Consequences of empowered CNA teams in nursing home settings: a longitudinal assessment.

PURPOSE Recent studies have concluded that there is a lack of "patient-centered" care in nursing homes and subsequently a need for nursing home culture change. As a result, a variety of new, promising initiatives have been introduced, with most of these incorporating the use of "empowered" employees. The purpose of this study was to evaluate the effects of empowered work teams--a work design specifically established to empower certified nurse aides (CNAs)--within the long-term-care setting. DESIGN AND METHODS We used a multimethod, pretest-post-test design to examine the effects of these teams. Our qualitative analysis included observations of over 270 team meetings. The quantitative analyses included five pairs of nursing homes, with five implementing empowered work teams and five acting as comparisons. RESULTS The quantitative as well as qualitative analyses indicate that the work teams had a variety of modest, positive effects: increased CNA empowerment; better CNA performance; improved resident care and choices; improved procedures, coordination, and cooperation between CNAs and nurses; and possibly reduced turnover. There appeared to be mixed effects on work attitudes. IMPLICATIONS As new initiatives strive to move away from the medical model and toward a person-centered model, the data suggest that empowered CNA work teams can help.

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