I was speaking to a group of certified nursing assistant (CNAs) during a training session on turnover reduction. The meeting was a hoot and one CNA in particular during my one-hour session shouted out, “You are right! You are SO right!” I felt validated by her excitement about how we often run off new nursing assistants by the way we treat them.

About 20 minutes had gone by and I had moved through a couple more points on turnover when a young woman walked into the facility and passed the open dining room where the training was being held. The same CNA who stood up 20 minutes earlier to validate my point, stood up again and shouted, “Quick, somebody get an application. There is fresh meat!”  Really, I mean really?

It was quite obvious to me that this CNA did not yet grasp the power of her influence and recognize her role in the big picture.

I guess it is true that students must hear the lesson multiple times to truly understand the power of their influence. I will keep teaching personal and professional accountability until my tongue falls out … it is just that important. Constant reinforcement of value, education, training and people skills must take place.  Even my old friend Zig Ziglar said motivation is like bathing: You need to do it more than once! 

This “fresh meat” experience illustrates the difference between appreciation and recognition. When a facility invites me to do a presentation to honor and motivate its CNAs, it is a sign of appreciation, but it is not recognition. Appreciation focuses on the value of the individual and complements the person unconditionally.

Recognition focuses more on professional performance or achievement. It is what you provide to those who recognize their self-worth and understand the power of their influence. 

I have rarely come across administration personnel at a care center who doesn’t appreciate their CNAs, or their entire team actually. They show it with words, occasionally a staff party or potluck and annually with a gift or other token of appreciation during CNA week or on anniversaries.

I do, however, often come across CNAs who do not recognize themselves and therefore have no understanding of the far-reaching power of their influence. This has been a long- term care epidemic since I started washing dishes in a skilled nursing center 34 years ago. 

I once heard someone say, “Don’t look for recognition without recognizing yourself first.”  Many CNAs do not recognize themselves, their caregiving skills, their roles on the team, or how their performance impacts the residents and helps move the mission of the organization toward quality goals.

So it is challenging for administrators and nursing directors to “recognize” the CNAs’ specific contributions on the team when many of them really don’t even recognize their contributions themselves.  This makes it difficult for CNAs to “receive” the recognition.

It’s sort of like giving someone a compliment on the shoes she is wearing only to have her reply, “These old things? I got them on sale and shouldn’t wear them out of the house.”  It is awkward for some to receive compliments, just as it is hard for some CNAs to identify and accept recognition.

I have had some heartfelt discussions with CNAs on this very topic.  When drilled down, they usually say they really feel like they don’t deserve the recognition, that they are “just a CNA” and that the nurses do all the “brain” work and they merely do the “heavy lifting” by carrying out instructions. 

As sad as this sounds, we’ve created much of this through our own actions and words — the environment we establish. We’ve allowed for many years people to use the phrase “just a CNA” and have care plan meetings including all the department heads and none of the individuals who actually deliver the care. We’ve changed residents’ roommates without asking for input from the CNAs and often have two “sets of rules,” one for CNAs and another for nurses — and we are all supposed to be on the same team.

Don’t be mistaken, CNAs not recognizing their own professional skills comes at a huge price to any care center. It spills over into other areas and ultimately contributes to CNA turnover, defeatist attitudes, and lack of ownership and professional pride. Additionally, it is more difficult for a CNA to fully value and respect the residents when she doesn’t value and respect (recognize) their work with them. Combined, this all impacts quality, meeting goals and moving the mission forward.

How can we help CNAs recognize their professional skills, role and greatness? In addition to nurturing an environment of respect and inclusion, one of the most important things a care center can do with today’s CareForce (NAHCA’s terminology, more descriptive and respectful to CNAs and residents than using the word “workforce”) is to invest in programs which allow them to develop a professional self-esteem and self-worth, confidence and knowledge base.  Once these are developed, CNAs recognize themselves and are then more able to graciously receive recognition.

As crazy as the “fresh meat” comment sounds, it is born from a lack of professional training, and a lack of self-worth and recognition. If I were a practicing administrator today, my number one goal would be to ensure the person closest to both my customer and to my latest hire is truly an expert in her field, respecting their role and themselves.  That person as we all know is the CNA.

Getting a certification is only half of becoming a professional CNA; the other half takes employer investment in their professional development. When done the right way, it should prove to be a small investment with a big return in terms of CNA turnover and delivery of quality care.

Lori Porter is a former certified nursing aide and nursing home administrator with more than 30 years of experience in long-term care. She is co-founder and CEO of the National Association of Health Care Assistants, a professional association of and for nursing assistants. A nationally sought-after speaker on frontline caregiving issues, she also is the author of the book “Everything I Learned In Life I Learned in Long Term Care.”