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Certified Nursing Assistants in Nursing Homes at High Risk of Work-Related Injuries

RESEARCH TRIANGLE PARK, N.C. — Certified nursing assistants (CNAs) are an essential part of the long-term care workforce, but more than 60 percent of CNAs working in nursing homes experience work-related injuries, according to a study conducted by researchers at RTI International.

Aside from the impact on workers' health, work-related injuries can negatively impact job satisfaction, contribute to job shortages and affect the overall quality of care provided by CNAs to more than 1.4 million nursing home residents across the country.

The study, which was partially funded by the Retirement Research Foundation and published by RTI Press, analyzes the predictors of work-related injuries among CNAs working in nursing homes.

"Work-related injuries are very common among CNAs working in nursing homes, but little is known about the nature and causes of these injuries," said Galina Khatutsky, a research analyst at RTI and lead author of the study. "Our goal was to explore how the use of assistive equipment, job training, workplace environment, and personal characteristics may affect injury rates."

The researchers analyzed data from the 2004 National Nursing Assistant Survey and National Nursing Home Survey, which are the most recent data available that combine responses from CNAs with information about their workplaces.

The study found that 60.2 percent of all CNAs nationally reported a work-related injury in the year prior to the survey. Among the injured CNAs, 65.8 percent reported being injured more than once in the past year, 16 percent required a transfer to light duty work and 24 percent were unable to work because of their injury.

Injuries ranged from cuts and back injuries to black eyes and human bites, and resulted from a variety of causes, including lifting, bathing and handling residents; resident aggression; and accidents involving facility equipment.

Though lifting residents is one of the most commonly reported causes of injury, the majority of survey participants reported having access to lifting equipment and using it regularly.

One unexpected finding was that the availability and use of lifting equipment did not significantly change the likelihood of being injured, once individual characteristics are controlled for.

"One of our main goals was to examine the relationship between assistive equipment in nursing homes and workplace injuries among CNAs," Khatutsky said. "The findings indicate that simply having lifting equipment available may not bring the benefits that are expected from it."

The surveys also showed that certain groups of CNAs were more likely to report injuries. These included new workers and those who changed jobs more frequently, received lower wages, worked mandatory overtime, and felt they had inadequate time to provide personal care. In contrast, CNAs who worked in facilities where they felt respected, valued and rewarded for their work were less likely to report an injury.

"Poor job preparation appears to be a serious issue among CNAs; the findings indicate that those who report being generally better prepared for the job seem to be able to handle many challenging aspects of direct care better, resulting in fewer injuries," Khatutsky said.

The authors suggest that several interventions to improve the workplace environment could reduce the rates of CNA injury, including providing more comprehensive initial training for CNAs, reducing mandatory overtime, providing support to newly hired CNAs and making efforts to reduce job turnover.

Additional authors of "Work-Related Injuries Among Certified Nursing Assistants Working in U.S. Nursing Homes" are Joshua Wiener, Ph.D., and Wayne Anderson, Ph.D., of RTI International.