By Geralyn Magan
A new report outlines nine recommendations to standardize career pathways for certified nursing assistants (CNA) and make them portable across state lines. These pathways will benefit CNAs and LeadingAge members.
What would it take to standardize career pathways for certified nursing assistants (CNA)?
This question was at the heart of a convening of aging services experts held on April 22 by the Moving Forward Nursing Home Quality Coalition in partnership with the LeadingAge LTSS Center @UMass Boston.
Attendees were tasked with developing actionable guidance to advance standardized, portable career-pathway models for CNAs. A report released in September summarizes the convening’s discussions and outlines nine recommendations to guide ongoing work.
How Will This Work Benefit LeadingAge Members?
The convening report is part of the Moving Forward Coalition’s ongoing effort to advance career-pathway models for CNAs. These models would benefit both professional caregivers and LeadingAge members. With these models in place:
- Direct care professionals across states could follow clear steps and meet standardized requirements to earn advanced certifications that would build their skills, improve retention, and enhance job quality.
- Small and single-site providers could implement a standardized, evidence-based career advancement model without the cost of developing one themselves.
- Larger providers operating in multiple states could benefit from the model’s portability, which would enable them to strengthen the CNA workforce across state lines.
Building on Previous Work to Enhance CNA Career Pathways
Advancing CNA Career Pathways: Toward a Multi-State Approach to Workforce Development in Nursing Homes begins by outlining troubling statistics facing providers of aging services: approximately 80-90% of hands-on care in nursing homes is delivered by CNAs, yet these professional caregivers are leaving the field faster than the system can replace them.
“Despite consistent evidence that advancement opportunities would improve both recruitment and retention, the field has never developed a viable, structured, or standardized career pathway for CNAs,” the report states.
The April 22 convening and its report build on the work Geriatric Workforce Enhancement Programs (GWEP) have done to train healthcare and supportive care workers in geriatric care.
With funding from the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce, these local and regional programs aim to educate and train the primary care and geriatrics workforce to care for older adults and deliver age- and dementia-friendly care. Dozens of regional GWEPs operate nationwide, tailoring training to local community needs.
GWEPs participating in the April 22 convening are exploring two approaches to strengthen CNA career pathways:
- Registered Apprenticeship Programs combine paid on-the-job learning with classroom instruction and offer higher wages and credentials as skills develop.
- Micro-credentialing helps CNAs acquire and demonstrate the competency, ability, or expertise needed to perform a specific job or role.
Both career pathways offer CNAs promising advancement opportunities. Yet a lack of standardization and portability across state lines has made their implementation challenging. Because state regulations vary, CNAs struggle to transfer credentials earned in one state when they move to another. Likewise, employers operating across state lines face challenges.
“Multi-state employers are forced to build and maintain different programs for each state they operate in, an approach that is neither efficient nor affordable,” the report says. “These factors have limited the field’s ability to scale promising practices or attract sustained investment.”
Nine Recommendations
Participants at the April 22 convening agreed on nine recommendations to advance the standardization of career pathways. These recommendations reflect feedback from convening participants and are intended to guide ongoing discussions about career pathways.
Read the report for more information on each recommendation.
- Establish a national convening body to align CNA career-pathway principles across states.
- Launch regional, multi-state, short-term career exploration and training programs to prepare students and job seekers for registered apprenticeships.
- Build the evidence base. Before the field can argue for a common standard, it needs a clear, current, and continually updated map of where states stand.
- Establish a National Board for CNA Practice to set competency-based training standards.
- Build a portable geriatric specialty credential that stacks on top of foundational CNA training, is tied to a wage increase, and travels with the worker across state lines via a digital badge.
- Build a shared business-case toolkit. This toolkit would enable smaller and single-site providers, which employ a substantial share of the workforce, to make the case for the new CNA training model.
- Co-design advanced CNA roles with providers and anchor those roles to a defined wage progression.
- Make the business case for embedding career-pathway wage increases into Medicaid reimbursement structures rather than treating them as add-on costs.
- Work with CNAs, residents, and families to co-create the next generation of pathway models and develop a culture-change campaign to support this effort.
The Moving Forward Coalition plans to sustain the convening’s momentum by coordinating with stakeholders across states to translate these recommendations into consensus-driven action on training, reimbursement, career pathways, workplace culture, and broader recognition of CNAs as essential professionals.
LTSS Center Involvement
Five members of the LTSS Center team helped the Moving Forward Coalition organize the convening and author the report. They are:
- Molly Carpenter, director of workforce strategy and development.
- Robyn Stone, founder and strategic advisor.
- Natasha Bryant, senior director of workforce research and development.
- Molly Wylie, research associate.
- Amma Addo, operations and service manager.