CNA Bonus Plan

Mariesmith · Mar 30, 2016

Hi there,

I'm a Compensation Analyst for the LTC world.

With that being said I am attempting to design a bonus plan for CNAs. (Before anyone goes crazy, we are doing something for LVN/LPNs and RNs) My goal is to give CNAs the ability to control their earnings based on their performance. Since I am not in a center I don't have first hand knowledge of what separates a good CNA from a not so good CNA. (Before you tell me to ask my own CNAs, please know that I can't and that's why I am here).

I'm reaching out to you to help me design the perfect CNA bonus structure for individual performance. Things to consider:

What should a CNA be measured on?

How easy would it be for a Supervisor to keep track of the CNAs performance?

Should a CNA be rewarded on a monthly, quarterly or annual basis?

What are some fair eligibility rules?

Any help would be greatly appreciated, not just from me but the 6,000+ CNAs my company employs nationally.

Respectfully,

Just someone trying to make a difference.

MedChica · Mar 30, 2016

A bonus plan for 'the heart of the nursing home'.

Yeah, because the rest of us run around, miss breaks, work off the clock, leave late and do nurse aide AND nursing tasks due to shortstaffing because we... don't care? The heart of the facility typically stands at the clockout machine 5 to 10 minutes before shift ends. Our aides work hard but let's be real, here.

I don't need a slap on the back but everyone busts ass in the nursing home sweatshop. Nursing, housekeeping, dietary and maintenance. It's not one group more than the other.

"Perhaps we could find a way to evaluate and track ---" Uh, uh. I dont like the sound of this already. I, for one, am not keeping track of or documenting *expletive*! If you pay them and support them? They will come and stay.

If you want to give money, offer more money per hour. The end.

The fact that you offer gimmicks instead of actual benefits is telling. I wont even pretend to be shocked. Frankly, I dont know how youd track anything but you guys are going to have to handle it on your own. No one on the floor has time to be doing corporate 'busy work'.

Ive found a very nice facility. Well staffed. Pays very well. Training is great and the only reason why it runs so efficiently, Im convinced, is because the CEO is a NURSE.

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

A bonus plan for 'the heart of the nursing home'.
Yeah, because the rest of us run around, miss breaks, work off the clock, leave late and do nurse aide AND nursing tasks due to shortstaffing because we... don't care? The heart of the facility typically stands at the clockout machine 5 to 10 minutes before shift ends. Our aides work hard but let's be real, here.
I don't need a slap on the back but everyone busts ass in the nursing home sweatshop. Nursing, housekeeping, dietary and maintenance. It's not one group more than the other.
"Perhaps we could find a way to evaluate and track ---" Uh, uh. I dont like the sound of this already. I, for one, am not keeping track of or documenting *expletive*! If you pay them and support them? They will come and stay.
If you want to give money, offer more money per hour. The end.
The fact that you offer gimmicks instead of actual benefits is telling. I wont even pretend to be shocked. Frankly, I dont know how youd track anything but you guys are going to have to handle it on your own. No one on the floor has time to be doing corporate 'busy work'.
Ive found a very nice facility. Well staffed. Pays very well. Training is great and the only reason why it runs so efficiently, Im convinced, is because the CEO is a NURSE.

"The heart of the facility typically stands at the clockout machine 5 to 10 minutes before shift ends. " Bingo! :yes:

smartassmommy · Mar 30, 2016

Great! What would you consider a "Safe patient/staff ratios"? Seriously guys, I'm an actual Corp. person who is trying to hear what you have to say and make a change for the better. Now I could be like the majority of Corp. people who assume they know what is best for you but I rather hear from the people that my decisions directly effect.
So if "Fake rewards" as you so eloquently put it, what are some ideas that would make a CNA feel recognized. That's all I'm trying to do.

Try the New Jersey model that their gov. Vetoed. No more than 6 on days. 10 on nights. Then up the ante, assign by level of care needed so that no one gets all limited assists and no one gets all total care. Or double the number and assign in teams of two.

canigraduate · Mar 30, 2016

I worked as a CNA in the nursing home realm. It sucks sideways.

How you keep good CNAs is recognition, ratios, good pay, and good management. Most leave because they are overwhelmed or because they are leaving their manager.

I left because my ADON was a **** and flirted with the docs all day while watching us drown, then yelled at us for doing our jobs. I got screamed at for talking to a family member who was concerned about his mother's care, before I even clocked in. I was at work 20 minutes early, as is my habit, and was talking with the family member on my own time. I took this to the DON and was told not to be there early and that talking to family members was not part of my job. All the guy was asking was for me to make sure his mom was ready to go when his sister picked her up to take her out for dinner, then we chit-chatted. This was just the inciting incident that made me want to leave, there were several other incidents where I was reamed for no reason.

So, for practical suggestions. Most LTCs have a newsletter. The ADON, DON, or other designated person can ask around for compliments to the CNAs and nurses and publish them in the newsletter. Instead of a bonus, give the good CNAs and nurses raises. And offer management classes to the DONs and ADONs so they don't treat their people like crap.

As for ratios, it depends on the facility and it's needs. A lot of states have minimum regulations for staffing. Ideally, double that. In reality, you need to increase the minimum by at least 25-50%. If your state doesn't have minimum staffing regulations, then call the facilities and ask the DON/ADON what their ideal would be. I don't know enough about general staffing to even give you suggestions. It would be different depending on the average acuity of the patients. For example, an LTC with a lot of vents, wound care, and total care patients is different than an LTC with mostly walkie-talkie patients.

I hope that helped.

BTW, this site doesn't do the reply directly under the post you're replying to. You'll need to use the "Quote" feature so we know who you are talking to.

OCNRN63, RN · Mar 30, 2016

Thank you for understanding where I am coming from.

Please use the "Quote" function so we know whose post you're responding to.

dishes, BSN, RN · Mar 31, 2016

@mariesmith, Do you do conduct staff surveys on patient safety culture?

Mariesmith · Mar 31, 2016

@mariesmith, Do you do conduct staff surveys on patient safety culture?

We do staff surveys but the questions are too vague and very structured. What you see in the results and what you actually see/hear what is happen are two different things.

ComeTogether, LPN · Mar 31, 2016

YES! This is a great idea.

Monthly, because yearly doesn't give you enough time to catch the unhappy ones who are good and leave due to burnout.

CNAs are absolutely the heart of healthcare, and I say that as I am preparing to take the NCLEX. It's an absurdley difficult job with little to no respect or thanks. A good CNA truly is worth their weight in gold. The reason I say this is because CNAs have to love what they do in order to do it well, as there is little pay involved and the job is grueling. Nurses have an equally difficult job, but it's just difficult in different ways.

CNAs should be measured on their competence, how well they "get it", and how well they work with their nurses. There isn't any reason there can't be a team atmosphere where the CNAs and Nurses work hand in hand.

Being on time should be a given, but a lot of the time it isn't. I think there should be some type of system in place that takes away a reward of some kind if they're late so many times in a month.

Patient care, how happy are the patients? Is there one CNA who is asked for when she or he is off? These are the kinds of CNAs we need to be retaining.

Feedback from the nurses as well as the other aides. CNAs who "hide" during their shifts should be appropriately reprimanded, I can't count the number of times I've come across this.

I worked my tail off as a CNA and honestly, I'd have done it forever if I could have. I absolutely loved it.

Ask them, listen to their answers and try to change the things that you can. That in and of itself will make a world of difference. Having 16 patients to provide care for is not easy, and it's especially not easy if the staff you work with aren't team players.

They can be evaluated a few different ways. You can check to see if the patients are being checked/changed by marking the briefs discretley prior to applying them on the confused patients. (Mark it with a dot in an inconspicuous place prior to applying it. If its still there 4 hours later, you know that pt hasn't been changed, etc. )

Aside from that, its really just feedback and asking the staff.

I think its a great idea, if we find and retain the good aides it would really make a world of difference.

neuron · Mar 31, 2016

A compensation plan would be to pay them 'per job'. For example, a hoyer lift transfer pay them extra for it, or pay per bath, if a CNA gives 3 baths per day, and sometimes they have to do 6, give them extra money for that.

Been there,done that, ASN, RN · Mar 31, 2016

A compensation plan would be to pay them 'per job'. For example, a hoyer lift transfer pay them extra for it, or pay per bath, if a CNA gives 3 baths per day, and sometimes they have to do 6, give them extra money for that.

:sarcastic: How much would the RN get for CPR, pain medication administration, disimpaction, or suctioning a trach?

ShaneTeam · Mar 31, 2016

How much would the RN get for CPR, pain medication administration, disimpaction, or suctioning a trach?

300 each? oh, 400 for the last two. I mean Ewwww.