Four Themes Are Key to Nurse-CNA Communication

Skilled nursing providers that want to improve communication between nurses and certified nursing assistants (CNAs) should study the four themes of the “rules of performance,” according to a University of Utah study scheduled to be published in the Sept.-Oct. edition of Geriatric Nursing.

For the study, researchers observed, shadowed and interviewed seven nurses and 10 CNAs who worked at a 120-bed, for-profit nursing home in the “Mountain West” region of the U.S.

Though communication between CNAs and nurses is vitally important, it’s not always easy to achieve. Poor communication processes can contribute to negative resident outcomes such as decreased function, dissatisfaction and ineffective pain management.


The researchers identified in their findings four main themes that made up the “rules of performance” in interactions between nurses and CNAs.

Maintaining information flow

The flow of information is crucial to communication in a skilled nursing facility (SNF), researchers found.


Both nurses and CNAs liked to swap information during shift change reports, but saw limited success due to interruptions or communication breakdowns. When important patient news wasn’t shared, it could lead to frustration from both parties, according to the researchers.

The CNAs told researchers that workload time demands could interfere with their ability to share information, while nurses said their ability to communicate was often constrained by inadequate staffing, either from a lack of nurses or inconsistent assignments.

Following procedure

Another factor identified as key for communication between nurses and CNAs was procedure that supported organizational structure and culture.

Some procedures were expectations set in place through workplace policy, such as speaking English in public areas; while others were unspoken norms, such as cooperation or taking initiative. When procedures were followed, both nurses and CNAs described the result as a “beautiful routine,” “like dancing” or “a smooth running machine,” according to the researchers.

Fostering collegiality

CNAs and nurses also said they wanted to feel as though their coworkers were willing to do their jobs to the best of their ability.

Workplace collegiality was often fostered through mentoring one another during resident care, such as a veteran nurse working with a less-experienced peer, the researchers found. The workers also bonded when they offered support or help to one another, especially during stressful times.

That’s not to say helping was always appreciated, however. Mentoring could backfire when unwanted, and communication suffered when there was a perception that authority was questioned. Mentoring was also nonexistent if nurses and CNAs perceived that a coworker was unwilling to make an effort.

Showing respect

Respect is crucial to most relationships, but especially important in a SNF.

Something as simple as responding to a question — even just an acknowledgement — was a basic indication of respect among CNAs and nurses, the researchers found. Timeliness in responding to a question or prompt was also considered a demonstration of respect.

Nurse and CNAs also felt more respected when they acknowledged the importance of each other’s responsibilities, such as when nurses expressed regard for the CNAs’ significant role in resident care. Another sign of respect was mutual trust, the researchers found.

Written by Tim Regan

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