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Fox Learning Systems develops and documents the effectiveness of our elder care products in collaboration with the National Institute of Health, National Institute on Aging, Agency for Healthcare Quality and Research, the National Institute of Nursing Research and other state and federal agencies and facilities. In funding and conducting research with our tools, these investigators are attempting to gain a better understanding of the factors that influence worker performance and worker turnover in the elder care community. Some of the findings are summarized below.
Why do elder care workers leave?
Direct care workers have more face-to-face interactions with elderly patients and residents than anyone else in their environment, including family members. With a turnover rate for these workers as high as 100% annually, maintaining quality of care is a challenge. Even a relatively low turnover rate of 25% per year presents challenges that are difficult for the best managers to overcome.
Why do workers leave? Popular belief is that a direct care worker will “jump ship” to earn another 25 cents per hour; however, research does not support that explanation. Recent focus groups funded in Pennsylvania by the U. S. Department of Labor found that Certified Nursing Assistants (CNA) see their work as “a calling.” While they would like to earn more, they also are aware that the opportunities to earn significantly higher wages in their field are limited. The focus groups also revealed that many CNAs are content to advance within their own ranks, rather than to become licensed nurses. CNAs identified several reasons for the high turnover rate. Chief among them was the perception that management was not providing “the right tools” to do the job.
Tools to succeed
To experience success, a workforce must be motivated and able to perform. Management must provide the tools that make both possible. Being able to do the job requires sufficient staff (caregiver/resident ratio), equipment (e.g., lifting devices) and knowledge (training). The tools of motivation include performance incentives (raises, promotions) and poor performance consequences (disciplinary action, termination).
Studying success
Several federally-funded studies have used Fox modules as the primary educational tools to determine whether improving worker ability and motivation would lead to enhanced quality of care and quality of life for residents as well as improve job satisfaction for caregivers. In one such study conducted by researchers at the University of Pittsburgh School of Medicine and Katz Graduate School of Business*, nursing home caregivers were trained with the Fox Skin Care module in an effort to reduce the incidence of pressure ulcers. That module uses graphic footage of actual lesions combined with animation to illustrate the different presentations of Stage One ulcers based on skin color. The module highlighted the importance of using proper lighting when examining the skin of Hispanic and African-American residents and others with highly pigmented skin. In addition, managers continuously used the reporting mechanism to assure 100% compliance with training and competency. The result was a dramatic reduction of pressure ulcers, especially among African-Americans, who are at particularly high risk. Overall, workers were able to reduce the incidence of pressure ulcers within their facility by more than 70%. At the same time, staff satisfaction increased significantly.
A study funded by the U.S. Agency for Healthcare Quality and Research** looked at job satisfaction among direct care workers trained with Fox modules. That research found that CNAs who improved their ability to perform required tasks experienced a significant increase in job satisfaction, as well as improved self-esteem and confidence in the workplace.
A quality improvement initiative by the Presbyterian Association on Aging*** in Erie, Pennsylvania used Fox Learning Systems as the basis of a career ladder in an effort to reduce staff turnover. In that research, caregivers were rewarded with promotion to higher CNA status as a result of successful training documented by passing grades and certificates of performance. Staff turnover declined by 25%.
The National Institute on Aging**** funded research documenting caregiver satisfaction with training and retention of knowledge using Fox multimedia training modules as compared to a format in which identical content was provided as lectures by masters-level nurse educators. This investigation is unique in that it is the only study of CNA education that actually assesses knowledge retention over an extended period, as opposed to immediate pre- and post-testing methodology. Results demonstrated significantly higher satisfaction with documentary-style video-based training. Most important, knowledge retention after six months compared to baseline performance improved only for staff trained with the multimedia modules. No change from baseline knowledge was detected for caregivers attending the lectures.