According to a report by the American Medical News, even a 2% cut in Medicare will result in the loss of 195,000 healthcare jobs by 2021. How do the Medicare cuts affect your future as a CNA?

Staffing Shortages

American nursing homes already suffer from staffing issues. Government studies have revealed that over half of the nation’s nursing homes do not have enough CNAs. These reports suggest that many patients in nursing homes receive substandard level of care due to the lack of nursing staff.

The following statistics reveal the amount of time that patients in long term care facilities currently receive throughout the day from nursing staff:

• Twelve minutes of care for registered nurses
• Forty-Five minutes of care for registered nurses and licensed practical nurses combined
• Two hours of care from CNAs

It’s easy to see that the cumulative total of 2.75 hours of staff time isn’t enough for these patients.

However, this statistic does reveal a glimmer of hope for CNA’s. It’s evident that CNA’s are on the front lines of patient care due to the fact that they spend the most time with the residents throughout the day. All long-term care facilities are in need of qualified CNA’s as part of their patient care plan.

Supply and Demand

 The job forecast for CNAs in nursing homes are definitely brighter than that of other skilled nursing staff. Nursing home administrators realize that CNAs offer the most bang for their buck due to factors such as:

• More time spent with patients
• Lower wages and other nursing staff
• Higher value for their wage
• Lower cost of training

Trained CNAs employed in nursing homes ultimately results in lower operating costs for the institution and therefore will increase the demand for CNAs.

Considerations

The demand for CNA’s may increase; however, it doesn’t mean that the clouds have cleared from this Medicare storm. According to the American Health Care Association, the nation’s Medicare costs will drastically undercut many institutions staffing efforts as well as reduce facility quality improvement programs.

The bottom line is that these cuts will result in a lower quality of healthcare and will affect the people who need it most – the patients.

Be prepared to invest some time and effort into writing a concise, compelling cover letter that allows your personality to show through. Put yourself for a moment in the shoes of the hiring manager. They have received an onslaught of dozens of resumes for this one position that they must fill. They need to weed through all of the applications they receive and try to pick the best person for the job.

Quick Tip: make sure you also check out our guide on how to write a compelling CNA resume.

Your job is to make the hiring manager’s job easier. Follow all of the directions in the job announcement to the letter. Just demonstrating that you are capable of following directions will separate you from those candidates that have sent in boilerplate letters and who did not follow the directions.

Here are five quick tips for preparing a CNA. resume cover letter:

 1. Always customize each cover letter

Find out the name of the hiring manager and address the letter to that person. Find out some interesting facts about the organization and mention them in your letter. The hiring manager wants to get the idea that you are applying for this particular job rather than any job you can get hired to do.

2. Use your cover letter to share who YOU are

Make your cover letter stand out from the stack of other resume cover letters that the hiring manager will be sifting through. Share how much you love working with babies, or the elderly, or whatever aspect of nursing you are passionate about. This is your opportunity to set yourself apart from the rest of the applicants.

3. Do not simply rewrite your resume in the form of a letter

Keep your cover letter fresh and unique. Remember your goal is to make the hiring manager want to pick up the phone and schedule an interview with you. Add relevant facts about your work history, education and experience.

4. Expand on how your experience matches the qualifications for the position

Pull all of the qualifications from the job announcement and write about how your education, skills and experience makes you a perfect match in every way.

5. Have someone objective review & proofread your cover letter

It’s challenging to proofread your own writing with 100% accuracy. Have a fresh set of eyes review your cover letter and point out any typos or areas that do not make sense.

*Bonus Tip: Work with a career counselor if your CNA training program provides one, or consider investing in hiring a career coach to help you refine your resume and cover letters, which you can then customize and refine for each specific job you apply for.

The health care field is a highly competitive one. Each year CNA training programs crank out hundreds of thousands of trainees. The job of your resume cover letter is to show how special you are, what a good fit you are for that specific job, and how the hiring manager would be foolish not to bring you in for an interview.

The medical community can sometimes be confusing to the general public; patients see a person in scrubs wearing a name tag with an acronym and are often unsure what the person does. To help shine some light on the differences between CNAs and MAs, let’s take a closer look at these two careers:

CNA Overview

CNAs work under the supervision of registered nurses and are on the frontline of patient care. On a daily basis, they perform tasks such as:

• Taking vital signs
• Bathing patients
• Grooming patients
• Helping patients walk
• Providing emotional care to patients
• Acting as liaison between patients and the nursing staff

MA Overview

MAs generally report directly to medical office managers, doctors and other health care practitioners. They typically work in a medical office setting or clinic and are responsible for duties such as:

• Updating patient’s medical records
• Completing insurance forms
• Arranging laboratory services for patients
• Scheduling hospital admissions for patients
• Scheduling patient appointments
• Handling bookkeeping
• Answering telephones

In clinical settings, MAs will sometimes also help take patient vital signs, obtain patient medical histories and are responsible for preparing exam room instruments and supplies.

Similarities

Both certified nursing assistants and medical assistants must work with the public. In this capacity, they need to act professional at all times. In a medical setting, they will be exposed to a wide variety of emotions such as fear, anger, sadness and apprehension daily.

CNAs and MAs are also subject to the following healthcare regulations:

• Joint Commission on Accreditation of Healthcare Organization (JCAHO)
• Health Insurance Accountability and Portability Act (HIPAA)
• Occupational Safety and Health Administration (OSHA)

Differences: Health Care Setting

Medical assistants are required to work in facilities where a doctor is present, such as a clinic or doctor’s office. Conversely, certified nursing assistants can work under the supervision of an RN or LPN. This allows them to work in many diverse settings to include:

• Nursing homes
• Community care facilities
• Long-term care facilities
• Hospitals
• Home healthcare settings

CNAs also have more freedom when it comes to patient care due to their certification. During the course of their career, CNAs have the opportunity to take on-going certification classes. This will afford them the opportunity to have additional responsibilities.

Differences: Training

Depending on the state’s requirements, CNAs undergo between 100 to 180 hours of training. The coursework includes class room training and hands-on clinical applications. At the conclusion of their training, prospective CNAs are required to successfully pass a CNA certification exam that tests the student’s competencies.

Medical assistants are trained in medical terminology, clinical and diagnostic procedures as well as typing, accounting and insurance processing. Training programs are regulated by the Accrediting Bureau of Health Education Schools.

Formal training for MAs is not always required; some medical assistants receive on-the-job training. MAs that begin their career this way will typically attend training sessions and work directly with an experienced medical assistant.

Earnings

The job forecast for CNAs and MAs is positive due to the increased need for healthcare workers in America. The lowest paid medical assistants earn approximately $20,000, while the highest-paid MAs make just over $30,000, notes the US Department of Labor.

A CNAs income ultimately depends on where they work. The highest-paid CNAs usually work in hospitals and nursing homes, while CNAs working as home-health aides are typically paid the least. The pay ranges from around $20,000 to just over $30,000 depending on location.

Due to the increased need for long-term care in America, the Department of Labor projects at 19% growth in employment opportunities for nurse’s aides through 2018.

What does this mean for you? This means that after training and passing the CNA exam, you stand a very strong chance of finding a job.

What to Expect

As a CNA, you will have direct patient contact daily. Your tasks may vary depending on what institution you work at; however, your typical duties will include helping patients eat, bathe and dress, as well as taking vital signs, helping patients to ambulate and reporting any change in the patient’s medical condition to other nursing staff.

Because patients need 24-hour care, you may be required to work a variety of different shifts. Most CNAs work full-time and as a new nurse’s aide you might have to work holidays and weekends, depending on the scheduling needs of your place of employment.

Where to Find Work

Nursing Homes/Community Care Facilities

Because Americans are living longer, the need for long-term care facilities, such as nursing homes is dramatically increasing. In fact, almost half of CNAs that are employed in America are working in some type of long-term care facility.

The multitude of opportunities to care for the elderly is valuable insurance for your future employment prospects, even in the midst of a troubled economy. Nursing homes are a great resource for CNAs that are looking to begin their careers in healthcare.

Many CNAs are also employed in community care facilities. These residential care facilities care for elderly patients and for people with special needs. The clinical setting is similar to nursing homes; however, these patients will typically require fewer needs than patients do in nursing homes.

Home Health Aide

Working as a CNA home health aide is another growing opportunity for CNAs. As a home health aide, you will be responsible for taking care of patients in their homes. Many home health aides will be responsible for a variety of patients at several different locations.

Working in this environment will require you to have a strong sense of independence. As the population in nursing homes increases, the home health aide path will continue to be an excellent career opportunity for CNAs.

Hospitals

CNAs employed in hospital settings will be exposed to a wide variety of assignments. As a CNA in a hospital, you will be responsible for several patients at the same time. A strong proficiency in multitasking is essential to be successful in this environment.

Another benefit to working in a hospital is that you may be exposed to several diverse specialties within the hospital. For example, a CNA working on a Medical/Surgical floor will observe different clinical procedures than a CNA employed on an Oncology or a Maternity unit.

CNA Wages

How much money you earn as a CNA will ultimately depend on a variety of factors such as the type of institution that you are employed at as well as in what part of the country you work. Since the cost of living varies in America, this will be factored into your pay.

Here are a few examples of typical hourly rates:

• Nursing homes -                   $10-$13
• Community care facilities -  $9-$12
• Hospitals -                             $11-$14
• Home health aides -              $8-$10

It’s up to you to be familiar with local, state and federal laws relevant to your scope of duty as a CNA. Failure to abide by these laws can result in a civil suit against you, possible loss of certification and in extreme cases may result in fines or imprisonment.

Now that I have your attention, let’s explore some basic guidelines that will help you stay out of the legal hot seat.

Patients Right to Privacy

In 1996, the Health Insurance Portability and Accountability Act was enacted to protect the confidentiality of patients. As a nursing assistant, you are responsible for safeguarding the privacy of patients. Medical issues should only be discussed with the patient’s doctor, nursing staff, other members of the medical team and close relatives.

Know Your Facility’s Policies

It’s essential that you perform your duties by following the correct procedures of your place of employment and within the scope of your training. If you are unsure about a certain policy or procedure, always check with your immediate supervisor.

Continuing Education

Keep up to date on continuing education requirements to provide the highest level of care to your patients. This will also allow you to stay informed about any new or changing medical procedure.

Legal Issues

In addition to the previously mentioned guidelines, there are a variety of legal terms that every CNA should be acquainted with. Be aware of the following legal issues and know how to avoid them during your career.

Malpractice

This involves negligent conduct that results in harm to the patient. Examples include practicing outside the scope of your duties, not providing care as previously trained and failing to follow your facility’s policies.

Negligence

This consists of the lack of reasonable care due to carelessness and often results in injury or harm to the patient. Negligence usually occurs when a CNA is in a hurry.

Types of Patient Abuse

There are four types of abuse that have been identified within the medical community. They consist of physical, sexual, psychological and verbal abuse.

Physical

Examples include hitting, kicking and roughhousing with patients. Another form of physical abuse involves providing the incorrect treatment to patients.

Sexual

This can involve any type of seductive or sexual harassing behavior directed toward the patient. Another form of sexual abuse is forcing a patient to do a sexual act against their will.

Psychological

This type of abuse includes patient intimidation through threats or any other harassing behavior that would cause emotional harm to the patient.

Verbal

This includes the inappropriate use of tone and language as well as any unpleasant gestures or names directed toward patients.

Property Rights

All patients have the right to have their personal items safeguarded during their stay in any healthcare facility. Theft of a patient’s property is nothing less than a crime.

Assault and Battery

Assault is defined as intentionally attempting to harm someone; battery involves actually committing the offense. In a medical environment, these terms don’t always involve attacking someone. Simply performing a treatment against the patient’s will could cause significant legal problems.

To avoid this situation, always inform patients of what treatment you plan to perform, and immediately stop if the patient refuses.

This is known as informed consent. Conversely, forcing the patient to do something against their will is defined as coercion. If the patient refuses treatment at any time, notify your supervising nurse.

False Imprisonment and Involuntary Seclusion

Patients have the right to come and go as they please. You must obtain proper authorization before restricting any movement. Additionally, the use of physical restraints must be specifically ordered by a doctor prior to being utilized on any patient.

When a patient is held against their will, it’s known as involuntary seclusion. Sometimes patients become unruly and can cause problems in common areas that are shared by other patients. Check with your supervisor before removing these patients.

Considerations

Your goal as a CNA is to provide the highest level of care to your patients. By following these guidelines and the proper legal standards, you are ensuring that you’re doing both you and your patients justice throughout your career.

The required hours vary by state. Some states may require 12 hours a year, while others set the standards at 24 hours. Check with your state’s nursing board regarding their CE requirements.

CE courses are offered through a variety of options such as: your current employer, local community colleges, your state’s nursing board and through numerous private vendors. When choosing a private company, make sure that they are accredited with your state.

The topics for CE courses are offered in subjects that are relevant to your duties as a CNA, such as:

• Current clinical methods
• Emotional support for the elderly and chronically ill
• Medical record documentation
• HIV/AIDS training
• Medical error prevention
• Communication with cognitively impaired patients
• Resident rights

This is just a small sample of some of the available courses for CNAs. Continuing education courses will help you maintain a high standard quality of care and can help keep you updated on current trends in healthcare.

Free Sources for CEs

Many members of the healthcare community pay fees to obtain CEs and simply consider it the cost of doing business; however, there are other options. If you know where to look, there are several low-cost and even free opportunities for continuing education. Before you read this you should read our previous article on free CNA inservices

Institution Education Departments

Many hospitals and nursing homes will develop CE courses through their education department. These CEs are usually free to employees. Check with your institution’s educational department to see what type of program they may offer.

Education Funds

Some employers make contributions to education funds. These funds frequently offer free continuing education courses for CNAs. An example available for CNAs who work in Los Angeles is the Service Employees International Union (SEIU) UHW-West & Joint Employer Education Fund. You must be employed by one of the companies affiliated with this union to qualify.

These free courses are specifically designed for CNAs. Examples of recent courses include a class on safe patient care and stress/end-of-life care. Each one of these courses provided eight contact hours.

Centers for Disease Control and Prevention

The U.S. Centers for Disease Control and Prevention’s (CDC) mission is to develop sound public health policies, promote healthy behavior as well as provide leadership and training. As part of this goal the CDC offers free continuing education for members of the medical community.

Courses in HIV education/treatment and other CEs are available on the website: http://www2a.cdc.gov/ce/availableactivities.asp. Take a look at the site to see if any available courses might fit your needs.

Armed Forces Service

If you are a working CNA and a member of the military on active duty for at least six months, some states will not require you to take in-service CEs that year. This exemption also applies to CNAs that are spouses of military members who were caused to be absent due to their spouse’s military duties. Check with your state’s board of nursing to see if you qualify.

Promotional Arrangements

Some companies, such as Johnson & Johnson as well as certain colleges will offer free CE courses. The majority of courses provide one hour; however, these units add up quickly. Here is a list of colleges that currently offer free courses:

• UCLA Health System
• Georgetown School of Nursing
• Kaplan University School of Nursing
• Walden University
• Chamberlain College of Nursing

To find out more information and to obtain a list of current Novell courses go to: http://ce.nurse.com/FreeCE.aspx. It’s up to you to investigate your options for free continuing education courses. These examples provide a starting point; check with the websites frequently for updated information.

This high demand for CNAs is also fueling the need for qualified CNA instructors. Before entering the workforce, certified nursing assistants receive hands-on training regarding procedures that will be later applied in medical settings, such as long-term facilities, hospitals, nursing homes, clinics and other health care facilities.

It’s up to the CNA instructor to arm CNA students with the necessary tools that will help them succeed in the healthcare environment. CNA instructors must have the proper experience, aptitude and knowledge in order to prepare future CNAs for the demands and requirements of the job.

CNA Instructor Qualifications

What does it take to become a CNA instructor? First and foremost, any qualified teacher needs to understand what characteristics are needed to educate and motivate students. Effective instructors utilize the following personal traits daily:

• Patience
• Knowledge
• Experience
• Compassion

In addition to these fundamental character traits, potential CNA instructors must be aware of the licensing requirements that are needed in the state where they want to teach. Contact your state’s nursing board to determine their specific licensing process.

Experience

Most states require two years of on-the-job experience working with elderly or chronically ill patients. Experience and familiarity in nursing homes and long-term care facilities will meet these requirements.

Prospective CNA instructors must not have any active administrative actions pending on their record at the time of application. Additionally, you must obtain your registered nursing (RN) license to become a CNA instructor. This will require you to take and pass the National Council License Examination (NCLEX – RN), and successfully graduate from an accredited nursing program. Most states also require two years of work experience as an RN before becoming an instructor.

Education

Prospective CNA instructors must pass a state-approved instructor training course. This course is available through technical schools, community college and nursing facilities. Your states nursing board can provide you with the specific requirements of your particular state.

Most states require 15 to 20 hours of instruction that will provide you with the necessary duties as a CNA instructor. Here is an example of an actual current instructor training program. This class is offered through Lincoln Land Community College in the state of Illinois:

Course Description

This five-day course qualifies RNs to teach the basic nursing assistant training program. The class includes a four hour lecture on Alzheimer’s disease and a clinical workshop.

• Date- August 8-12
• Time- 8:30 AM- 5:00 PM
• Cost- $480.00 per student

Obtaining Your License

Now that you have the necessary experience and have completed your education requirements, it’s time to obtain your CNA instructor license. To obtain your license, you will have to submit an application along with the required fee to your state’s nursing board. Some states will also require you to pass a background check.

After you have successfully navigated through the educational and licensing process, you can begin a rewarding career as a CNA instructor. Whether you choose to teach in a community college, technical school, or trade school, you can rest assured that your hard work has paid off.

Instructor Duties

As an instructor, you will be responsible for teaching courses in nursing theory and clinical practice. You will also train students to take patients vital signs as well as to observe and record patient health changes. In addition to the technical skills, you will also instruct CNA students to spot and clear safety hazards from the patient’s room.

On a daily basis you will supervise students as they practice clinical skills such as:

• Mobility
• Feeding
• Toileting
• Hygiene

Along with supervising these skills, you will review the student’s progress with the ultimate goal of preparing them to successfully pass the CNA exam.

Unfortunately, not everyone passes the test on their first attempt. If you find yourself in this unfortunate circumstance, don’t worry you will have another chance to shine. Most states will allow you to retake the exam up to three times within two years of completing your CNA training.

You only need to retake the section that you didn’t pass. If you fail both the written and skills sections, you will be allowed to retake both areas. If you are unsuccessful after three attempts, you will need to retrain at a state approved CNA program and then restart the testing process after training.

While it’s always good to have a backup plan just in case you don’t pass, there are several steps you can take that will help you ace the test.

How to Pass the Skills Section

Most people that don’t pass the exam usually have trouble in the skills section of the test. Since you are tested randomly on five skills from a list of 25 potential nursing functions, you need to be proficient in all 25 skills.

The best way to perform well in this section is to practice each set with a classmate or partner. Take the time to review your training notes and rehearse all possible scenarios until you can put them to memory.

Another potential resource is to investigate your study options online. Download a skills section study guide or take the time to watch hands-on CNA training videos that are available online. Many times these videos are performed by people who have gone through the CNA testing process.

Additionally, don’t forget that during the actual test, you will be evaluated by an instructor. Most people fail the test because they don’t remember to do the simple steps. It doesn’t matter how good you are at a particular skill, if you forget to do the crucial steps, such as wash your hands or knock on a patient’s door.

How to Pass the Written Section

There are practice written tests that you can acquaint yourself with online. This is a very effective way of scoring and measuring your progress. The written tests will provide you with sample questions and a chance to grade your score at the conclusion of the exam. Take as many practice tests as you need until you feel confident that you are ready to take the actual CNA exam.

Here are a few additional tips that will help you study and take the written portion of the exam:

Study Tips

• Don’t cram all the information in right before the test. Space out your study. Use a CNA Practice Study Guide
• Take detailed notes during training.
• Take breaks during studying sessions. Your memory retains information at the start and end of studying better than what you study in the middle of the session.
• Test yourself frequently with flashcards.

Test-Taking Tips

• Read the entire question carefully before answering. Don’t make assumptions.
• If you don’t know the answer to a question, skip it and go back later.
• Budget your time carefully and don’t forget to bring a watch.
• If you have time, read over your completed test and make sure you answer all the questions.

A certified nursing assistant plays a crucial role as a vital member of the healthcare team. CNAs are directly responsible for ensuring basic healthcare needs in a variety of settings such as: hospitals, nursing homes, community health care facilities, clinics, and in private homes.

After training and successful completion of the CNA exam, you will need to determine what type of facility that you want to work at. Keep in mind some of the following options when choosing your preferences:

• Choose your environment – Do you want to work in a large or small facility?
• Choose your location – Do want to work in the city you live in now or would you rather relocate?
• Type of facility – What type of facility are you best suited for? Talk to CNAs in a variety of settings; this will help you clarify your preferences.

Employment Resources

Now that you have picked the type of facility you want to work at, it’s time to research your opportunities for employment. As a qualified CNA, you have several options that are readily available for you during your job hunt:

Staffing Agencies

A CNA staffing agency can assist you in your search for employment. A staffing agency can help you find the ideal job in the setting of your choice.

A qualified staffing agency can offer you benefits such as:

• Flexibility in the amount of hours you work.
• Type of setting, where you work
• Location of employment
• Convenient way to find jobs

The role of the staff agency is to fill both full and part-time positions along with temporary and hard to fill vacancies in a wide variety of healthcare facilities. The agency will also consider your qualifications and match them up to the correct institution.

Networking

During your job search, don’t forget the simple, yet effective concept of networking. Talk to other prospective CNAs and find out what resources they are using for their job search.

Seek out other working CNAs. They are often equated with the needs and “inside scoop” of their places of employment. They may also know somebody in human resources that may have potential information about current or future vacancies.

Networking is also a viable resource for a new CNA to discover the pros and cons of the different types of medical settings and environments. If you decide later in your career to pursue other advanced nursing options, networking will be a valuable resource to help propel you in your search for additional training and employment opportunities.

Pound the Pavement

If you are the type of person that feels comfortable taking the job search into your own hands, this is another very viable opportunity for you to uncover that perfect job.

Visit local hospitals, nursing homes, or whatever type of setting you choose. Sometimes, a position has not been publicly advertised or is just getting ready to become available. This proactive search will help you get a leg up on the competition.

Don’t forget to visit the career centers of vocational schools. Talk to your school’s counselor about potential resources regarding the job process. Some schools have dedicated programs that help to place recent graduates in positions at local employers.

- High school diploma or GED certificate
- Over 18 years old
- Pass a CNA training course
- Pass the CNA written and skills exam
- Pass a background check

After you have obtained the aforementioned requirements, you can attain your state CNA license and begin your career as a CNA; however, your CNA license isn’t valid forever.

License Renewal Process

Most state nursing boards will send you notification when it’s time to renew your license. Prior to renewal, you have to pay a fee. The required fee differs from state to state. Since the notification of your licensure renewal is sent through the mail, it’s important to update your current address information frequently with your state licensing authority.

The renewal notice is typically sent to you 60 days prior to your license expiration. In most states, the renewal process can be done online. Additionally, in some states CNAs must meet certain continuing education requirements each year prior to license renewal. Your state’s board of nursing will notify you of your specific states CE requirements.

How Do I Renew My Expired CNA License?

Many states require CNAs to renew their license every two years in order to stay actively employed. If you have not received a notification via mail from your states nursing board, there are other ways you can check on the status of your license. Access your states CNA registry online. Most states will have an online certification verification page.

You can query by your name or license number to check the current status of your CNA license. Some states will also have a toll-free number that you can call to check your status.

Additionally, if your CNA license has been expired for more than five years, you will need to complete a new CNA training program and successfully pass your states CNA examination.

Expired License Renewal Process

In order to renew your expired CNA license, you must have been employed as a CNA within the past 24 months. The following steps are the typical process for renewal in most states:

1. Download a nurse aid registry renewal form from your state’s nursing board website.
2. Complete the renewal form with all required personal information, and have your employer fill out the additional information that is needed from them.
3. After your employer completes their required section, sign and date the form and mail it along with required fee to the state nursing board.

If you have not performed CNA work in the past 24 months, you will need to retake the state certification test.