Articles

Learning The Maplewood Way from the Start: In-House CNA Training Program

CNA long term care training

In 1987 federal legislation was passed that enhanced the framework for nursing homes and long-term care in our country. Referred to as OBRA ’87, this legislation provided guidelines for the Certified Nurse Aide Training program and Nursing Assistants. Other focuses of this legislature were quality care, resident assessment, care planning and the use of physical restraints. Subsequent OBRA legislation in 1989 and 1990 added to the specific training and competency that must be met by every certified nursing assistant (CNA), and established a state Nurse Aide Registry that would track these important caregivers.

Maplewood’s first Staff Educator Judy Carville, along with Toni Bobeck, then Assistant Director of Nursing, and Judy Chambery, then Director of Nursing, worked collaboratively to create the first edition of the CNA training curriculum. In 2006 Staff Educator Joan Weise updated this curriculum as the New York State Department of Health had updated the structure and guidelines of this training.

The Staff Educator oversees the CNA Training Program at The Maplewood. This Registered Nurse must have also completed the “Train the Trainer” curriculum. This training program gives the participant an overview of the learning needs of adults, different teaching strategies, guidance on research and literature reviews and an opportunity to create an inservice to be presented to a group of peers for review. For the past few years, the New York State Health Facilities Association, NYSHFA, has offered this training. Maplewood Staff Educators Joan Weise, Yvonne Arnold and Kathleen Doremus have participated in this training program.

The Training Program and Testing Process

At The Maplewood, the training program begins with the hiring process. Our facility hires trainees to not only complete the training but also to become a staff member. Director of Human Resources Deb Gates, Assistant Director of Nursing Suzanne Allman, Staff Scheduler Brigid Gerhard, and the Staff Educator all work together to screen applications, invite perspective students to an open house and then interview each person. Offers of employment are made after the traditional pre-employment criteria are satisfied. Each class must have a minimum of four students and may have a maximum of eight.

The training program, also referred to as the 100 Hour Program, runs over a calendar of 21 days. Most of the classroom days run eight hours. Each student must complete homework reading and written assignments on a weekly basis. Beginning on day 10 of the calendar, each student completes a clinical morning with the Staff Educator or another experienced nurse. The trainee, under the direct supervision of the licensed nurse, delivers resident care. These are wonderful experiences for both the trainee and nurse as it gives the student an opportunity to begin to use the skills they have learned in class while providing the nurse time to instruct at the bedside and share the benefit of her knowledge. On these mornings some of our residents receive an extra bit of pampering through the 2:1 ratio of care!

Training in the classroom takes many different forms: didactic instruction; use of instructional recorded materials; discussions; demonstration of clinical skills in the classroom and practicing of these clinical skills; use of electronic documentation; presentations by our therapy department, our social worker, our ombudsman, and our nursing department members. Therapy and Wellness Department Manager Ann Shanders works with the class several times, to assist in teaching transferring and ambulation skills.

Exceeding Standards

According to the government guidelines, the 100 Hour Program must provide 70 hours of classroom time and 30 hours of clinical time. The Maplewood CNA program exceeds this minimum guideline. Following the completion of classroom training, the students work four-day shifts, 6 AM – 2:30 PM, under the mentorship of an experienced nursing assistant while still under this supervision of the Staff Educator. The students work on the unit that they will be assigned to once the training class has been completed. These clinical shifts give each student an opportunity to learn the routine of that unit and to get to know the residents that live there. It continues a period of bonding with our residents as they get to know the trainees as well. Many residents happily share what their preferences are, as well as their past social and professional experiences. Relationships with the people that live at The Maplewood are forged and the beginning of the caregiver role is established.

Testing

At the conclusion of the training program, each student takes the Maplewood Final Exam. This is a 200-question comprehensive test. A passing grade must be obtained on this exam for successful completion of this training. A clinical skills checklist has been completed throughout the class as each skill has been taught and demonstrated back to the Staff Educator.

New York State tests and certifies each graduate as a Certified Nursing Assistant. New York State works with a testing organization to administer this test. An electronic/written test is administered to the group and then each student is tested clinically. This test is administered at The Maplewood by a Registered Nurse evaluator. Students are able to electronically access the test results, usually by the end of the test day.

The training program is packed with information! For these students, they are not only learning the skills of a Certified Nursing Assistant, they are also being oriented to Maplewood and the five dimensions of The Maplewood Way. The behaviors and beliefs that are the framework of The Maplewood Way dimensions are: Exceptional Customer Service; Experience, Expertise and Innovation; Lead by Example; Operational Excellence; Great Place to Work. Through these working principles, each new employee is guided to a high standard of quality care and performance.
When is the Training Complete?

Training continues for many weeks following the completion of class and certification testing. Each new graduate has orientation to his or her shift and assignment. The new CNA remains on that assignment for a minimum of 4-6 weeks. They continue to rotate through the primary care assignments on their units. During the class it is emphasized to the students that they should expect to continue the learning process up to the six-month post certification point. As adult learners, the hands-on experience enhances the learning process. At approximately the six-month mark, each new CNA will have had at least one rotation with each assigned group of residents on the unit where they work. Some of the staff are full time employees, others are part time. This will also impact the incline up the learning curve.

Learning never ends. Encouragement is given to each class to recognize that they will meet and care for individuals with specific needs and requests. In their new profession they will get to know family members as part of the health care team and a great resource of information to care for residents.
The Benefits of Having a CNA Training Program

Over the last few years, The Maplewood has run three CNA training classes per year. In 2012, four classes were held. Through years of hiring, it has become evident that the investment of time and training in the Nursing Assistant Program provides Maplewood with an opportunity to teach each trainee from the onset to the standard of quality care that is expected at The Maplewood. This approach results in a special connection – a “bonding” – between the new CNA and our skilled nursing facility. An essential element that is vital to the success of all our employees is being actively engaged in our Maplewood Way program which includes teamwork, supporting one another, and giving personalized, compassionate care to our residents. This is developed from the start of their training.

In-house CNA training programs are rare, and The Maplewood’s residents and family members have long enjoyed the benefits of low turnover, high job satisfaction and a thorough understanding of The Maplewood Way among our CNA staff. Our CNA trainees learn from the beginning the level of care they’re expected to deliver at The Maplewood, and understand that they’re expected to sustain that level throughout their career. Our goal is to have our CNA’s choose to stay with The Maplewood, where they can deliver the same elevated level of care they were taught to provide while in our CNA Training Program.
Possible Additions

A possible future addition to the training program is the implementation of a formal mentoring program for nursing assistants. The Staff Educator would oversee this training. It would provide nursing assistants that mentor trainees an opportunity to explore this role and receive specialized training.
Conclusions

Our goal is to provide individualized care for each resident to the highest level of quality available. Our in-house CNA training program is a significant contributor to forging deeper connections with residents, greater job satisfaction among our CNAs and lower turnover. This in turn has a positive effect on quality of care.

Yvonne Arnold, RN