New UGA study explores why CNAs are leaving the workforce and what can be done

As the American population ages, the nation faces a crisis in its long-term care system—a shortage of Certified Nursing Assistants (CNAs).

A new study from the University of Georgia College of Public Health examines how challenges around compensation, recruitment, and retention are leading to this workforce shortage, while providing potential solutions to protect the future of long-term care.

A small workforce with a big role

CNAs make up about one-third of all staff in nursing homes but provide about 90 percent of direct care, from helping with eating, bathing, and mobility to providing companionship and monitoring for signs of illness.

Curt Harris

“I don’t think most people realize what a CNA does on a day-to-day basis, how oftentimes they are really the go-to person for the resident,” said Curt Harris, director of the UGA College of Public Health’s Institute for Disaster Management and a study co-author.

And the number of CNAs is dwindling. The workforce shortage is not new, researchers said, but it was intensified by the COVID-19 pandemic, during which nursing homes lost more than 220,000 employees, including many CNAs. This led to reduced quality of care for residents, heightened stress for remaining staff, and an escalating cycle of burnout and attrition.

“The crisis just continues to build upon itself and grow and grow and grow,” said Austin Dobbs, study co-author and emergency preparedness manager in the Institute for Disaster Management. “This is a disaster in the sense that something has to change. It can’t keep going the way it’s going because the system can’t sustain itself.”

Lack of recruitment, advancement opportunities, and mental health resources leads to a shortage

The study also identified challenges in recruitment and retention as key factors in the shortage.

Barriers to training, a general lack of awareness of the career, financial constraints, and accessibility of certification tests all hamper CNA recruitment. And it doesn’t end once a CNA enters the workforce. Insufficient career advancement opportunities, as well as disrespect from colleagues and residents, hamper retention in the field, according to the study.

Another factor that is often overlooked is the mental health of the workforce.

Direct resident care can take a physical and emotional toll, said Harris, and CNAs often lack access to mental health resources.

“The amount of care they provide and the amount of baggage they take home leads to significant turnover,” Harris said.

The disaster management lens

The Institute for Disaster Management is well-suited to finding solutions because this meets the operational definition of a disaster, Harris said. Needs exceed available resources, and approaching this situation using disaster management skills can determine solutions to meet needs.

“One of the areas where IDM excels in is the ability to think outside of the box and the ability to look at things from a multidisciplinary approach,” Harris said.

This includes faculty and staff with backgrounds in public health, emergency medicine, gerontology and public policy, all with unique academic and professional experience. IDM also connected with additional community and professional partners.

“When we first got to this problem, we understood that it was going to be too big for us to try and tackle on our own,” Dobbs said. “When we started trying to identify those barriers, we gathered a team of subject matter experts and practitioners from across the field.”

This included discussions with the Georgia Department of Public Health and Department of Community Health, the Georgia Health Care Association, and Leading Age Georgia. Co-authors from the Institute of Gerontology also contributed to the study.

“We’re applying emergency management frameworks to chronic healthcare issues,” said Harris. “That allows us to think creatively, collaboratively and quickly.”

Creating solutions and moving forward

And while the study makes recommendations for warding off a growing shortage, researchers acknowledge that this is not a one-size-fits-all solution.

“When we think about developing a plan, it’s not that we just go and implement it immediately,” Harris said. “We call these groups and have a conversation.”

Ultimately, researchers agreed that advocacy for CNAs and other members of the long-term care facility workforce is key. Pushing for improved access to training, setting up tracks for career advancement and supporting initiatives to increase pay and funding support are a few examples, Dobbs said.

Other potential solutions include building on grant-funded work like the Georgia CNA Career Pathway Initiative, which addressed early barriers to the workforce. This also led to the CNA Virtual Skills Evaluation program, which helps CNAs overcome testing barriers. As a result of this program, more than 6,000 Georgia CNAs have been able to take their skills evaluations virtually, increasing access to the field.

Supporting the people behind the care

CNAs face stressful jobs and seemingly endless challenges, but in the end, they’re driven by a passion for helping others at their most vulnerable.

“What is keeping disaster at bay is the incredible individuals that are working out in the field right now: From CNAs in the field, students studying to become CNAs, those training them in the training programs across Georgia and beyond in the United States,” Dobbs said. “They are the heroes in the story. But they need support. Be an advocate for those who are caring for your loved ones.”

“You don’t need a degree to be an advocate,” Harris said. “You just need to care.”

By Erica Techo and Erin Mumper