Certified Nurse Aides Research Articles

Examining the Factors Affecting Psychological Well-Being in Certified Nurse Aides Working at Long-Term Care Institutions.

The demand for certified nurse aides (CNAs) in long-term care institutions is gradually increasing. Factors such as well-being that positively influence the work of CNAs have been inadequately explored in the literature. This study was designed to examine the relationships among social support, self-efficacy, demographics, and psychological well-being in CNAs during the recent COVID-19 pandemic and to assess the moderating role of social support on self-efficacy and well-being in this population. In this quantitative correlational study, CNAs from 24 legally registered long-term care institutions were recruited as participants. Data were collected using a demographic questionnaire, the General Self-Efficacy Scale, the Social Support Scale, and the Chinese Happiness Inventory. Partial least squares structural equation modeling was used to test the research hypotheses model. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was followed in this cross-sectional study. A total of 148 CNAs were enrolled as participants. The mean age of the participants was 46.48 years. Social support and having children were identified as being significantly and positively correlated with well-being, and self-efficacy was identified as having no significant impact on well-being. Importantly, social support was found to moderate the relationship between self-efficacy and well-being. Overall, social support and having children were important predictors of well-being, with a combined explanatory power of 41.6% ( Q2 = .28, f2 = 0.40). Self-efficacy was found to be less predictive of well-being in the presence of higher levels of social support. Being a parent was also identified as an important factor affecting the well-being of CNAs under stress. Managers of long-term care institutions should intervene to improve the CNA's social support. Also, CNAs who do not have children should pay more attention to their well-being.

UTILIZATION OF LASSO AND POISSON REGRESSION DEALING WITH COUNT VARIABLES IN NURSING HOME RESEARCH

Abstract Regression has been used for decades; thus, more empirical studies are necessary to choose appropriate regression methods, as traditional regression has many drawbacks and is limited in analysis and synthesis with large numbers of covariates. This study aims to investigate factors related to pressure ulcers in nursing homes using three regressions: least absolute shrinkage and selection operator (LASSO) Poisson, LASSO linear, and LASSO logistic regression. We represent how each model’s estimating, inferencing, and performance measures work. The datasets accrued from 51 nursing homes that operated between 2021 and 2022. A total of 35 independent variables included organizational and nurse staffing variables. The variable of interest was the number of residents in each nursing home who had an occurrence of pressure ulcers within the last 3 months. The significant factors were different; turnover of Certified Nurse Aides and government incentives of more RNs were significant in the LASSO Poison regression, no factors were significant in the LASSO Linear regression, while and the percentage of residents who are completely dependent for activities of daily living in LASSO was significant factor in the Logistic regression. Using the coefficients in the Poisson regression, we interpreted that more nursing staff turnover increased the percentage of residents with pressure ulcers by 3.02 times, which would not be possible with linear regression. The Lasso model uses a technique of shrinking coefficient estimates to zero to improve the fit of a model that includes all explanatory variables and improves model interpretability by identifying most important features.

Human Resource Management Interventions to Address Traumatic Stress and Compassion Fatigue Among Certified Nurse Aides in Institutional Long Term Care Facilities

Human Resource Management Interventions to Address Traumatic Stress and Compassion Fatigue Among Certified Nurse Aides in Institutional Long Term Care Facilities

Examining the Predictors of Turnover Behavior in Newly Employed Certified Nurse Aides: A Prospective Cohort Study

BackgroundThe turnover rate of nurse aides in Taiwan is high. However, the predictors of turnover behavior in the newly employed are still unclear. ObjectiveTo examine the predictors of turnover behavior in newly employed licensed nurse aides. MethodsA longitudinal study design was used and subjects were newly employed certified nurse aides from a nurse aid training association in Taiwan. A total of five questionnaire surveys were conducted. The questionnaire was mainly used to collect information on turnover behavior, personal socioeconomic background, workplace psychosocial hazards, worker health hazards, and musculoskeletal disorders. ResultsA total of 300 participants were recruited in the study. Cox regression analysis results showed that short working experience (hazard ratio [HR] = 0.21, p < 0.01), work as non-home nurse aides (HR = 0.58, p = 0.01), low monthly salary (HR = 0.68, p < 0.01), high work mental load (HR = 1.01, p = 0.01), low workplace justice (HR = 0.97, p < 0.01), high workplace violence (HR = 1.60, p < 0.01), high burnout (HR = 1.01, p = 0.04), poor mental health (HR = 1.06, p = 0.04), and high total number of musculoskeletal disorder sites (HR = 1.08, p = 0.01) contribute to a higher risk of turnover. ConclusionThe results indicated that employment period, work as a home nurse aide, monthly salary, work mental load, workplace justice, workplace violence, work-related burnout, mental health, and total number of musculoskeletal disorder sites are predictors of turnover behavior in newly employed certified nurse aides.

Just Keep MOVEN: An Evidence-Based Approach to Improving Outcomes in Patients Receiving Mechanical Ventilation

Just Keep MOVEN: An Evidence-Based Approach to Improving Outcomes in Patients Receiving Mechanical Ventilation

SUPPLEMENTAL PAYMENTS AND NURSING HOME STAFFING: A CASE STUDY OF INDIANA

Abstract Adequate reimbursements are key to improving quality in nursing homes (NHs), but Medicaid payments remain low. Indiana implemented Medicaid supplemental payment program to non-state government (NSGOs) owned NHs to boost Medicaid payment rates. Under the program, NSGOs contribute the state-share of the supplemental payments through intergovernmental transfers allowing the state to claim federal matching funds. The supplemental payments are distributed between NSGOs and NHs but little is known about whether NHs invested the supplemental payments to improve staffing levels. In this study, we examine whether NHs receiving supplemental payments, proxied by NSGO-ownership, have higher staffing hours per resident day (HPRD) for registered nurse (RN), licensed practical nurse (LPN), and certified nurse aide (CNA) compared with NHs without supplemental payments. We use facility-year data on NSGO ownership (State of Indiana), staffing levels (Nursing Home Compare), and facility and resident characteristics (LTCfocus.org) on 500 NHs from 2009 to 2017. We use difference-in-difference (DD) regressions with year and facility fixed effects to estimate the potentially causal effect of NSGO ownership on NH staffing controlling for facility and resident characteristics. DD estimates suggest that NSGO-ownership is associated with decreased staffing level across all three types of staffing. More specifically, RN staffing decreased by 0.019 HPRD (p&amp;lt; 0.05), LPN staffing decreased by 0.041 HPRD (p&amp;lt; 0,05), and CNA staffing decreased by 0.089 HPRD (p&amp;lt; 0.001). Policymakers should increase the transparency of supplemental payment programs and audit the expenditures to ensure that supplemental payments are tied to quality improvement.

PROMOTING RESIDENT SAFETY THROUGH TRAINING FOR CERTIFIED NURSE AIDES, RESIDENTS, FAMILIES, AND OMBUDSMEN

Abstract Preventing COVID-19 infections and ensuring resident safety in the nursing home (NH) setting requires collaboration among NH leadership, staff, residents, and their advocates including families, caregivers, and nursing home ombudsmen. To address this multi-collaborative need, the University of North Texas Health Science Center Geriatric Workforce Enhancement Program developed training in two focus areas. The first focused on resilience training for Certified Nurse Aides (CNAs) with the United Way that addresses factors influencing well-being, economic stability, mental health, and other social determinants. The second focused on training residents, families, ombudsmen, and other resident advocates to become active partners with NH leadership and staff in the prevention and control of healthcare acquired infections. To ensure training reflects the needs and preferences of key NH stakeholders, we developed a Nursing Home Advisory Council in partnership with state Ombudsman Programs in Texas, Louisiana, and New Mexico.

The Effect of Nurse Aide Retention on Ohio's Nursing Home Resident Care Experience Scores: A Facility-Level Analysis.

This study examined whether certified nurse aide (CNA) retention was positively related to nursing home (NH) resident care experiences at the organizational-level. The 2017 Ohio Biennial Survey of Long-Term Care Facilities and the 2017 Ohio Nursing Home Resident Satisfaction Survey provided the key variables. Quartiles of CNA retention (0-48%, 49-60%, 61-72%, 73-100%) were created from the analysis sample (N = 667). Regression analyses clustered NHs within counties and controlled for structural characteristics, financial resources, empowered managers, resilience, quality of work-life, resident, and community characteristics. NHs in Quartile 3 of CNA retention had higher environment scores by 1.36 percentage points compared to Quartile 1 (p < .05). NHs in Quartile 4 had lower facility culture scores by 1.31 percentage points than NHs in Quartiles 1-3 (p < .05); this pattern repeated when Quartiles 3 and 4 were compared on other outcomes. Future research should explore NHs with very high CNA retention to improve understanding of the measure.

HRM Practices, Organizational Culture and Nurse Staffing Turnover among High-Medicaid Nursing Homes

Nurse staffing turnover has been associated with nursing home quality, such as worse resident outcomes, higher rates of infection, and hospitalizations. Nurse staffing turnover can be worse in under-resourced nursing homes, such as those with a high proportion of Medicaid residents. These organizations may lack the resources to attract and retain nurse staff, and this could contribute to higher nurse turnover. However, even within this group of under-resourced nursing homes, we observe variations in nurse turnover rates. Using the resource-based view of the firm (RBV), we explored the role that both human resource management (HRM) practices and organizational culture may have in explaining the variations in nursing staff turnover among high Medicaid nursing homes. Data consisted of survey and secondary data sources for 2017-2018. Survey data comprised 348 responses (33% response rate) from a national mailer of US nursing home administrators in high-Medicaid (85% or higher) facilities. Survey data were merged with secondary datasets including Long-Term Care Focus (LTCFocus) and the Area Health Resource File (AHRF). The dependent variables (nurse staffing turnover rates) consisted of the percentages of registered nurses (RNs)/licensed practical nurses (LPNs)/certified nurse aides (CNAs) that had voluntarily quit the organization during the past year. The first independent variable, HRM practices, consisted of three sub-scales: traditional, employee-centered, and high involvement practices. The second independent variable consisted of nursing homes’ classification into one of four organizational cultures: clan, market, hierarchical, and non-dominant. Organizational and market variables were controlled for. Data were modeled using Poisson log-linear regression, and propensity score weights were used to adjust for potential survey non-response bias. Results show that high involvement HRM practices and having a clan culture (compared to a market, hierarchical, and non-dominant culture) are associated with lower RN, LPN, and CNA staffing turnover. The findings of this study highlight the importance of organizational culture as well as HRM practices for practitioners and policy makers to more effectively target their efforts to reduce nurse turnover in high Medicaid nursing homes. By reducing turnover, these under-resourced facilities may be able to lower costs and improve their financial performance, which may ultimately reduce the likelihood of closure with implications for access to long-term care. Similarly, lower nurse staffing turnover rates may improve quality of care for a particularly vulnerable nursing home population, i.e. those with lower SES and racial/ethnic minorities.

Daily Variation in Nursing Home Staffing and Its Association With Quality Measures

Average staffing measures are a focus of nursing homes' quality assessments and reporting. They may, however, mask daily variation in staffing, additional information that could be important for understanding nursing home quality and relative ranking. To examine daily variation in staffing, its association with quality, and whether daily variation provides information regarding quality ranking of nursing homes over and above the information provided by average staffing levels. This quality improvement study included registered nurses (RNs) and certified nurse aide (CNAs) at 13 339 certified nursing homes throughout the United States during 2017 to 2018. Retrospective analyses of the Payroll-Based Journal, Medicare Cost Reports, and Nursing Home Care Compare were conducted. Data were analyzed from January 2017 to December 2018. Three measures of daily variation, ie, coefficient of variation (COV), total outlier days (TOD), and low outlier days (LOD), were calculated for RNs and CNAs. The association between these measures and quality rankings and other facility characteristics were evaluated. A total of 13 339 nursing homes were included in this study, with 9476 (71%) for-profit facilities. The mean (SD) hours-per-resident-day were 0.41 (0.29) for RNs and 2.16 (0.49) for CNAs, and a mean (SD) 55% (26%) of residents were Medicaid beneficiaries. Outcome measures were as follows: mean (SD) COV, 0.5 (0.6) for RNs and 0.1 (0.1) for CNAs; mean (SD) TOD, 220 (69) for RNs and 44 (45) for CNAs; and mean (SD) LOD, 116 (45) for RNs and 22 (24) for CNAs. All 3 variation measures, for both RNs and CNAs, were significantly associated with both the 5-Star Quality Measures (COV among RNs, -0.014 [95% CI, -0.021 to -0.007]; P < .001; COV among CNAs: -0.004 [95% CI, -0.006 to -0.003]; P < .001; TOD among RNs, -3.79 [95% CI, -4.59 to -2.99]; P < .001; TOD among CNAs, -2.52 [95% CI, -3.08 to -1.96]; P < .001; LOD among RNs, -2.46 [95% CI, -3.03 to -1.88]; P < .001; LOD among CNAs, -1.29 [95% CI, -1.58 to -0.99]; P < .001) and the 5-Star Survey rankings (COV among RNs,-0.026 [95% CI, -0.033 to -0.019]; P < .001; COV among CNAs: -0.006 [95% CI, -0.007 to -0.004]; P < .001; TOD among RNs, -5.10 [95% CI, -5.97 to -4.23]; P < .001; TOD among CNAs, -4.16 [95% CI, -4.77 to -3.55]; P < .001; LOD among RNs, -3.04 [95% CI, -3.65 to -2.44]; P < .001; LOD among CNAs, -1.97 [95% CI, -2.29 to -1.65]; P < .001) published in Nursing Home Care Compare. Low κ values, ranging from 0.23 to 0.63, indicated that the variation measures add information about ranking to the information provided by average staffing measure. These findings highlight the importance of reporting daily variation in staffing to improve understanding of the relationship between staffing and quality. They suggest that 2 facilities with the same average staffing achieve different quality of resident care and survey ratings in association with on the day-to-day variation in staffing. Measures of daily staffing may enhance the value of Nursing Home Care Compare for nursing homes and others engaged in quality improvement and consumers searching for high quality nursing homes.

Association Between Wages and Nursing Staff Turnover in Iowa Nursing Homes

Background and ObjectivesNursing staff turnover is a substantial concern for nursing homes that care for millions of older individuals, especially during the coronavirus disease 2019 pandemic. Low pay is considered as one of the key reasons for high turnover. However, we do not know whether increasing wages can lead to lower turnover. In this study, we fill this gap in our understanding by analyzing the relationship between wages and nursing staff turnover.Research Design and MethodsWe obtained data on hourly wages (Medicare Cost Reports), turnover (Iowa Department of Human Services), and nursing home and resident characteristics (Nursing Home Compare and LTCFocus) from 2013 to 2017. We summarized the characteristics of nursing homes as well as turnover trends over time. Next, we used pooled ordinary least squares (OLS) and facility fixed effects regressions to examine the relationship between wages and turnover adjusting for nursing home and resident characteristics.ResultsAmong the 396 nursing homes in Iowa, average hourly wage was $27.0 for registered nurses (RNs), $21.6 for licensed practical nurses (LPNs), and $14.1 for certified nurse aides (CNAs) during 2013–2017. Average turnover rates were increasing over time for all staff types and in 2017, turnover rates were 46.0% for RNs, 44.4% for LPNs, and 64.7% for CNAs. In both pooled OLS and facility fixed effects regressions, higher wages were associated with lower turnover of CNAs but not LPNs or RNs. The magnitude of the effect of wages on turnover for CNAs was lower in facility fixed effects regressions.Discussion and ImplicationsWe found a significant relationship between hourly wages and turnover for CNAs but not for LPNs or RNs. Focusing on higher wages alone may not lead to lower turnover of all types of nursing staff in nursing homes. We should also focus on nonwage factors related to turnover.

Collaboration Between Licensed Nurses and Certified Nurse Aides in the Nursing Home: A Mixed Methods Study.

The current mixed methods study explored how nursing team collaboration is perceived and experienced in four nursing homes (NHs) in the western United States. Licensed nurses (LNs) and certified nurse aides (CNAs) completed two survey tools to assess their perception of collaboration and team-work in their current work environment. LNs and CNAs were paired and interviewed individually and as a caregiving pair to explore the lived experience of collaboration in NH residents' care. Quantitative survey results were analyzed, and participants reported a collaborative working environment with equally strong ratings in the following categories: partnership, cooperation, and coordination; they agreed with statements reflective of teamwork, including team structure, leadership, situation monitoring, mutual support, and communication. No significant differences were found between LN and CNA responses or between team members in any of the four participating facilities. Qualitative survey data were analyzed using a thematic analysis approach. Findings revealed five primary themes, including essential elements in successful team collaboration-perspective, coworker connection, communication, mutual support, and "it makes a difference"-and ways teamwork and collaboration impact resident care. These findings provide rich insights into successful LN/CNA collaboration for academic and clinical LN and CNA educators. [Research in Gerontological Nursing, 15(1), 16-26.].

Undergirding CNAs in LTC: The Experience of Collaborative LN-CNA Caregiving Pairs

This research explores support provided by licensed nurses (LNs) to certified nurse aide (CNA) coworkers in the nursing home (NH). Using purposive sampling, we interviewed 12 LN and 12 CNA participants individually and as part of an LN/CNA caregiving pair. Semi-structured interviews were recorded, transcribed verbatim, and coded for meaning using NVivo software. LN and CNA participants described anticipated and unanticipated holistic support for CNAs. We applied the term undergirding to this phenomenon , and we present descriptions and examples of undergirding in nine categories: listen and respond, show respect, help with resident care and answer call lights, protect the CNA, support physical needs, and provide emotional support. Undergirding promotes work success for the CNA and the LN, as the LN job includes oversight of CNA responsibilities. Most notably, participants report undergirding facilitates high-quality resident care. These findings may be helpful for educators and administrators, but perhaps are most important for policymakers. CNAs need additional support to decrease turnover, improve retention, and elevate NH residents' quality of care. The study design identified and explored optimal collaboration as it is possible in the current NH setting. It does not represent all LN/CNA caregiving pairs.

It’s All about the Nurse Aides

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.

Organizational Learning and Motivation in Certified Nurse Aides: A Qualitative Study.

Organizational learning is linked to improved outcomes in health care settings. In long-term care facilities, the unique position and expertise of certified nurse aides (CNAs) are crucial for excellent resident care, thus is it important to understand their sources of motivation. However, CNA motivation has not been adequately studied. The current qualitative descriptive study explored sources and implications of CNA motivation, particularly as it relates to engaging in organizational learning. Twenty-four CNAs working in a state Veteran's home were interviewed. CNAs described their sources of motivation as: I'm a Natural Caregiver, Support From Administration, Working as a Team, Love for Residents, and Self-Care. When motivated, CNAs had more positive attitudes about their work, a higher level of engagement with residents, a stronger drive to accomplish extra tasks, and less desire to quit. Engaging CNAs in organizational learning may provide an opportunity to motivate CNAs and optimize their unique position and expertise to improve resident care. [Research in Gerontological Nursing, 14(5), 255-263.].

Licensed Nurse/Certified Nurse Aide Collaboration in the Care of Nursing Home Residents

This mixed-method study explores how nursing team collaboration is perceived and experienced in four nursing homes (NHs) in the Western United States. Licensed nurse (LN) and certified nurse aide (CNA) participants completed two survey tools to assess their perception of collaboration and teamwork in their current work environment. The LNs and CNAs were paired and interviewed both individually and as a caregiving pair to explore the lived experience of collaboration in the care of NH residents. Quantitative survey results were analyzed using IBM® SPSS Version 25, and participants reported a collaborative working environment with equally strong ratings in the following categories: partnership, cooperation, and coordination; they agreed with statements reflective of teamwork including team structure, leadership, situation monitoring, mutual support, and communication. No significant difference was found between LN and CNA responses or between team members in any of the four participating facilities. Qualitative survey data were loaded in NVivo12 and analyzed using a thematic analysis approach. The findings revealed five primary themes, including essential elements in successful team collaboration—perspective, coworker connection, communication, and mutual support—and ways teamwork and collaboration impact resident care.

CE Module: Work-Related Asthma Among Certified Nurse Aides in Texas.

CE Module: Work-Related Asthma Among Certified Nurse Aides in Texas.

Work-Related Asthma Among Certified Nurse Aides in Texas.

Background: Although nurses are well described as being at risk of work-related asthma, certified nurse aides (CNAs) are understudied. Using a statewide registry in Texas, we measured prevalence and risk factors for work-related asthma and bronchial hyperresponsiveness (BHR) symptoms among CNAs. Methods: For this cross-sectional study, a questionnaire was mailed to a random sample of CNAs (n = 2,114) identified through the Texas Department of Aging and Disability Services registry, working in health care during 2016-2017, to collect data on job history, asthma symptoms, and sociodemographics. Two outcomes were defined: (a) new-onset asthma (NOA) after entry into the health care field and (b) BHR-related symptoms. Job exposures to cleaning compounds and tasks were assigned using an externally coded CNA-specific job-exposure matrix. Logistic regression modeling was used to measure associations between cleaning exposures and the two asthma outcomes. Findings: The final sample consisted of 413 CNAs (response rate 21.6%). The prevalence of NOA and BHR symptoms were 3.6% and 26.9%, respectively. In adjusted models, elevated odds for BHR symptoms were observed for patient care cleaning (odds ratio [OR] = 1.71, 95% confidence interval [CI] = [0.45, 6.51]), instrument cleaning (OR = 1.33, 95% CI = [0.66, 2.68]), building-surface cleaning (OR = 1.39, 95% CI = [0.35, 5.60]), exposure to glutaraldehyde/orthophthalaldehyde (OR = 1.33, 95% CI = [0.66, 2.68]), and latex glove use during 1992-2000 (OR = 1.62, 95% CI = [0.84, 3.12]). There were too few NOA cases to warrant meaningful regression analysis. Conclusion/Application to Practice: Although not statistically significant, we observed elevated odds of BHR symptoms among nurse aides, associated with cleaning exposures, suggesting this is an at-risk group of health care professionals for work-related respiratory disease, meriting further study.

Certified Nurse Aides and Scope of Practice: Clinical Outcomes and Patient Safety.

To understand the impact of scope of practice and allowable certified nurse aide (CNA) tasks across states, the current study compared clinical outcomes in states with a basic scope of practice versus those that allowed for an expanded scope. The current study used data from the Minimum Data Set as well as staffing data from the Centers for Medicare and Medicaid Services. Clinical outcomes included: (a) percent of residents whose need for help with daily activities has increased, (b) percent of high-risk residents with pressure ulcers, (c) percent of residents who self-report moderate to severe pain, (d) percent of residents experiencing one or more falls with major injury, and (e) CNA staffing hours. There was no difference in clinical outcomes between states with expanded or basic scopes. Many factors influence clinical outcomes among residents and additional staffing and facility characteristics should be considered in future studies.

Certified Nurse Aide Scope of Practice: State-by-State Differences in Allowable Delegated Activities

ObjectivesTo gain a better understanding of the state-by-state differences in allowable delegated activities for Certified Nurse Aides (CNAs) working in long-term care settings, this exploratory descriptive study assessed what are the allowable tasks for CNAs based on findings from each state board of nursing. Specifically, findings from each state determined whether the care tasks allowed were consistent with those delineated by the 42 CFR § 483. DesignThis descriptive study included data drawn from all 50 states' regulatory offices or health care services agencies. Data were obtained from the regulations listed on each state's board of nursing, department of health, department of aging, department of health professions, department of commerce, and office of long-term care, among like agencies. MeasuresThe Code of Federal regulations (42 CFR § 483) listed 9 tasks that are allowable by each state. These tasks are identified as items 1 to 9: (1) personal care skills, (2) safety/emergency procedures, (3) basic nursing skills, (4) infection control, (5) communication and interpersonal skills, (6) care of cognitively impaired residents, (7) basic restorative care, (8) mental health and social service needs, and (9) residents’ rights. ResultsNine tasks delineated in the 42 CFR § 483 were identified as allowable in each state. On data analysis, it was found that 11 states noted that CNAs were able to perform workplace tasks that could be considered “expanded” care tasks, tasks beyond the basic care tasks listed in the 42 CFR § 483. ConclusionsFindings from this exploratory study aid in limiting the confusion around the application of workplace duties across states, providing a useful description of the care tasks CNAs are allowed to perform in an attempt to find uniformity state-by-state. Overall, states reported considering expanding the scope of practice or authorized duties for CNAs to strengthen patient care and safety. States may choose to expand CNA authorized duties so as to equip CNAs with specific training so that the CNA is able to provide a certain level of care when or if he or she is needed to do so. Without uniformity of CNA authorized duties, it is difficult to interpret whether expanding the scope of the CNA can result in outcomes such as improved patient care. State regulations vary and there were state boards of nursing that were not sure about the true extent of CNA workplace responsibilities.