State of the Nursing Home Workforce (Part 3): To Bolster Frontline Staff, Operators Open Up Their Own CNA Schools, Graduating Thousands

Building the frontline workforce continues to be crucial for the nursing home sector as the industry faces a federal minimum staffing mandate. However, barriers exist in the form of civil monetary penalties (CMPs), which can pause in-house training programs if a facility is cited, and existing staff is stretched so thin that educational demands just add to the burnout.

To facilitate education amid these hurdles, operators have had to take matters into their own hands, having either started new education side businesses for staffing solutions or expanding in-house programs in order to get the staff they need.

Small regional operator, Alabama-based Schmidt Wallace Healthcare, created a nursing school to graduate thousands of certified nurse aides (CNAs). Meanwhile, other operators continue to work closely with academic institutions in the area while also developing their own in-house program.

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On the educational institution end, many nursing schools including the largest – Chamberlain University in Illinois – have also ramped up efforts to increase the frontline workforce. This response came after trends indicated that health care settings across the continuum, including nursing homes, were experiencing critical staffing shortages.

Co-curricular practical experience for nursing students was enabled through a $1.2 million grant and is now a part of the nursing program at Chamberlain. It’s an effort to reduce turnover rates and get students “practice-ready,” Danika Bowen, vice president of clinical operations and innovative strategies at Chamberlain, told Skilled Nursing News.

The 16-week co-curricular course places nursing students in care settings, including nursing homes, in which they may previously have not spent too much during the clinical experience phase of their training. Also, more time is spent matching students with the right setting in an effort to curb turnover.

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Entry into the right setting is key to longer retention rates, Bowen said.

“If we can dramatically reduce year one and year two turnover, it saves health care entities millions and millions of dollars,” said Bowen. “And because of the scope and scale of Chamberlain as the largest nursing school, we can have a large volume and a large impact in a lot of these specialties.”

Separate business for education

Schmidt Wallace Healthcare CEO Chris Schmidt joined his mother Patti Wallace in the business 38 years ago, owning and operating five skilled nursing facilities in Alabama and caring for about 780 patients with a roster of 1,100 staff.

Schmidt’s Nursing Assistants Academy, a separate business from Schmidt Wallace Healthcare, graduates anywhere from 800 to 1,000 CNAs in Alabama out of four locations per year, he said. There’s an opportunity for growth too, he said, but it depends on if the provider side of the business grows. Schmidt would want to acquire another SNF, then set up a school building nearby.

And, because it’s a separate business from the provider side, there’s no worry of the program being paused due to civil monetary penalties (CMPs), a common worry among operators with in-house CNA programs, Schmidt told SNN.

“This is a totally separate company … it’s a private school,” added Schmidt.

Turnover is still a concern, however. If a class starts with 15 people, about 10 will graduate. And of the 10, about one half will get certified and stay on after deciding skilled nursing is the profession for them, Schmidt said.

“It is a little bit of a numbers game to some degree. They aren’t all going to make it, some are going to quit right out of the gate. Some are going to be let go for breaking policy,” said Schmidt. “We’ve got to keep these numbers up.”

In its 39-year history, even during the pandemic, Schmidt Wallace never used any agency staff. And, the education business is expanding to train medication technicians as well, or CNAs that can also pass out medications to residents.

“One of the things my mom always believed in was heavy, heavy staffing in nursing and therapy,” said Schmidt. “She never believed in contracting out really anything … She had a philosophy that we would control our own situation or destiny, so to speak, and if we wanted to have more nurses, we had to work on things that we can control.”

While the number of nurses graduating from nearby universities is out of their control, the number of certified nursing assistants (CNAs) was certainly in their control, he said. About 20 years ago, the mother-son team decided to do things differently – instead of doing an in-house program like everyone else, Schmidt Wallace set up their own school with the sole purpose of producing CNAs in training, to be eligible to sit for the certification exam.

“We went to the Department of Education in Alabama, and got a license to do a private school,” said Schmidt. They’re students, not employees. It’s an important designation. They’re not receiving a wage until they’re hired by the provider.

The Dwyer Workforce Development Program (DWD), which is covered in more depth in the last part of SNN’s workforce series, is probably the closest education program that is graduating CNAs at this level, and the Red Cross also graduates CNAs in the same manner but not at the same scale, Schmidt said.

It’s based on the 80-hour program published by the American Health Care Association (AHCA), he said, but the difference is the trainees go to a school setting right down the street from Schmidt Wallace buildings. There’s a clear separation between trainers and staff that work in the nursing homes.

“The instructor does one thing: teach,” said Schmidt. “She doesn’t have staff development duty, she doesn’t have infection control duties, she’s not pulled to the [medication] cart, she’s not pulled during a survey. Her main and sole function is to train, train and train.”

At Chamberlain, Bowen said she’s seeing a lack of teachers overall on the education end as well, with existing nurses and those in leadership roles too busy to spend a proper amount of time mentoring future frontline staff.

“Everybody’s working their tails off. It’s hard for people to serve as preceptors to students on a very consistent basis,” said Bowen. “Some health care entities actually go so far as to mandate that these individuals serve in this capacity … We have to continue to reward the preceptors, because that’s what helps with the future of nursing and coming into respective health care institutions.”

Homegrown CNAs without the burnout

This is different from the old school approach of having the trainees be in-house the whole time, where the trainers are often also juggling a bunch of different responsibilities.

In terms of finances, facilities in the area sponsor trainees if they can’t pay the $850 for the training themselves. In some cases, once a CNA has been working for Schmidt Wallace, they may pay for that staff member to get licensed as a licensed practical nurse (LPN) or even registered nurse (RN) down the line.

It’s a path of upward momentum for people in the area, notably single mothers who make up a good portion of their CNA trainees.

“The idea basically is to populate the area or the community with as many CNAs as possible … we’re expanding the pie,” said Schmidt. “They don’t all come and work for me after they finish, they may go work for someone down the street, or a competitor, and that’s fine. The goal is to populate the area.”

The education business hasn’t been a moneymaker, Schmidt admitted. But then, it was never designed to be.

Despite this, recruiting for the academy is “very aggressive,” Schmidt said, with the team setting up tables and booths at high schools, the mall and grocery stores, even the DMV.

Once trainees complete 80-hours of classroom education, laboratory, and two days of clinicals, they are designated as a nursing assistant in training – they have 120 days to get their certification after that, said Schmidt, where they must pass a written test and manual skills test.

“It’s really something that I think has helped us, but it really also has helped out the nursing homes in the surrounding areas. That’s one way where we can help each other out,” said Schmidt. “This is the way we can get out of this situation, y’all. As we create more, we don’t take pieces of pie from each other. We must expand the pie.”

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