WIN-A-STEP-UP

About the Project

Why focus on frontline caregivers?

If we are concerned about the quality of care of our disabled elders in long-term care organizations, we must also be concerned about the nursing assistants as an occupational group. Nursing assistants provide 80 to 90% of the direct resident care and make up the majority of all nursing home direct care personnel.* Yet, nursing assistant turnover levels in North Carolina's nursing homes have exceeded 100% for the last three years, far above that of LPNs and RNs.** Also, nursing assistants and home health aides are on the list of occupations with the largest job growth expected between 1994 and 2005.*** Nursing assistants share job characteristics with other front line service occupations which include low wages, extensive part time work, few benefits, little job discretion, and physically and psychologically demanding daily work. Clearly, the job situation of nursing assistants needs to be improved.

Overview

The WIN A STEP UP program was created through a partnership with the North Carolina Department of Health and Human Services and the UNC Institute on Aging. WIN A STEP UP is aimed at examining and improving the situation of nursing assistants in the long-term care industry in North Carolina . In the pilot phase, the primary objective was to conduct a comprehensive assessment of the current situation of nursing assistants and to develop educational and incentive programs to improve job quality and reduce turnover in various sectors of the long term care workforce, including nursing homes, adult care homes, and home health, home care and hospice settings. With the closure of a successful pilot program, we have begun the second phase of the WIN A STEP UP program, in which we hope to improve job quality and increase the retention of nursing assistants through the implementation of an educational and reward system in nursing home settings. Our second phase only includes nursing homes, but many of the lessons learned here may be applied to other long term care settings.

What is the WIN A STEP UP program?

WIN A STEP UP is a workforce intervention for nursing assistants in nursing homes in North Carolina . WIN A STEP UP aims to reduce turnover of nursing assistants through providing training, education, and rewards. The WIN A STEP UP program is based on 3 basic principles:

• Education: Education is essential for quality service in long term care and builds competence and self-esteem in the workforce.
• Compensation: Real concern about direct care workers must be reflected in their paychecks and benefits.
• Commitment: All parties who receive benefits from the program should formally agree to contribute to it and be held accountable for performance.

WIN A STEP UP is composed of a 36-hour training package, monetary payments and recognition for participating nursing assistants and nursing homes. The aims of our program are to upgrade the skill base of nursing assistants , increase their career commitment and job satisfaction, and provide rewards and recognition to participants. Through achieving these aims, we hope to decrease turnover and improve job satisfaction of nursing assistants, and enhance the quality of care for North Carolina nursing home residents.

The pilot phase of the WIN A STEP UP program was successful in accomplishing our goals of increasing job satisfaction, job quality, job retention, and the skill levels of nursing assistants. For detailed program results, please click here.

Recent Innovations

North Carolina is the only state in the nation that has been awarded two of the Better Jobs, Better Care grants. These grants are funded from The Robert Wood Johnson Foundation & The Atlantic Philanthropies. A demonstration grant was awarded to the North Carolina Foundation for Advanced Health Programs and an applied research and evaluation grant was awarded to Cecil G. Sheps Center at UNC-CH. These grants are intended to conduct workforce innovations aimed at attracting and retaining high quality paraprofessional direct care workers. More information about the Better Jobs, Better Care National Program is available at www.bjbc.org

 The Cecil G. Sheps Center for Health Services Research at the University of North Carolina was awarded one of the eight applied research and evaluation grants. The new study builds on the successful WIN A STEP UP program . Under the new grant, researchers will study which factors promote or obstruct successful implementation of the program. It will use the findings to improve the WIN A STEP UP program, and develop an "enhanced" program at additional sites. This “enhanced” program will adapt the nationally recognized “Coaching Supervision Training” developed by the Paraprofessional Healthcare Institute (PHI) in hopes to bridge the chasm between nurses and nursing assistants by fostering communication and teamwork. The study will measure the impact of the "comparisons" and "enhanced" interventions on job satisfaction, job and organizational commitment, turnover rates, perceived quality of care, and nursing assistants’ performance. The project will also examine ways to expand the program to home and community-based settings.

By enhancing the working situation of nursing assistants, we are making an effort to improve the quality of care for the residents and clients.

Enrollment Information

See our enrollment information

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* Wunderlich GS, Sloan, FA, Davis CK. Nursing Staff in Hospitals and Nursing Homes: Is it Adequate? Institute of Medicine: Washington, DC, 1996.
** Wage Survey Results. North Carolina Health Care Facilities Association: Raleigh, 1997.
*** Monthly Labor Review, Nov. 1995. US Dept of Labor: Bureau of Labor Statistics, pgs 79-83.