Health Care Workforce Needs in Wyoming: Update 2017

Chapter 4: The Education and Career Pathways of Certified Nursing Assistants

by: Lynae Mohondro, Senior Research Analyst

This chapter will look at the career pathways of certified nursing assistants (CNAs), and focus on those certified in Wyoming in 2010 and their role in the labor market.

The success of individuals in the workforce can vary based on decisions they make regarding education and training. A high school graduate who enrolls in postsecondary education will likely experience different outcomes than a high school graduate who goes directly into the workforce. Understanding typical routes or pathways to employment can help researchers and policymakers understand how different groups of individuals could use education, work experience, and training programs to improve their professional opportunities.

The Workforce Innovation and Opportunity Act (WIOA) provides many definitions of a career pathway. Most applicable to this chapter, WIOA states that a career pathway “is a combination of rigorous and high quality education, training, and other services that … organizes education, training, and other services to meet the particular needs of an individual in a manner that accelerates the educational and career advancement of the individual to the extent practicable” (U.S. Department of Labor, 2014). How well such planned strategies might perform depends on how well the naturally occurring pathways are understood.

Considering the population being evaluated is as important as considering the outcomes of individuals who followed different paths in pathway evaluation (SWEAP, 2015). For example, a study of a population of high school graduates and non-high school graduates may not produce the same outcomes, regardless of the path taken. The Research & Planning (R&P) section of the Wyoming Department of Workforce Services recently produced Wyoming Career Assist, which provides demographic and employment data of University of Wyoming and Wyoming community college graduates working in Wyoming and 11 partner states¹ from five years prior to graduation to five years after graduation. Knowing the conditions of a population before an event, such as graduation from a training program, can help to understand the outcomes of the same population on similar career pathways. For more information on Wyoming Career Assist, go to http://doe.state.wy.us/LMI/education_we_connect/2017/consumer_reports_intro.htm.

Nursing Pathways

Direct care workers who provide long-term care made up 20.8% of the health care workforce in 2014 (GAO, 2016). These workers include home health aides, psychiatric aides, personal care aides, and nursing assistants. Difficulties in recruiting and retaining direct care workers and an aging population who need the services of direct care workers have increased concerns of a possible shortage of this portion of the workforce in the near future. Understanding the career pathways of the individuals in these occupations may shine a light on the root of the issue surrounding the shortage.

While students may withdraw from or enroll in any program that fits their current interests, one pathway that seems more natural is that of nursing occupations, or the progression from a CNA to a registered nurse (RN). For those individuals who would like to work in a nursing occupation, several licenses and certifications exist with varying education and training requirements. The most easily attainable certificate for a nursing occupation is for a CNA. According to O*Net Online (n.d.), a CNA may perform tasks such as feed, bathe, or change linens for patients while under supervision of an RN or licensed practical nurse (LPN).

In Wyoming, “an individual can only become a CNA by completing the Wyoming Department of Health approved educational program, successfully passing a national written and skills exam, applying and being granted certification. Once certified, a CNA can take additional coursework/test to expand to level two (CNA II) certification or Medication Aide-Certified (MA-CE)” (Burns, 2017). The minimum requirements to become a CNA include 75 hours of training, at least 16 of which must be in a classroom and 16 must be practical training (Knapp, 2017). Additional training and education allows the certified individual more responsibilities; for example, a CNA can obtain an associate’s degree to become an RN and work without the supervision required as a CNA.

In 2012, R&P published dashboards that provided employment, Unemployment Insurance (UI), and Workers’ Compensation data for CNAs, LPNs, and RNs working in the health care industry (NAICS 62) from third quarter 2009 (2009Q3) to third quarter 2011 (2011Q3; Leonard, 2012); these dashboards are available online at http://doe.state.wy.us/LMI/nursing/2012/DASHBOARDS_COMPLETE_FEB2012.pdf.

Table 4.1 provides some updated information from the 2012 dashboards and shows the number of CNAs who worked in Wyoming in health care & social assistance (NAICS 62) from 2009Q1 to 2015Q4 by age groups. In 2010Q3, just over one-fourth (26.5%) of the 3,326 CNAs working in Wyoming in health care & social assistance were under age 25. By 2015Q3, the percentage of CNAs under age 25 increased to 29.8% (of 3,178 CNAs). The percentage of CNAs age 65 and older also increased from 2010Q3 (2.3%) to 2015Q3 (2.9%); the percentage of all other age groups decreased. The decrease in percentages of those between the ages of 25 and 54 with an increase in the percentage of the younger age group indicates that as a whole, CNAs in Wyoming who worked in health care & social assistance became younger. Employers in this industry appear to rely on younger workers, such as those who get training right after high school, to fill their CNA positions.

Between 2009Q3 and 2011Q3, CNAs worked for the same primary employer in health care & social assistance for more than three and a half years on average, compared to RNs, who worked for the same primary employer in the health care industry for almost six years on average (Leonard, 2012). The high turnover of CNAs could be a result of those individuals returning to postsecondary education to obtain a higher degree, such as an LPN license or a degree in registered nursing. In addition, nursing students may use their CNA certification as a way to fund their education by working as a CNA while enrolled in postsecondary education.

To illustrate career pathways, Table 4.2 shows the educational outcomes for the 5,833 individuals that held a CNA certificate in Wyoming in 2010. Of those 5,833 CNAs, 50.5% enrolled in postsecondary education in Wyoming, either at the University of Wyoming or the community colleges, after they became certified as CNAs but before or during 2014/15, the most recent school year for which data are available (see Table 4.2). During this time, 1,763 (30.2%) individuals with a CNA certificate did not obtain another certificate or degree from a Wyoming postsecondary education institution. Individuals with CNA certificates who earned an associate’s degree (8.7%) and CNAs who earned a bachelor’s degree (4.1%) made up the next most common academic achievements of all certified CNAs. These individuals may have returned to school to earn an associate’s or bachelor’s degree to increase their wages, or they may have been financing their degree by working as a CNA. Table 4.2 also shows the number and percentage of CNAs with other academic awards by 2015.

The degree a CNA obtains and whether or not that individual continues working in Wyoming or goes to work in a partner state results in different outcomes. Of all 5,833 individuals holding a CNA certificate in 2010, more than 75% worked either in Wyoming or a partner state from three years prior to becoming certified to five years after (see Table 4.3). One year after becoming certified, 89.6% of CNAs earned wages in Wyoming or a partner state. The median annual wage of these CNAs increased by over $9,000 (63.9%), from $14,759 three years before becoming certified to $24,189 five years after becoming certified.

For the purposes of this chapter, if an individual worked in Wyoming and a partner state in the same quarter, that individual is counted as working in the state in which he or she earned the highest wages. One year after becoming a CNA, 4,911 individuals (84.2%) earned wages in Wyoming (see Table 4.3). Overall, as with many other populations, the CNAs who held a certificate in 2010 gradually left Wyoming’s workforce, and a greater percentage were found working in a partner state or could not be found working in Wyoming or a partner state (see Figure 4.1). By the fifth year after obtaining certification, 66.4% of CNAs from 2010 worked in Wyoming and earned an annual median wage of $24,766. The number of CNAs who worked in partner states nearly doubled from the first year after certification (318 individuals) to the fifth (631 individuals), and the number of individuals not found working in Wyoming or a partner state increased from 604 from 1,327. The time period five years after the 2010 CNA cohort became certified coincided with the time when coal, natural gas, and oil prices dropped and triggered economic contraction in the state. With the data currently available to R&P, it is not known if the increase in CNAs working in partner states or not found is due to the downturn or other reasons.

Whether a CNA enrolls in postsecondary education and earns a degree after certification or not after affects his or her employment outcomes. As shown in Table 4.2, approximately half (2,873, or 49.3%) of all CNAs from the 2010 cohort did not enroll in postsecondary education after becoming certified in Wyoming. Five years after becoming certified, 35.7% (2,081) of CNAs never enrolled in postsecondary education, and earned an annual median wage of $24,859 (see Table 4.4). The CNAs who enrolled in postsecondary education in Wyoming but did not obtain a degree earned the lowest annual median wage ($20,419) five years after becoming certified.

Of all CNAs presented in Table 4.4 and shown in Figure 4.2, the CNAs who earned a certificate, an associate’s degree, and a bachelor’s degree between their date of certification and 2015 earned the lowest wages three years prior to certification. By the fifth year of holding a CNA certificate, these individuals made up just 0.6% of the cohort found working, but earned the highest annual median wage of $49,945. CNAs who obtained a bachelor’s degree by 2015 made up 4.3% of the cohort found working and earned the second highest wage of $39,023. Table 4.4 also shows the employment and wage data for CNAs that chose to obtain other academic awards by 2015. The wages presented in Table 4.3 and Table 4.4 are nominal and do not account for inflation over the eight-year period.

By 2015, the majority (57.8%, or 3,370 individuals) of the 2010 CNA cohort no longer held a certificate or license from any licensing board in Wyoming (see Table 4.5). Overall, almost 70% of the entire cohort took a different career path, whether that included becoming licensed in another area of health care other than as a CNA or going to work in a different industry entirely. By 2015, only 30.7% (1,792 individuals) of the 2010 CNA cohort still held a CNA certificate as their highest license, while almost 10% went on to obtain a license in another type of nursing: 8.6% became licensed as an RN and 1.3% became licensed as an LPN or vocational nurse. Table 4.5 also lists other licenses held by the individuals from the 2010 CNA cohort in the health care industry.

Although 3,370 individuals from the 2010 CNA cohort no longer held a certificate or license from a licensing board in Wyoming in 2015, many continued working in health care (756 individuals) and in Wyoming (1,313 individuals). Table 4.6 shows the industries and state in which individuals from the 2010 CNA cohort worked in 2015 if they did not hold a certificate or license in 2015. Of the 756 individuals still working in health care, 342 (45.2%) worked in a partner state. These individuals may have obtained CNA jobs in another state and no longer needed to remain certified in Wyoming. After health care and social assistance, CNAs from the 2010 CNA cohort who were not certified or licensed in 2015 worked in retail trade, accommodation & food services, and educational services. Of the 3,370 individuals from the 2010 CNA cohort, 1,475 (43.8%) did not work in Wyoming or the 11 partner states.

Possible Reasons for Change

A natural progression towards becoming an RN starts with a CNA certificate. While 8.6% (501 individuals) of the 2010 CNA cohort did obtain an RN license by 2015, the majority (57.8%, or 3,370 individuals) did not have a certificate or license in Wyoming at all. In addition, a relatively high percentage of those individuals went to work in lower paying industries in 2015 (retail trade and accommodation & food services; see Table 4.6). The reasons why the majority of the CNAs in the 2010 cohort did not continue working as CNAs or obtain a higher health care license are unknown. One issue encouraging CNAs to leave the health care industry could be workplace safety. As discussed in Chapter 7 of this publication, CNAs had the highest incidence rate of workplace injuries in the health care industry. Although there could be many other reasons why CNAs do not remain certified, the movement of former CNAs into the lower paying industries of retail trade and accommodation & food services suggests that wages may not be a common reason. Future pathway evaluations may provide a better understanding of why so many CNAs do not enter into higher paying licensed occupations in the health care industry.

Conclusion

Analyzing different career pathways of populations provides a better understanding of the population’s role in the workforce and what leads to successful outcomes. For example, individuals interested in working in a nursing occupation have many options for education and training. CNAs who eventually obtain a degree earn much higher wages than those who do not enroll in postsecondary education and those who enroll but do not earn a degree. Understanding the conditions of the economy also allows for a better understanding of why certain populations follow the paths that they do, such as going to work in a partner state or enrolling in postsecondary education during a time of economic contraction.

In addition, policymakers can use career pathways to understand shortages of occupations to produce successful solutions to the issues. For example, as noted earlier, concerns of a shortage of direct care workers exist (GAO, 2016). However, in Wyoming, many people train to acquire the skills to obtain certification as a CNA, but most do not remain certified as CNAs five years later.
Similar studies to the one in this chapter may apply to the natural pathways of other occupations as well. Future pathway evaluations will analyze different populations over time to identify student pathways that lead to success.

References

Government Accountability Office. (August, 2016). Long-Term Care Workforce: Better Information Needed on Nursing Assistants, Home Health Aides, and Other Direct Care Workers. Retrieved April 17, 2017 from http://www.gao.gov/assets/680/679100.pdf

Knapp, L. (personal communication, March 28, 2017).

Burns, J. (personal communication, May 30, 2017).

Leonard, D. (2012). Dashboard: Nursing employment in Wyoming. Retrieved March 28, 2017, from http://doe.state.wy.us/LMI/nursing/2012/DASHBOARDS_COMPLETE_FEB2012.pdf

O*NET Online. (n.d.) Summary report for: 31-1014.00 - nursing assistants. Retrieved April 6, 2017, from https://www.onetonline.org/link/summary/31-1014.00

U.S. Department of Labor. (2014). Workforce Innovation and Opportunity Act, H.R. 803 §3(7)(E), 2014. Retrieved April 11, 2017, from https://www.doleta.gov/wioa/

¹ Partner states are those state labor market information (LMI) offices with which Research & Planning has data-sharing agreements: Alaska, Colorado, Idaho, Montana, Nebraska, New Mexico, Ohio, Oklahoma, South Dakota, Texas, and Utah.