Nurse supervisors younger than nursing assistants. There is an old saying in nursing: “Nurses eat their young.” There used to be a time when an experienced nurse held high expectations and gave little support to new nurses and nursing assistants. While times have changed and field culture is improving, we must be aware that opportunities for change still arise.

One such situation is hiring nursing supervisors who may be less experienced in their role and younger than the staff they support. For some older or experienced CNAs and Home Health Aides, this can feel unfair or difficult to navigate. It may appear that the new staff member is “lost,” “doesn’t understand,” or “has no idea what they’re doing,” even though they are well qualified and have received the necessary training to perform the role.

Nursing assistant turnover rates. In the CDC’s latest National Nursing Home Survey, 49% of CNA respondents indicated that they chose the career because they enjoy helping people. But, in the Hospital and Healthcare Compensation Services (HCS) Salary & Benefits Report, turnover rates for CNAs increased last year from 41.08% to 45.87%. COVID-19 is a definite contributor to that statistic, as nursing assistants were asked to increase working hours to cover the increase in patient and client volume.

This statistic is absolutely devastating in a field where workforce numbers equals quality of care. For many nurses, the presence or absence of a single nursing assistant is the make or break of any one shift.

Tough job that is under-appreciated. Bending, bathing, stretching, pulling, toileting. These are only a few of the actions demanded of nursing assistants repeatedly at work. It is a demanding job both physically and mentally, requiring professional poise even when 35% of the workforce has reported injuries created by the patients, clients, and residents they care for. At the end of a tough day, compensation may not seem equitable to the work’s long hours and physical strain.

Be humble. A license to practice nursing comes with great pride and greater responsibility, governed by the laws of each state. While it does certify the RN to delegate and supervise unlicensed personnel, it does not take the place of patient or client-centered care. Each role that touches the patient or client’s care is equally as important as the other.

Delegation exists in the context of conferring one’s ability onto another – as an extension of the originator’s hand. It is not meant to delineate superiority or inferiority. Nursing assistant expertise, coupled with nursing expertise, is critical to delivering safe and effective care. One struggles to exist efficiently without the other.

Promote the team. Teamwork makes the dream work! Strive to make sure that nursing assistants feel a part of the team. Bring them into decision-making as it relates to the patient or client. Their knowledge of the patient’s day-to-day condition is an important piece of the often winding puzzle to excellent care. Create opportunities to refine and strengthen discussions by including the assistant’s voice when communicating with the medical team. Be mindful of their time and responsibilities, noting that their role is vital to positive client outcomes.

Nursing assistants, home health aides, and caregivers often spend more one-on-one time with the client than their supervising nurses. Patients and clients trust them. They are often the first to receive reports of changing signs and symptoms. Strong communication and teamwork will ensure that changes are reportedly quickly and necessary action is taken appropriately.

Be a servant leader. Some of the greatest nursing leaders lead their teams from the back, providing an example of excellent care from the basics to the most complex competencies. Encourage nurses to jump in and assist caregivers, home health aides or certified nursing assistants with a hectic caseload. There is no gap in competency stopping your nurses from taking on the tasks and responsibilities of their nursing assistants. Check in periodically and offer training, assistance or an ear to your assistive personnel. Their appreciative responses will likely reward your nursing staff in ways you never thought possible.

Show appreciation. From TV shows and movies to radio skits and fast-food giveaways, nurses and doctors are often the first to receive praise from patients and their families. The nurse must create space in their work week to appreciate the role and hard work of their nursing assistant staff. There are so many ways to show meaningful appreciation to your nursing assistant staff that does not pull away from the busy workday of nurses. Sometimes, just hearing “Wow, great job!” is enough to change a bad day into a great day for nursing assistants. Cards, gift cards, splitting the work, a positive mention to upper management, or a nomination for excellent care awards are all easy ways to show that you notice and care.

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