In the face of an unrelenting staffing crisis, the temporary nursing aide (TNA) program developed in response to the pandemic is still tied to public health emergencies and accompanying 1135 waivers, a condition operators and aging advocacy groups hope will change.
Virginia Beach, Va.-based operator Beth Sholom Village hired 10 TNAs through the program, according to Shinelle Whitaker, registered nurse and staff development specialist for the facility.
Seven TNAs are currently employed by the operator, six of which have their certified nursing assistant (CNA) test dates on the books. Three of Beth Sholom’s initial TNA hires didn’t work out, Whitaker said.
The extra hands on the floor helped facility CNAs so much so that when the extra help wasn’t available, it was felt by frontline staff: “When I go out on the floor and I hear staff say, ‘Where’s our TNA? We don’t have any TNAs today?’ That is success. They feel the relief from another set of hands,” said Whitaker.
The program “fast tracks” prospective CNAs through an accelerated program that is more hands-on than classroom learning, Whitaker said. TNAs are brought on as full-time employees, getting on-the-job training right up until they take their CNA test which Beth Sholom pays for the first time.
TNAs are paired with what Whitaker calls “best practice” CNAs for the majority of the program — the Virginia Board of Nursing requires TNAs to have 80 hours of on-the-job training and complete a skilled competency test before they can take the CNA test.
“I was very clear with the candidates that, you know, it’s not really school, traditional school. You will have more floor time,” said Whitaker. “I made sure that they did infection control, vital signs, and competencies before they hit the floor … [personal protective equipment] donning and doffing, hand washing and things of that nature.”
The TNA program allows facilities to utilize the extra staff how they see fit — some skilled nursing facilities have utilized the extra staff just for administrative duties, while others are having them do more hands-on work like Beth Sholom.
“I consulted with my team here and I said well, I’d like them to do a little bit more than that, because we teach families to do more than that,” said Whitaker.
Beth Sholom was hesitant to take on more TNAs when Skilled Nursing News spoke with Whitaker in early October; prospective CNAs wouldn’t have had enough time to qualify for testing with the Virginia Board of Nursing before the state’s PHE was set to expire Oct. 18.
“The TNAs must be eligible to test for the CNA boards and submit their applications to the Virginia Board of Nursing no later than Oct. 18 to be considered to take the test,” explained Whitaker at the time. “If they are still on board and they have not submitted an application, they can still work, but in a way, it’ll be futile because they won’t have the ability to become a CNA unless the Virginia Board of Nursing says okay, we’re going to extend it.”
TNAs may stay employed four months after the public health emergency expires, but if they don’t have a way to gain CNA certification or retain certification as a TNA, they would not be able to continue as staff at a skilled nursing facility, noted Whitaker.
Whitaker doesn’t want her TNAs, individuals that are technically full-time employees with Beth Sholom, to be “left in limbo” while trying to finish this particular route to become a CNA. The facility found itself in a similar situation in June, when leadership was once again waiting on an extension of the public health emergency in Virginia.
“We kind of knew like 99% that they were going to reinstate the ability, and they did, thank goodness. But that is one of the reasons why moving forward, I decided to only bring on board nursing students because they have two tracks in which they could test [to become a CNA],” said Whitaker. “As a nursing student you have the capability to challenge your boards once you complete 40 hours of clinicals as a nursing student in an approved program.”
Beth Sholom has four nursing students in its TNA program, along with other college students, one pre-med and one studying pharmacy, Whitaker said.
More permanent efforts to keep the TNA track include the Nurses CARE Act, introduced late last year by U.S. Reps. Susan Wild (D-Pa.) and Fred Keller (R-Pa.). The legislation, which was reintroduced this year but hasn’t moved in Congress, would allow TNAs to continue working in the same capacity after the national emergency has expired and provide a permanent path to certification.
“LeadingAge will continue to work with these members of Congress as [the legislation] progress[es],” senior care advocacy group LeadingAge said in an email to Skilled Nursing News; the group is in support of the legislation.
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) voiced their support for the legislation too as part of a statement issued late October.
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