It’s All about the Nurse Aides

Abstract

Context: Collaboration between the certified nurse aide (CNA) and licensed nurse (LN) is crucial for the provision of safe, personalized, quality care in the nursing home. This study explored the lived work experience of collaboration in caregiving pairs that identified one another as successful care partners in the delivery of high-quality resident care. Objective: This research explored the CNA and LN experience of mutual support in four nursing homes in the Western United States with a particular focus on varied approaches of LN support for CNAs. Methods: Using a purposive sampling design, we surveyed 12 LN and 12 CNA participants individually and as part of an LN/CNA caregiving pair. Semi-structured interviews were recorded, transcribed verbatim, loaded into NVivo software, and coded for meaning. Findings: LN participants described feeling most supported by CNAs who do their job well. LN and CNA participants described ways LNs in the sample provide holistic support to their CNA coworkers—a phenomenon we coinedundergirding: listen and respond, show respect, help with resident care and answer call lights, educate and explain, provide feedback and encouragement, adjust and divide workloads, protect the CNA, support physical needs, and provide emotional support. Undergirding promotes work success for the CNA and the LN. Most importantly, participants described how undergirding facilitates high-quality resident care. Limitations: This study was designed to identify and explore optimal collaboration as it is possible in the current nursing home setting. It was not intended to represent all LN/CNA caregiving pairs. Implications: These findings may be helpful for educators and administrators, but perhaps they are most important for policymakers. More effective support for CNAs is needed if we hope to decrease turnover, improve retention, and elevate nursing home residents’ quality of care.