As Nursing Homes Wrestle with Staffing Challenges, Leadership May Be Path to Nursing Assistant Retention

September 29, 2020

Nursing home (NH) workforce instability, particularly for certified nursing assistants (CNAs), has been a growing challenge exacerbated by the COVID-19 pandemic. As facilities struggle to attract and retain good CNAs, effective leadership skills are gaining attention as a path to retention and engagement.

According to Leadership, Staff Empowerment and the Retention of Nursing Assistants: Findings from a Survey of U.S. Nursing Homes—a study in the September issue of JAMDA—leadership and staff empowerment practices show great promise for retaining staff, especially those practices that support staff independence, involvement in care planning and decision-making, two-way communication, training, and respect for staff.

Using national data from surveys of NH administrators, Clara Berridge, PhD, NSW, assistant professor at the University of Washington, and her colleagues found that greater leadership and staff empowerment levels were consistently associated with high CNA retention. Occupancy rate, chain status, and lower NH administrator turnover also were positive factors.

“These findings speak to the value of CNA team membership, inclusion, and involvement in decision-making,” according to the authors. “There are many opportunities to incorporate such practices, including involving CNAs in quality improvement teams and resident care plan meetings, and providing rewards for extra training for education.”

The authors also noted that, “Practices that promote shared and open decision-making, such as having formal processes that allow CNAs to contribute ideas on improving resident care and sharing facility-wide management decision-making power with staff, also may promote staffing stability.” Looking forward, they offer the possibility of staff empowerment and leadership practices, implemented in tandem with other job quality improvement efforts, as a way to encourage more workforce stability.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email




JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.