Nursing assistant certification can get students through a program and into a job in a few weeks. But the value of those certificates tends to be low, and there's no clear path to advancement, according to health-care and workforce experts.
While the work certified nursing assistants, or CNAs, do is critical, the reality of the job can make it undesirable. In many cases, CNAs are paid barely more than minimum wage. Nationally, the typical wage for a CNA in 2018 was $13.72 per hour, which comes out to less than $30,000 per year, according to the U.S. Bureau of Labor Statistics.
"One solution to that problem is to help people get out of those jobs," said Michelle Van Noy, associate director of the Education and Employment Research Center at Rutgers University. "But that doesn't affect the problem itself."
Some health-care programs are trying to tackle this issue and others with special pathways, articulation partnerships and intermediate certificates. These options can help students who earn CNAs from getting stuck in low-paying jobs while not requiring them to spend two, four or even more years in college to receive a nursing degree when that time commitment might not be plausible for everyone.
Bergen Community College in New Jersey received a $15 million Trade Adjustment Assistance Community College and Career Training (TAACCCT) grant to build a health professionals consortium. With those funds, the college was able to let noncredit certificate courses be counted as credits if the students wanted to continue their education in health care, according to Susan Callahan Barnard, dean of health professions at the college.
While the credits may just fill elective requirements for nursing assistants pursuing a registered nursing, or R.N., degree, that's better than nothing. The state also recognizes patient care technicians, which not every state does. That position can be a step up from earning a CNA in terms of pay.
The College of Health Care Professions in Houston switched to a stackable model that lets students move up the pay scale in their careers while furthering their education. Students can start by earning certificates in nine months, sometimes doubling their salaries.
But the college doesn't offer a nursing assistant certificate, said Eric Bing, CEO of the college.
"The CNA program is a super-short program where you’re just learning the very basics," Bing said. "There’s just not a lot there."
Instead, the college offers stackable pathways where it makes more sense. For example, a student can get a radiology certificate, then move on to become a technologist, then get a radiology bachelor's degree or go the business route and open an urgent care center.
For "adult learners that have such complicated lives, the earn-and-learn method is such a great way to move up," Bing said.
There's a caveat: the college "spent a tremendous amount of time and money in developing programs and making sure pieces work."
Some, however, believe that ladders could be built out of CNA programs.
Paul Osterman, co-director of the Sloan Institute for Work and Employment Research at the Massachusetts Institute of Technology and author of "Who Will Care for Us?" on the workforce for long-term care, said it's unrealistic to think that nursing assistants can easily become registered nurses because of the time needed to achieve the latter. But, he said, there are jobs in different settings that could naturally follow from a CNA position, like patient care technicians and phlebotomists.
Others believe the system needs to be taken apart. Roy Swift, executive director of Workcred, a not-for-profit aimed at evaluating the quality and effectiveness of workforce credentials, believes health-care programs need "more transparent pathways and mapping and latticing." While CNAs could move on to other programs or certifications that are better paying, "that mapping and latticing is not clear to people, and there are gaps."
Swift believes competency-based learning could help this issue. If programs were built as pathways to ensure there were no gaps between certifications, and the education was based on competencies of skills rather than checking boxes on certain classes, it would be easier for students to move through programs and switch institutions.
Right now, institutions often don't trust each other's programs, Swift said, so articulation between health-care programs can be difficult.
Cheryl Feldman is executive director of the District 1199C Training and Upgrading Fund, a Philadelphia labor management partnership created by bargaining agreements between health-care facilities and the local affiliate of the National Union of Hospital and Health Care Employees. The fund's mission is to provide workers access to career pathways through education and training and to build the region's workforce. Colleges in Feldman's area make some articulation easier, she said. It's not the case in every city or every state.
"It depends on the region as to what the opportunities are," Feldman said. In Philadelphia, the licensed practical nursing, or L.P.N., program is a technical degree not for college credit. But the Community College of Philadelphia will waive the first semester of registered nursing courses for L.P.N.s who achieved a certain grade point average in their programs.
Feldman said she believes it should be easier to roll time spent in lower-level health programs into further education. But "making that happen is another challenge," she said.
"I don’t know if it’s doable, because every state has its own state board of nursing," she said. "So how do you align all of that nationally?"
Swift said it will take time to make the changes he believes are necessary. But he thinks the industry will need to adapt eventually.
"A lot of these occupations are going to change drastically because of how we change health care," he said. For example, as the industry has more of a need for home health aides and community health workers, those workers will need to be competent in several skills taken from different health-care professions. But they won't necessarily need to be experts in any one area.
One certain thing is the nation will need workers like CNAs in the near future.
"We desperately need CNAs, and we also need home health aides," Osterman said. "There’s going to be a big increasing demand for long-term care as baby boomers get older."