Certified nursing assistants: a key to resident quality of life.

The lead editorial this month is by a nursing home resident who draws attention to the importance of certified nursing assistants (CNAs) in enhancing quality of life in nursing home residents.1 The Journal recently had an article by Lerner et al2 confirming this. They found that high CNA turnover resulted in large numbers of deficiencies for quality of care and resident behavior. Burack et al3 used the Quality of Life Scales for Nursing Home Residents to demonstrate that the key quality-of-life issues for residents were dignity, spiritual well-being, and food enjoyment. CNAs play a key role in maintaining the functional ability of residents.4 The International Association of Gerontology and Geriatrics (IAGG) has placed quality-of-life improvement as a key need for nursing homes around the world.5,6 The research needs for nursing homes as identified by an IAGG survey focused on many areas that will lead to enhanced quality of life.7 It is clear that improving quality of life as opposed to medical care in nursing homes is highly dependent on CNAs. In many parts of the world this is recognized by the fact that nursing homes follow either a nursing or social model, rather than a medical model.8 Factors shown to improve CNA job satisfaction among CNAs include sufficient time to undertake their tasks, appropriate communication from supervisors, and a feeling of being valued.9 Similarly, in end-of-life care, better staff communication among CNAs leads to better end-of-life care.10 Another study found that the supervisor approach is the key factor to producing satisfaction and commitment among CNAs.11 The author concluded that “When the workplace adds quality to the life of caregivers, the caregivers add quality to the life of residents.” Supportive supervision is a major predictor of job satisfaction in CNAs.12 CNAs require both a clear description of the tasks they need to perform, as well as autonomy in how they do this to maintain job satisfaction.13 Appropriate training leads to an increase in CNA’s performance and a decrease in burnout.14 Nursing home leadership needs to involve all staff if they are going to make a significant improvement in quality of care.15 There are a number of areas in which CNAs clearly play a major role in enhancing quality of life. Overwhelmingly, there is a need for CNAs to have time to have one-to-one communication with the resident. CNAs also play a key role in allowing residents choices in their lives.16 Appropriate choices include when to get up in the morning, when to get dressed and what to wear, incontinence care,