Empowered CNA Teams Perform Better

      Heidi Splete is a senior writer with Elsevier Global Medical News.
      WASHINGTON — Does empowering workers to make decisions in long-term care facilities really matter? Yes it does, say sociologists Dale E. Yeatts, PhD, and Cynthia Cready, PhD, of the University of North Texas in Denton, and they have the hard data to prove it.
      Certified nurse assistants (CNAs) who were on teams given decision-making authority reported better attitudes, and others cited better performance by the CNAs, compared with counterparts who didn't participate in such teams, the researchers reported at a joint conference of the American Society on Aging and the National Council on Aging.
      Research on “empowered work teams” in other industries has shown that participants improve attitudes and efficiency, but little research has addressed long-term care, said Dr. Yeatts and Dr. Cready.
      The Texas researchers tested the hypothesis that empowerment matters to patient care by selecting five nursing homes that were about to implement empowered work teams and five that were not.
      Surveys of the CNAs themselves, other nurses, and family members of residents before half the homes created the teams and approximately 16 months afterward revealed significant differences between the two sets of nursing homes. The researchers also observed more than 270 weekly team meetings over a 3-year period and reviewed written communications between nurse managers and the CNAs.
      The CNAs on the empowered teams “believed that they had more say in their jobs,” Dr. Cready said. “They also felt that their jobs were more worthwhile and that they were making a difference in the residents' lives.” Nearly 60% of the team members said that participation helped them “learn what residents like and don't like.”
      CNAs on the teams were significantly less likely to leave their jobs by the 16-month mark than were their counterparts (37% vs. 51%).
      Nurses working with the CNAs said they felt that the team members were more efficient, more coordinated with each other, and more cooperative than they had been, so the nurses had more time to do their own paperwork. More than half the nurses agreed that the teams provided helpful new ideas, Dr. Cready noted.
      Consequently, nurses who worked with the empowered CNAs were themselves happier with their jobs and less likely to be thinking of quitting than were nurses in the facilities without teams, she added. The researchers published their findings last year (Gerontologist 2007;47:323–39).
      In addition, the researchers noted what appeared to be several positive effects of empowered work teams on patient care. For example, a resident's health problem, such as a skin breakdown, was less likely to remain unattended, Dr. Cready said. And team-member CNAs appeared to be better informed about the health conditions of residents and more likely to educate new workers about residents' preferences and needs, she said.
      Dr. Yeatts presented guidelines for how to implement empowered work teams in a long-term care facility. Start by surveying management and nurses on the potential benefits and problems of forming teams. Then meet with these facility leaders to introduce the idea of empowerment. Once the management and nurses commit to the plan, introduce the concept to the CNAs or other facility workers. Choose trainers to facilitate the team meetings and identify managers or nurses who will work with the teams. The next step is to work out logistics.
      Agenda items for weekly team meetings include updates on any incidents that occurred during night shifts; information on new residents; reports of changes in the behavior, health, or eating habits of residents; and questions about issues or procedures related to the workers' tasks.
      “You have to continually give the teams things to work on,” Dr. Yeatts said. Working together to solve a problem, such as how to improve residents' hydration, is what makes work team members feel the most empowered, he explained.
      “The biggest cost is time, because someone needs to communicate with the CNA teams each week and give them projects to work on,” Dr. Yeatts said. In addition, the nurses must be willing to pitch in and help by answering resident calls while the CNAs are meeting.