How will raising the minimum wage affect hiring and operations of long-term and skilled nursing facilities? While politicians, unions and protesters weigh in on this controversial subject, the fact remains that nursing home leaders must prepare for the real possibility of increased expense as well as the loss of direct care providers to higher paying, less stressful job opportunities. Attracting and retaining excellent aide staff is a daily struggle, and these care providers are critical to the patient experience, quality outcomes and the documentation which is so critical to reimbursement.
The role of the Nursing Assistant is physically and emotionally demanding. Many who were drawn to the profession are now looking elsewhere as they can obtain higher paying, less demanding entry-level positions. The number of qualified applicants for State Tested Nursing Assistant (STNA) training programs is down, as is the number of students who pass the Nurse Aide Training Competency Evaluation Program (NATCEP) and exam.
According to a report published in March of 2015 by He, Goodkind and Kowal; An Aging World: 2015, United States Census Bureau; “Growth of the world’s older population will continue to outpace the younger population for the next 35 years.”
Couple this with the fact that the nursing shortage as predicted by the Health Resources Service Administration (HRSA) is expected to fall 36% below anticipated need by 2020 unless serious interventions are put into place, and we have serious reason for concern.
Nursing home administrators and nursing leaders need to look for creative alternative methods of providing direct care. I believe that creating a hybrid LPN/STNA role is a very viable answer. In this model a new graduate Licensed Practical Nurse (LPN) would start at a rate of pay slightly higher than an STNA but below that of an experienced LPN. The new grad LPN would begin with a direct care assignment similar to that of the traditional STNA. As training progresses the LPN would begin to take on additional responsibilities for treatments, medication pass and other delegated duties within the appropriate level and scope of practice. As the LPN learns facility policies and procedures he/she would be evaluated and earn additional pay for successfully achieving at an increased level of responsibility.
This care model offers several instances of value. It attracts STNAs currently enrolled in LPN school and ensures that these new LPNs are trained and competent, based upon facility standards. This should lead to better overall compliance with regulatory and quality expectations, while providing incentives for staff fulfillment and retention.
Wan, He, Daniel Goodkind, and Paul Kowal
U.S. Census Bureau,
International Population Reports, P95/16-1,
An Aging Works: 2015, U.S. Government Publishing Office,
Washington DC, 2016.
Department of Health and Human Services, (2004). What’s behind HRSA’s projected supply, demand, and shortage of registered nurses? September 2004. http://bhw.hrsa.gov/healthworkforce/reports/behindrnprojections/index.htm