Infection Prevention and Staff Retention: Perspectives from Skilled Nursing Facility Cnas

Session Description: Staff retention is a chronic challenge at nursing homes that leads to inconsistent infection prevention training, lack of accountability, and poor adherence to infection control standards. According to data from the Centers for Medicare & Medicaid Services (CMS), the average annual nursing staff turnover rate at Illinois-based nursing homes is 48.6%. The Chicago Department of Public Health (CDPH) convened virtual focus groups with 61 Certified Nursing Assistants (CNAs) representing 30 Chicago-based Skilled Nursing Facilities (SNFs) to better understand factors influencing CNA staff retention and infection prevention and control compliance. The focus groups addressed infection prevention and control practices including training, availability of personal protective equipment (PPE), hand hygiene, presenteeism, and perceived risk of healthcare associated infections. Additionally, the groups explored barriers and motivators to remain employed at a SNF including relationships with facility leadership, non-monetary incentives, and scope creep in job duties. Key retention factors identified included strong infection prevention and control programs, recognition of the importance of CNAs by facility leadership and nursing colleagues, and fair and equitable treatment of staff. CNAs highlighted inadequate infection prevention and control training, feeling unsafe reporting colleagues’ infection prevention and control lapses, and being asked to perform duties beyond their scope of practice as areas for improvement. CDPH shared results and strategic implications with Chicago-based SNF facility and corporate leadership so that they could operationalize the findings within their respective facilities. Findings were also used as a justification to purchase and distribute hand hygiene supplies to over one hundred long-term care facilities across Chicago.