Disclaimer: Posts are solely the views of the author and do not represent the views of Brandeis University or The Institute on Assets and Social Policy.
It’s not a stretch to say that Nursing Aides keep our healthcare system afloat. When my husband collapsed while recovering from surgery six months ago, it was a Nursing Aide who was able to pick him up and sling him back into the hospital bed, preventing further injury. I’m not unique, though, if you spoke to 100 people, you’d have 100 different positive stories about how a Nursing Aide or a Home Health Aide went above and beyond to care for a loved one, help them navigate our healthcare system, or just made them feel better in a trying time.
In these times, we are asking entry-level healthcare workers to put themselves at extreme risk to keep us all healthy and alive through the COVID-19 pandemic, despite the fact that they make over $10 less on average per hour than food service managers.
It’s unfortunate, then, that Nursing Aides have some of the worst jobs in health care. With an injury rate double that of Registered Nurses[i] and an average wage that puts them below the poverty line for a family of three, it can be very difficult for even the most passionate and care-driven Nursing Aide to stay in the profession. The turnover rate for Nursing Aides at long term care facilities, which makes up the largest proportion of the workforce, can exceed 100% in some years, with more people leaving than coming to replace them.[ii] What’s more, the people working these poor-quality entry-level healthcare jobs are more likely to be women of color than people who work in the better-paying jobs in healthcare.[iii]
In these times, we are asking entry-level healthcare workers to put themselves at extreme risk to keep us all healthy and alive through the COVID-19 pandemic, despite the fact that they make over $10 less on average per hour than food service managers.[iv],[v] The simple answer, of course, is to pay nursing assistants more, but in the short-term, it’s important to pay attention to advancement and how we do workforce development, so people can move towards better jobs now.
Approximately 85% of HPOG participants go for short-term trainings that are associated with poor pay and few advancement opportunities.
Despite the fact that these jobs are bad by almost every accepted metric of job quality, our healthcare career training programs still encourage almost everyone to start their health careers as a Nursing Aide or Certified Nursing Aide (CNA) because the training is short, it does not require much education, and there is high demand. Of course, the hope is that people will be able to start at the bottom and then advance into progressively better jobs with more pay, benefits, and control over their worklife. In fact, the whole conceptualization of career advancement in healthcare begins at the CNA level, progressing to an LPN, and finally ending at an RN. But this does not play out in reality, contributing to a segregated and stratified industry that hurts all of us.
One of the great innovations in workforce development in the last two decades has been the implementation of the Career Pathways framework. Created by community based organizations, Career Pathways programming is a broad umbrella for programming that is made to first help people reach the level of competency needed to take classes and pass a certification test while providing career and non-career supports to help people get through training and get their first job. Then, the hope is that they will be able to move along a defined career pathway to reach their career goals. This approach gained enough interest that the Administration for Children and Families decided to implement two programs based on this approach that are primarily for the healthcare profession: Pathways for Advancing Careers and Education (PACE) and the Health Professions Opportunity Grant (HPOG). These programs have some promising initial results, but they are both oriented in practice to getting people on the first step of their career, not to foster long-term advancement.
Source: Peck, L., Litwok, D., Walton, D., Harvill, E., and Werner, A. (2019)
Now more than ever, we need to focus on helping people move into increasingly higher jobs, not just on helping them get any job.
Evaluations of HPOG show that the programs are very effective at getting people into an entry level healthcare job and getting people through progressively higher education, but other impacts are a bit more muddled. While HPOG participants have higher wages, this raise only translates to approximately $140 per quarter, or $10 per week. Furthermore, there is no significant difference in the receipt of public assistance or employment in general. Approximately 85% of HPOG participants go for short-term trainings that are associated with poor pay and few advancement opportunities, and only 10% of participants, regardless of whether they initially choose short- or long-term trainings go back to get another certification.[vi]
So, from preliminary data, HPOG can be called a mild success. It is helping low income people get jobs in their desired profession and it does help people get education and training. But the jobs that people are most likely to get are either Nursing Aides or jobs that are very similar in terms of what they offer to the worker. Career Pathways as a framework for workforce development has the potential to do so much more.
Shifting to Meet Modern Needs
Every stakeholder in the system has an important role to play in making our system mobile and equitable. Workforce development practitioners need to build systems that provide long-term supports to bringing the promise of health career mobility into practice by providing long-term supports and advancement-specific curriculum that truly prepares people to face realities of the health career system. Local practitioners also should build stronger relationships with employers to anticipate needs for positions that are higher quality and directly prepare workers to fill those roles. Employers should re-invest in their internal labor markets to prepare their own workers to move up internal career pathways. As a nation, we also need to build incentives in our federal workforce system to track and support efforts that move people into better jobs, not just get them that first job.
Now more than ever, we need to focus on helping people move into increasingly higher jobs, not just on helping them get any job. Black and Latinx women are much more likely to be in poor-quality, entry-level healthcare jobs and creating systems that break through the stratified and segregated workforce is vital to racial equity in healthcare careers. For years, we have also been projecting skilled nursing shortfalls across the nation due to our aging population,[vii] and calls to solve this are only growing in urgency as we pass benchmark by benchmark with no solution. If we can prepare and support our current entry-level workforce for advancement, we may just avert a care crisis in the near future. Here, we have the perfect opportunity to both support those who utilize our health system and the workers of color stuck in low-wage healthcare work.
[i] Pompeii L. A., Lipscomb H. J., Schoenfisch A. L., & Dement J. M. (2019) Musculoskeletal injuries resulting from patient handling tasks among hospital workers. American Journal of Industrial Medicine, 52(7), 571-578.
[ii] Loprest, P., & Sick, N. (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. Retrieved from https://www.acf.hhs.gov/opre/resource/career-prospects-certified-nursing-assistants-insights-training-programs-policymakers-hpog-program
[iii] Hurtado, D. A., Sabbath, E. L., Ertel, K. A., Buxton, O. M., & Berkman, L. F. (2012). Racial disparities in job strain among American and immigrant long-term care workers. International Nursing Review, 59(2), 237–244. https://doi.org/10.1111/j.1466-7657.2011.00948.x
[iv] U.S. Bureau of Labor Statistics. (2020, April 10). Quick Facts: Nursing Assistants and Orderlies. https://www.bls.gov/ooh/healthcare/nursing-assistants.htm
[vi] Peck, L. R., Litwok, D., Walton, D., Harvill, E., & Werner, A. (2019). Health Profession Opportunity Grants (HPOG 1.0) Impact Study: Three-Year Impacts Report. OPRE Report 2019-114. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Retrieved from https://www.acf.hhs.gov/opre/resource/health-profession-opportunity-grants-hpog-10-impact-study-three-year-impacts-report