Increased Clinical Skills

ECCLI funding provided for a great deal of training, mostly for frontline staff, but also for supervisors and upper management. CommCorp records indicate wide variation in the number of employees who participated in trainings, as well as how many trainings

employees completed. Through these trainings, CNAs and HHAs especially, had

opportunities to gain clinical knowledge (through lectures and field experiences), as well as improve methods of communicating with clients, peers and supervisors. Not only did frontline staff receive wage increases and advanced titles, many also became more engaged in the nursing care they provided because they understood the importance of their work, from a clinical perspective. As one CNA reported:

We’ve taken them all—CNA II, CNA III, Mentor, Alzheimer’s. It just gives you knowledge of what to do with the residents. Why you’re doing for the residents.

It gave me the understanding WHY I’m doing the range of motion. In one course, they talked about meds and side effects. Back then, all we’d think about is, “Why do we have to learn about meds?” Now we understand the reaction of meds. If we see certain side effects, we know to rush to the nurse and tell them. The benefits of clinical training were not limited to CNA/HHAs. At a nursing home that offered career ladder classes for other frontline staff, dietary staff members were taught about death and dying, which helped dietary aides realize that their job is more than just bringing the food to the residents—that they also can help by empathizing with residents. This helped the dietary aides understand that care is not just about nursing. They reported that they now feel they are more an important part of the organization.

There was some unevenness with respect to whether frontline staff could use newly acquired skills. At one nursing home, nurse supervisors were uncomfortable with CNAs doing tasks traditionally done only by nurses; they thought CNAs should attend college and become LPNs if they were to be given such responsibilities. At a home health agency, management reported difficulty helping HHAs integrate new skills into their actual work. For example, it proved to be difficult to match HHAs with training on particular conditions or procedures with clients who had matching needs. Moreover, the organization has not yet worked out how to incorporate HHAs’ newly acquired

supervisory skills into the team.

One nursing home was more successful at integrating trained CNAs. Supervisors reported that the organization does a good job of rewarding people and acknowledging their achievements. When CNAs receive training on any topic, management makes sure that all the supervisors are aware that the CNA has been trained so supervisors can support the CNA in putting this newly acquired knowledge into practice.

Some nurse supervisors reported that, as a result of improved communication and clinical skills of CNAs with ECCLI training, their own jobs were made easier. Advanced aides learned to take resident vital signs, thereby freeing nurses to focus on other clinical or supervisory activities. As well, CNAs spoke of being able to contribute more because of their clinical knowledge. One CNA reported, “Because of the classes, I can help nurses more than before with dressings, taking temperatures and other things. I feel good about learning.”

Especially in more recent ECCLI funding rounds, nursing homes and even home health agencies began to develop bridge-to-nursing capabilities. This typically involved college preparedness for CNAs and HHAs who aspired to be nurses. Some organizations went further and supported employees to go through an LPN program. A few organizations funded the aides, while others supported them with getting scholarships, gave them release time or allowed them to reduce their hours. We heard reports of several LPN graduates and many more who were attending LPN programs full or part-time. As an example, one CNA reported that her family had been encouraging her to apply to nursing school. She had never admitted to not having a GED before and initially, just brushed off

their suggestions. The ECCLI training allowed her to earn her GED equivalency and to prepare to take college-level nursing classes.

Administrators reported a number of benefits to helping frontline staff become LPNs. One nursing home had as its primary ECCLI goal to “grow their own nurses.” This organization believed nurses who had worked for many years at the nursing home and knew how it operated would contribute more upon graduation than nurses hired from the outside. Typically, the employees had to agree to return to the organization for a

minimum of two years upon graduation. For home health agencies, where there is less need for nurses, administrators know they are likely to lose the employees once they graduate, but they are committed to improving the quality of the LTC workforce. A bridge-to-nursing program also could serve as an incentive to attract motivated

applicants who have ambitions to move up a nursing career ladder but who need financial and case management support to do so. In organizations that supported LPN students, there was great pride in this program as well as in the LPN students/graduates, many of whom had begun working at the organization with only a GED.