As a wound care consultant, I receive many requests to conduct ongoing in-services of various topics with "all" nursing staff. This request is intended for the LVN/LPN and RN staff. My definition of "all" nursing staff is licensed nurses AND certified or state tested nursing assistants.

I am usually the one to ask if I could possibly include an in-service for the nursing assistants, since they are the caregivers working the front lines. The most frequent answer I receive is "NO, we will just do it later or another time." Every time I hear this my heart sinks. I am so passionate about my work, and want to spread my knowledge to every nurse and nursing assistant I can.

What Certified Nursing Assistants Do

Thinking back to the days of when I was a brand new CNA, I remember it being quite overwhelming. I remember my CNA training being crammed into a short span of time with me thinking, "This is it?" There's a lot to learn and cover in those first few days at work. Skills such as bathing/showering, personal hygiene, and skin care were covered briefly.

Although CNAs do not assess, nurses depend upon nursing assistants to report timely data each shift. Nursing assistants are to report what they see, smell, hear, feel, and touch. The nursing assistant in all corners of the world is probably the most undervalued staff member. Nursing assistants are truly the backbone of LTC.

Education for Certified Nursing Assistants

I decided to research the different CNA course offerings. Nursing homes often times will offer free classes if they are facing nursing assistant shortages. Course costs can start from $395 and up. The CNA curriculum is divided into an average of 18 units, which include objectives, vocabulary and suggested content. The content varies from state to state, but they are close in comparison. Classroom and laboratory work time must be a minimum of 60 hours. A trainee shall complete a minimum of 16 hours training before being allowed to work in a facility. These 16 hours should include the following: Define vocabulary, describe the purpose of the skin, discuss age-related skin changes, and describe common skin injuries.

As I reviewed the topics/skills checklist, I noticed there wasn't much focus on pressure ulcer prevention. I was looking for HOW pressure injuries form, what conditions increase the RISK of pressure injuries, WHY prevention is so important, changes in skin color, positioning, and the pressure points. There were very few course agendas that compiled these topics. The list below is what the average CNA course consisted of for topics/skills:

• Vital Signs
• Transfers
• Hand Washing
• Bed Making
• Body Mechanics
• Mechanical Lift
• Intake & Output
• Side Lying Positions
• Nutrition & Fluids
• Admission/Discharge
• Perineal Care
• Shower & Tub Bath
• Partial Bath
• Oral Hygiene
• Shaving
• Catheter care
• Nail Care
• Resident Feeding
• Apply PPE
• Documentation
• Dressing a resident
• Specimen Collection
• Height & Weight
• Range of motion
• End of Life Care

If we refer to the National Pressure Ulcer Advisory Panel guidelines, over half of the pressure ulcer prevention points mentioned fall under the nursing assistant job description. There is a significant need for more comprehensive CNA education. The CNA's ability to do their job effectively is also hindered by administrative staff's tolerance of understaffing, lack of peer mentors, and informal education.

Further Education for CNAs

There are several wound care certifications now offered to CNAs and Nursing Assistants. The coursework consists of basic wound care and prevention. CNAs, Nursing Assistants, Home Health Aides and Medical Assistants can sit for the national board certification. Each certifying body has different criteria that must be met to sit for the examination. The links are provided below.

Healthcare & Legal Education Resource Group, LLC - Wound Prevention Certified (WPC)
CNA-MA Skin Management & Wound Prevention Course is offered to Certified Nursing Assistants, Medical Assistants, Personal Care Assistants, and Certified Home Health Aides.
*Examination is offered by the National Organization of Healthcare & Legal Professionals
Website: http://www.healthcarelegaleducation.com/cna-ma-training/

American Board of Wound Management - Certified Wound Care Associate (CWCA)
Offered to RN w/Associates, LVN/LPN, Sales and Marketing, CNAs, Nursing Assistants, Home Health Aides and Medical Assistants.
*Examination is offered by the American Board of Wound Management
Website: www.abwmfoundation.org/online-courses/

Empowering Colleagues in Health Care

Providing nurse or CNA mentors is just one way long term care facilities can help support newer CNAs with skin and wound care education. Retaining nursing staff is difficult, especially within the long term care arena. The lack of mentorship programs has contributed to high turnover, average quality of care for residents, and poor satisfaction surveys.

Nurse Managers need to provide CNAs with a strong support system along with the opportunity to learn and grow. Those who are empowered and confident are therefore more committed.

EMPOWER. EDUCATE. MENTOR. SUCCEED.

About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.