Introduction
Research Questions
- What were the characteristics of CNA training and employment in the United States during the last decade, and what are the opportunities for career advancement?
- What were the characteristics of the CNA trainings funded under HPOG 1.0 and the participants who engaged in this training?
- What were the education and employment outcomes of HPOG 1.0 CNA training completers?
The Health Profession Opportunity Grants (HPOG) Program awards grants to organizations that provide education and training to Temporary Assistance for Needy Families (TANF) recipients and other low-income individuals for healthcare occupations that pay well and are expected to either experience labor shortages or be in high demand. Ninety percent of grantees in the first round of HPOG (the set of grants awarded in 2010, referred to here as HPOG 1.0) decided to offer training to become a certified nursing assistant (CNA) and it was the most frequently taken training by HPOG participants.
According to government projections, CNA is one of the fastest growing occupations that requires some postsecondary education but no degree. At the same time, CNAs earn low wages, with annual mean earnings near the poverty level. Because one of the primary purposes of HPOG is to help low-income individuals to secure healthcare employment that pays well, it is important to understand whether CNA training in HPOG can lead to better paying jobs over time and the ways programs can assist individuals who complete CNA training in moving along a career pathway. This report summarizes what was learned about CNA training and employment during HPOG 1.0 to provide insights for training programs and policymakers on the benefits and drawbacks of CNA training and career pathway advancement opportunities.
The report concludes providers should assist those completing CNA training to attain the certification by helping them prepare to take and pass the examination. Providers can also offer and encourage those interested in CNA training to bundle it with other short-term trainings. Anecdotal evidence suggests this can improve their job opportunities and wages, although the data reported here do not yet provide evidence of substantially higher wages for workers who did complete these additional short-term trainings; more research is needed. In addition, providers can consider partnering with employers to create CNA apprenticeships or extended programs that offer ways for CNAs to gain additional skills and earn more while working. Finally, programs can work to assist those who would like to move up in the nursing occupation through financial, academic, and other supports that enable low-income individuals to enter and complete these longer-term nursing education programs.
Purpose
The CNA occupation is one of the fastest growing in the healthcare sector. With an average wage of $13.29 per hour (or $27,650 annually full-time), it is low paying and can be stressful, resulting in high turnover. However, CNA training is short (on average two months in HPOG 1.0) and has low skill requirements, making it popular among individuals with low basic skills or limited work experience who need or want to get a job quickly. The extensive data collected from multiple sources in HPOG 1.0 can provide training programs and policymakers with clear insights on the benefits and drawbacks of providing and receiving CNA training, including the potential career pathways available to CNA workers.
Key Findings and Highlights
- Demand for CNAs is high and projected to grow.
- Most participants complete CNA training, and disadvantaged groups might meet academic requirements for CNA training relatively easily.
- Participants completing CNA training can bundle it with other short-term trainings to improve employment opportunities, but beyond these trainings achieving the next step on the career ladder can be challenging.
- CNAs earn relatively low wages and have high turnover.
- Training providers who consider offering CNA training must weigh the needs and abilities of the population they serve and consider the ways they can help those completing CNA training be as successful as possible.
Methods
This report uses research literature and other publicly available information to examine CNA training and employment in the United States. Additionally, it uses interviews (conducted under the National Implementation Evaluation of HPOG 1.0) with grantees, training providers, and healthcare employers. For information on healthcare training participants and their outcomes, this report used data from the HPOG 1.0 management information system. For information on quarterly earnings and employment, it relied on data from the National Directory of New Hires. A 15-month follow-up survey of a sample of HPOG 1.0 participants provided information on type of employment and employment characteristics. All data from HPOG 1.0 is based on participants in the 27 non-tribal grantees who provided informed consent to participate in the evaluation.
Citation
Loprest, Pamela, and Nathan Sick (2018). Career prospects for certified nursing assistants: Insights for Training Programs and Policymakers from the Health Profession Opportunity Grants (HPOG) Program. OPRE Report 2018-92, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.