR decisions plays a huge role in how CNAs are hired and retained. Moreover, the primary function of HRM is to increase the effectiveness and contribution of employees in the attainment of organizational goals and objectives, and HR specialists are responsible for creating favorable conditions in which nurses can successfully accomplish their professional mission. Diversity and equal employment opportunities, HR planning and recruitment, Human Resource Development and growth, as well as compensation and employee relations, altogether, greatly impact CNAs’ chances to cope with their obligations. As of today, diversity and shortage remain the two most serious issues facing the entire nursing profession. Added to these are the difficulties faced by nurses in their communication with physicians and employers. Based on the knowledge provided in class assignments and professional literature, as well as personal knowledge and experiences, in the nearest future, CNAs will have to prepare themselves to operate in the tough conditions of low diversity and the changing nature of employee relations in the health care field.
EEO, Affirmative Action, and CNAs
As of today, one of the greatest problems facing the nursing profession in general and CNAs, in particular, is the lack of diversity. Inherent in the current state of the nursing profession is the absence of minority representatives and male nurses. However, these problems are not due to the absence of affirmative action policies in nursing. These gender and race/ethnicity misbalances reflect the historical legacy of the nursing profession, which has been traditionally assigned to white women (Hein, 2001). Hein (2001) writes that nearly 9 of 10 registered nurses are white, compared to only 70% of white citizens in the U.S. While the health care system fails to attend to the needs of minority patients, minority nurses coming to work in the U.S. health care system face considerable barriers to career development and growth.
Affirmative action policies in nursing were first developed in the 1960s to open nursing schools and facilities to minority students and applicants (Hein, 2001). Affirmative action had to expand the educational and employment opportunities for women and minorities (Hein, 2001). However, when it comes to the nursing profession, the need to open its doors to women is not as urgent as it is with men: with just a few men working as CNAs, educational institutions and nursing facilities readily open themselves to male applicants (Britz, 2006). Nonetheless, even the best affirmative action policies in nursing have failed to meet their goals. Enrollment in the nursing profession steadily decreases (Hein, 2001). Declining admissions reflect the changes in the national job market. Students and the public have a perception that new employment opportunities for graduate students are meager (Hein, 2001). In this situation, chances for minority and male nurses to find an adequate position become even poorer. “Nursing, as many other health care professions, faces the challenge of increasing the number of minority nurses to reflect the diversity of the American population” (Hein, 2001, p.130).
These problems have direct impacts on the quality and efficiency of HRM decisions in nursing. Moreover, these issues greatly affect the way CNAs must operate. On the one hand, a Certified Nursing Assistant must be prepared to face low-diversity professional environments and increased workloads, due to the lack of professional nurses. Most probably, in the nearest future, most CNAs will have to function in professional environments comprised mainly of white women. Even if, according to BLS (2012), employment for orderlies and nursing aides goes faster than in other occupations, the rapid decrease in the number of baby boomers and their subsequent retirement from the nursing profession will still leave fewer nurses onboard. For the reasons stated above, HRM professionals in health care facilities will need to focus on attracting a larger nursing workforce, which is both culturally sensitive and diverse.
From my experience, not all CNAs have knowledge and willingness to operate in diverse professional environments. They are quite satisfied with being surrounded by white female professionals. However, these CNAs also forget that being sensitive to the cultural backgrounds of diverse clients is one of their primary tasks (Hein, 2001). Diversity is not a curse but a benefit given to nurses in their striving to become more culturally sensitive and tolerant in their relations with patients. It is crucial for every nurse to learn the principles of culturally based care and develop sufficient cultural competence (Hein, 2001). As a certified nursing assistant, I will need to become more attentive to the way I deal with each patient and the way patients’ cultural background affects the provision of quality nursing care.
Again, based on my personal experience, affirmative action policies and EEO can do little to ensure greater diversity among the CNA staff. CNAs are not diverse not because health care facilities violate the basic rights and conditions of employment contracts, but because nursing has an image of being a profession for white women. Morris-Thompson, Shepherd, Plata and Marks-Maran (2011) have found that the image of nursing held by public differs greatly from what nurses actually do. As a result, instead of making the public better informed, HR professionals in nursing focus on attracting diverse applicants by all means. One of such cases was described by Britz (2006), when the most prospective women-applicants in nursing colleges and courses were placed on a waiting list, just to give way to male candidates. This is just another side of the affirmative action issue in the nursing profession, of which I am not aware, but which can potentially impact my career prospects. For all these reasons, I will have to try twice as hard as my male colleagues to prove that I deserve to be part of a CNA team. Irrespective of the severity of these problems, the best I can do is to become a professional CNA, who is sensitive to patients’ cultural backgrounds and open to their complaints and concerns. Even if the prevailing majority of my colleagues are white women, I will have to work hard to retain my professional individuality and cultural sensitivity. I also hope that, from my entry-level position, I will have a voice in HRM decisions and will be able to inform HR specialists about my vision on the affirmative action and diversity problems in action.
HR Planning, Recruitment, and Selection in Nursing
In any service organization, including health care facilities, choosing the right people from the outset is vital for the future success of all its members (Booyens, 1998). One of the primary functions of HRM is to facilitate the selection and retention of the job candidates who have skills, knowledge, ability, and attitudes to support the organization in its movement to strategic objectives (Booyens, 1998). As a CNA, I will hardly play any crucial role in the selection and recruitment decisions in my organizations. Therefore, I need to consider these processes and their implications from my professional position of a certified nursing assistant.
To begin with, the nursing profession is extremely mobile (Booyens, 1998). Dozens of nurses leave the profession or move to other positions, creating vacant posts. Reasons why nurses are so mobile are beyond the scope of this discussion, but this mobility implies that the planning, selection, and recruitment processes in nursing and health care facilities cannot be a one-time event (Booyens, 1998). As of today, the problem of hiring and retaining prospective nurse aides is widely recognized. Vacancy rates for nurses across various health care and nursing facilities range between 8 and 17 percent (Scanlon, 2001). The rates of turnover among nurse aides are higher compared to other professions (Scanlon, 2001). Depending on the health care institution, the rates of turnover for nursing assistants may range between 40 and 100 percent (Scanlon, 2001). The public image of nursing is negative, and, for this reason, most people would not recommend a nursing career for their children, students, or themselves (Morris-Thompson et al., 2011). Low compensation and few benefits make the whole situation even more complicated (Scanlon, 2001). Thus, any certified nursing assistant must be prepared to operate in an environment with mostly homogenous and extremely mobile workforce.
All these problems will have profound implications for my profession and position in a nursing environment. As a CNA, I will face increased workloads, due to the lack of nursing aides. I may experience difficulties developing strong connections with nurses, due to the high turnover rates. However, I do not think that difficulties with selecting and retaining the best CNAs will make it easier for me to pursue a good career. The fact is that developing a career is very different from simply doing my job (Masters, 2009). “A career involves a commitment not just to the work of an employee but to the well-being of the entire organization” (Masters, 2009, p.150). Consequently, my efforts will have to extend beyond caring for patients and involve the activities, which confirm my commitment to the institution. Here, again, it is the task of HR managers to motivate nurses to retain their positions and develop strong commitments to their workplace responsibilities. From my position of the CNA, I will not be able to produce any tangible influence on the quality and efficiency of HR decisions within my organization. However, the nursing profession offers remarkable growth opportunities, of which few society members are actually aware. I believe that one of the primary HRM tasks tomorrow will be to advance the positive image of the nursing profession, thus creating conditions that favor effective planning, selection, and retention of professional nurse aides.
HRD, Safety, Compensation and Benefits
Human resource development (HRD) is a vital part of nurses’ jobs. CNAs are no exception to this rule. Health care employers should provide nurses with regular training and supervision opportunities to avoid the liability for the injuries caused by their employees (Trandel-Korenchuk & Trandel-Korenchuk, 1997). Nurses must participate in regular training sessions, to update and improve their skills (Trandel-Korenchuk & Trandel-Korenchuk, 1997). Additionally, health care employers must screen their nurses and job applicants for any diseases that may constitute danger to patients and other nurses (Trandel-Korenchuk & Trandel-Korenchuk, 1997). Finally, it is within health care employers’ responsibility to ensure that qualified nurses are not assigned to work with unqualified ones (Trandel-Korenchuk & Trandel-Korenchuk, 1997).
All these are the elements of one HRD field, which is designed to improve the skills and professionalism of the nursing staff. Yet, for nurses, who believe in the sanctity of HRD ideals, the reality of the nursing profession may become a real disappointment. Not all supervisors and HR managers can successfully analyze the most acute organizational problems faced by nurses (Swansburg & Swansburg, 2002). Very often, providing more training is a regular response to the problems that emerge in nurses’ workplace relationships. Furthermore, not all employers provide regular training opportunities, simply because most states do not obligate them to do it (Trandel-Korenchuk & Trandel-Korenchuk, 1997). Therefore, even from my entry-level position, I will have to voice the main problems and concerns influencing CNAs. I know that my compensation and benefits may not be too extensive and even satisfying. BLS (2012) suggests that, as of May 2010, nursing aides in the U.S. earned $24,010 on average. To achieve the goals of the nursing profession, CNAs will have to become more persistent in their striving to establish and use effective communication with their employers.
Employment at-will is the fundamental principle governing employer relations with nurses. Simply stated, an employer can fire the nurse any time, even without reasonable cause (Trandel-Korenchuk & Trandel-Korenchuk, 1997). Simultaneously, nurses have the right to quit their jobs at any time without a cause (Trandel-Korenchuk & Trandel-Korenchuk, 1997). Governed by considerations of efficiency and increasing demand for nursing care, employers disregard the other side of their relations with employees (Shi, 2010). Driven by efficiency, the nursing care system is losing its personal touch with patients and lacks a well-functioning system of employer-nurse communication (Shi, 2010). In all phases of employer-nurse communication, from meeting to directing, CNAs expect their supervisors to be congenial, open, and fair (Rowland & Rowland, 1997). As a nurse, I see that the issues of quality leadership in nursing are becoming more pressing. Quality leadership is likely to become one of the most challenging tasks for future employers. Today’s nurses call for greater autonomy, empowerment, and self-governance. However, before it happens, certified nursing assistants will have to undergo a series of changes and develop a stronger HRM voice to ensure greater diversity and improved retention of nursing aides in health care facilities.
Certified nursing assistants are bound to operate in challenging workplace environments. For this reason, CNAs will have to assume more power and strength in their decisions regarding the nursing career and be prepared to operate in the tough conditions of nursing shortages, low diversity, and the changing nature of physician-nurse relations. The quality of HRM impacts nurses’ chances to cope with their primary obligations. Unfortunately, from their entry-level position, CNAs have little voice and can hardly change the direction of HR policies and development programs in health care organizations. Employers have been rather successful in the development of effective health, safety, and compensation mechanisms, while other HRM elements, such as recruitment and selection, deserve particular attention. Unfortunately, contemporary literature discusses the major HRM issues in nursing from a leader’s or supervisor’s position. Therefore, future researchers need to focus on the way CNAs can contribute to the development of more salient HRM systems and policies in the workplace.
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