CNA Bonus Plan

JustBeachyNurse, LPN · Mar 30, 2016

While a noble idea I think your highly misguided. Without nurses you have no CNAs. Period. Put the compensation plan into better staff ratios. Better ratios > more effective staff >> happier staff + happier residents + happier families and reduced negative outcomes when you have proper ratios of adequately paid staff

Farawyn · Mar 30, 2016

Why have a bonus plan just for CNAs? I don't understand the though process behind this. All LTC staff are generally overworked and underpaid. Most companies and facilities implement 6 month and/or annual raises so I don't see how you could better that.

Because we, as nurses, see through it.

Farawyn · Mar 30, 2016

You know that's not what I'm saying. As said previously, nurses bring the brains. But CNAs truly are the hearts.

So, you say it again?

I agree with BTDT.

I have worked with amazing, loving CNAs.

Nurses can work without CNAs, not the other way around.

OP, have you asked your CNAs what they want?

MagsMom · Mar 30, 2016

We recently put an incentive plan in place to decrease turnover and increase investment in the work. We give incentives every quarter - monthly is too soon to make it meaningful for long term commitment and yearly is too long for someone to wait to make it a reality. It is hard to determine what you would measure since I am not in that environment - but a few things that might be comparable are - attendance (including lates and early leaves), customer service (through quality surveys by patients) and professionalism (we audit performance each quarter) - as I said this might not translate to your setting but since we have implemented the program we have seen far fewer missed days of work and better attitudes. Hope that helps.

Tenebrae, BSN, RN · Mar 30, 2016

- Pay them more

- Decrease the staff/patient ratio

Much happier CNAs

allnurses Guide · Mar 30, 2016

Another vote here for adequate staffing, but suspect the entire true motivation is to squeeze more work out of already overworked people rather than spend the money needed to staff appropriately. Bonuses are much cheaper after all. Especially if they come in the form of "recognition" rather than money.

How about accepting a slightly smaller profit margin in exchange for safer staffing? After all, that is the one thing consistently demonstrated in the research to actually equate to fewer falls, fewer bedsores and higher satisfaction scores. Call me crazy but why not try that? You will see all staff performance improve, not just CNAs.

Anonymous865 · Mar 30, 2016

The OP asked for ideas for assessing CNA performance, because she is working on the compensation plan for CNAs.

She may not be responsible for the compensation plan for nurses.

She may have already completed the compensation plan for nurses.

The compensation analysis for nurses might not be scheduled until December.

Just because she is looking at a way to better compensate the CNAs does not mean nurses are being ignored.

The compensation analysis may show that CNAs are being paid a comparable rate to other CNAs in the area, but the analyst wants a way to give them more money. That is when you look to bonuses.

A pay raise commits the company to spending that money from now until forever.

A bonus can be given this year if the company is profitable, but not given next year if the company is bleeding red ink. If you give everyone a raise, you can't take the raise back next year. Because of that, it is easier to get bonuses for employees than it is a pay raise.

It is like in your home budget, you may be willing to spend $5K for a one time home improvement, but you think long and hard about taking on a debt that costs you an additional $300 a month for the next 20 years.

To answer the OP's question -

I worked for a system of 8 acute care hospitals, inpatient psych hospital, home health, physician offices, etc. That system gave annual bonuses. The bonuses were based on

1. employee had to get "meets expectations" or better to be eligible for bonus

2. bonus $s were based on how well the hospital performed on various performance metrics like patient satisfaction surveys, joint commission survey, infections, pressure ulcers, falls, etc.

3. bonus $s were also based on how well the individual unit performed on various performance metrics

4. the amount of money available for bonuses was based on how well the system did financially that year. The better the system did, the more money for bonuses.

I'm not sure if this would relate to LTC.

One thing to consider is what behavior do you want to encourage?

Do you want to encourage greater teamwork? Then tie bonuses to how well the unit does.

Are you concerned about pressure sores, falls, etc. Then tie bonuses to reducing the number of pressure ulcers and falls from last year's number.

The system I worked for changed what metrics they were looking at each year to determine bonuses. The employees knew at the beginning of the year what metrics were being used to determine the bonuses for that year.

Conqueror+, BSN, RN · Mar 30, 2016

The only sytem that I have seen work is an attendance bonus. It was paid monthly and there were two tiers. I do not remember the exact amount but I think it was $100 if no absences and an additional $50 if no tardies. Our chronic short staffing seemed to disappear overnight and the late birds became extinct. It worked well because it was completely in the hands of the employee and could not be blamed on "that nurse does not like me" or "Sandra sucks worse than me and she got it". There was never an argument when the bonus was not received and it improved morale a great deal.

ShaneTeam · Mar 30, 2016

OK.

OP, I do applaud your efforts to try to get something more for your CNA's, who work really hard at what they do, and get little recognition for it. Your company's heart is in the right place, however no matter how innocent your first line was in your post, the nurse is the heart of the facility. The previous remarks are made because that particular platitude has been shoved down nurses' throats for years now, and while other workers are indeed VERY important to the care of the residents, nurses do get tired of that line. I would be first in line to make sure CNA's are adequately compensated, but it should be ALL employees, not just a particular set of employees. That plan will sow discourse among your employees.

As far as the PP talking about bonuses in the hospital setting, yes, some of the metrics can cross over, but in the hospital I am at, the quarterly bonuses are for everyone, including custodial, dietary, business office, nursing, etc. NOT just CNA's. Yes, they may have done a separate bonus plan for nurses, but the OP stated she fights everyday to ensure everyone knows the CNA is the heart of the facility. The other posters have given excellent advice on how to reduce falls, PU occurrences, and to increase staff morale. And I completely understand how feasible those may not be, but those suggestions are coming from the front line.

Before any CNA's start on me, I DO appreciate what you do. You make every nurse's life much easier, because all that you do is part of our job. We delegate to you what you can do to assist us, so we will have time for the things that need to be done that you can NOT do. And, yes, I started my healthcare career as a CNA. In LTC. For 4 years (Actually 7, if you count the time I was working while going to school, but that was in the hospital). To this day, I will put myself on the floor as an aide when we have call-ins, and leave the LPN as charge. It is a wonderful change of pace, and I still enjoy it.

One final note, PLEASE OP, do not make the mistake that just because the nurses make the assignments for the CNA's that they are supervisors. They are not. The CNA's are not their employees, the person who does their performance evals is. The nurses are responsible for the care of the resident. Offering something to the CNA's and not the nursing department in its entirety is the same thing as offering something only to first shift, and not the other shifts. Please think of that BEFORE implementing anything. I do not envy your position, and I wish you luck in whatever you decide.

ShaneTeam · Mar 30, 2016

The OP asked for ideas for assessing CNA performance, because she is working on the compensation plan for CNAs.

Yes, she did. Can a moderator please move the discussion to the LTC Director thread? I think the OP will get the responses she is looking for there.

ShaneTeam · Mar 30, 2016

So, you say it again?
I agree with BTDT.
I have worked with amazing, loving CNAs.
Nurses can work without CNAs, not the other way around.
OP, have you asked your CNAs what they want?

Love it. Far, your tell it like it is still remains refreshing.

Been there,done that, ASN, RN · Mar 30, 2016

The only sytem that I have seen work is an attendance bonus. It was paid monthly and there were two tiers. I do not remember the exact amount but I think it was $100 if no absences and an additional $50 if no tardies. Our chronic short staffing seemed to disappear overnight and the late birds became extinct. It worked well because it was completely in the hands of the employee and could not be blamed on "that nurse does not like me" or "Sandra sucks worse than me and she got it". There was never an argument when the bonus was not received and it improved morale a great deal.

Wish I got a bonus for showing up and on time. Attendance and punctuality are a requirement of employment.

Now in order to meet that requirement... a BONUS must be paid???