Gezondheidszorg27 oktober, 2023

Empowering Certified Nursing Assistants for nursing's future: Beyond exam-centric teaching

Door:Pamela J. Carter, RN, BSN, MEd, CNOR

The National Academy of Medicine's Vital Directions of Health and Health Care, as well as the World Health Organization, tell us that by the year 2030, there will be more people in the United States older than age 65 than those younger than age 5. And, that our healthcare system is largely unprepared for the complexity of caring for this population of older adults. Teaching those who will be responsible for caring for these people, especially at the CNA level, will require more in-depth preparation. This is something that the Lippincott® nursing assisting textbooks specialize in.

The evolving future of nursing

There are many factors that play into the changes facing today's nurses. Shortages in staffing have resulted in older nurses retiring and fewer newer nurses filling the ranks during the COVID-19 pandemic. However, the number of people needing nursing care has increased. And those people needing care are more likely to have complex care needs. To fill the void, more and more nursing assistants are being hired to work in acute care settings. As educators, we need to better prepare our nursing assistants to succeed in this environment.

Nursing assistant education

In 1987, the Nursing Home Reform Act or OBRA 87 set requirements for the training and certification of nursing assistants who work in long-term care settings. For many years, nursing assistant training only focused on the basic requirements set forth by this legislation. In most places in the United States, long-term care facilities were the primary employers of nursing assistants, and the duties performed by these paraprofessionals were primarily focused on assisting residents with personal care and activities of daily living (ADLs). Acute care facilities, such as hospitals, were primarily staffed by licensed nurses.

Since that time, increasing budget constraints within healthcare systems have resulted in fewer nursing personnel to staff hospitals. An increasing trend is for nursing assistants to be hired to assist nurses with the care of their patients, many of whom are acutely ill. This has increased the burden of providing additional training by the healthcare facility for nursing assistants so they can safely work in this environment.

Our aging population

People all over the world are living longer. The National Academy of Medicine's Vital Directions of Health and Health Care tells us that by the year 2030, there will be more people in the United States older than age 65 than those younger than age five. The World Health Organization predicts that by 2050 the proportion of the world’s population over 60 years old will nearly double. And, that our healthcare system is largely unprepared for the complexity of caring for this population of older adults.

The Centers for Disease Control and Prevention (CDC) estimates that by 2060, adults age 65 or older will make up nearly 25% of the population of the US. With aging, comes the increased risk of chronic conditions such as heart disease, type 2 diabetes, disabling arthritis, dementia, and cancer.

Many of our aging population will be able to remain quite healthy and independent due to advances in healthcare and an increasing focus on ensuring the availability of healthcare to underserved populations. However, the increasing number of older adults living longer with multiple medical conditions means that more people will eventually depend on long-term care facilities for their care. Because of this trend, long-term care facilities will be providing more acute-level care for the residents.

Future need for higher-level nursing assistant education

Nursing assistants, now and in the future, need more than the “basic” training to be able to successfully assist licensed nurses and provide safe, competent care in this more acute environment. They will need to learn much more than the basic facts that allow them to successfully pass their state certification exams. Real-life caregiving will require that nursing assistants know the “why behind the how.” More in-depth instruction about normal anatomy and body processes will help them understand how illness and aging affect a patient's or resident's functioning. This will help to develop better critical-thinking skills so that nursing assistants can collaborate as important members of the healthcare team.

It is also important to note that many nursing programs are now requiring that their applicants have current certified nursing assistant (CNA) certifications for application into the program. It is realistic to think that a better-prepared CNA will become a better-prepared licensed nurse.

Pamela J. Carter, RN, BSN, MEd, CNOR
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