Certified nursing assistants (CNAs) say the biggest challenge they face every day working in nursing homes stems from a staffing shortage for back-breaking work.

It’s the second year in a row that the workforce crisis was listed as top priority in a survey conducted by the National Association of Health Care Assistants (NAHCA), which collected thousands of written responses from its members. Appreciation, better pay and ongoing training were top demands.

“The survey results and comments show how little has changed in the past year,” NAHCA Board Chair Sherry Perry said in a statement. “Efforts to recover from the pandemic and enable health care settings to move forward must include attention to the needs of CNAs.”

NAHCA represents more than 26,000 CNAs across the country.

The CNA role has met with consistent calls for change as a result of hardships faced by such caregivers. And some skilled nursing facilities (SNFs) have responded by expanding the role to include education for certified medication aide training, creating more specialized positions with governmental support.

Past National Academies of Sciences, Engineering and Medicine (NASEM) reports have discussed the role’s expansion as a crucial step toward CNA empowerment, with demand for the position continually high.

However, the survey shows that despite these efforts and CNAs knowing residents the best, they are paid “very little and recognized even less,” Perry added.

About 92% of respondents said they wanted to continue their careers as CNAs, but in a way that allowed for additional education, pay raises and recognition, according to the survey.

“We are working for pennies in this field,” one CNA commented. “Raising the hourly rate would help, and affordable benefits wouldn’t hurt.”

Another CNA suggested in the survey that the position needs to garner at least $25 to $30 per hour, and that the “back-breaking work” being done takes a heavy toll on the body.

Other commenters said they are stuck with high patient ratios and a severe lack of facility resources to do the job correctly, and that those given a “quick” CNA license during the pandemic need a lot more training.

In terms of education and training, the following specialities were identified as areas of interest: dementia care, end-of-life care, infection control, and fall prevention.

There were nearly 3,000 responses as part of the survey, which consisted of eight questions about CNA work, and how they contend with the staffing shortage and insufficient compensation.

“As CNAs continue to work amid shortages, they are becoming more and more burned out and stretched thin,” added Lori Porter, NAHCA CEO and co-founder. “Results of this survey, as well as numerous accounts from our members, will help inform and shape our policy priorities and advocacy efforts as we consider the impending proposed rule on minimum staffing standards for nursing homes.”

CNA unmet needs have consequences on both quality of care and the ongoing workforce crisis, she noted.