National Nursing Home COVID-19 Action Network
The past 16 months of the COVID-19 pandemic have exacted an enormous toll on the nearly 1 million certified nursing assistants (CNAs) who care for and protect our nation’s nursing home residents. These dedicated workers have put in long hours; experienced stress, anxiety, and loss; and risked getting the virus themselves.

Never has it been more fitting to honor and celebrate CNAs—which makes National CNA Week this year (June 17 through June 24) uniquely special. We at the AHRQ ECHO National Nursing Home COVID-19 Action Network  are grateful and appreciate the critical service that CNAs around the country perform.

This issue highlights a special resource, a toolkit developed by the National Association for Health Care Assistants (NAHCA) to help celebrate CNA Week. In addition, Chris Laxton, Executive Director of AMDA – The Society for Post-Acute and Long-Term Care Medicine, shares his thoughts on how medical directors who work at nursing homes can help address the concerns that many CNAs have about the COVID-19 vaccines.

As always, we are eager to hear your feedback. Please send any questions, comments, photos, lessons learned, or story ideas you have to us at ProjectECHOComms@salud.unm.edu.

And, once again, thank you for all you do to protect our nation’s nursing home residents and each other.

Sincerely,

David Meyers, MD, Acting Director, Agency for Healthcare Research and Quality

Kedar Mate, MD, President and CEO, Institute for Healthcare Improvement

Sanjeev Arora, MD, Founder and Director, Project ECHO
 

Featured Resource

NAHCA Guide To Celebrating CNA Week

The service that certified nursing assistants (CNAs) perform—caring for and protecting our nation’s nursing home residents—is critical, and never more so than during these past 16 months. To celebrate and support CNA Week (June 17-24), the National Association for Health Care Assistants (NAHCA) created this toolkit to build recognition and support for these dedicated workers, who make such a powerful difference in the lives of America’s elderly.

The toolkit is designed for nursing home leaders to use in celebrating CNAs via social media and within the walls of their facilities. It includes downloadable and appropriately sized social media posts for use on Facebook, Twitter, and Instagram. It also features a downloadable CNA appreciation video in a file format that is compatible with most platforms, as well as registration links to a two-part webinar series NACHA has organized to help CNAs feel empowered, confident, and secure on the job.
 

From the Field
Chris Laxton: How Medical Directors Can Help Address CNAs’ Concerns Around COVID-19 Vaccines
 
Chris Laxton is the Executive Director of AMDA – The Society for Post-Acute and Long-Term Care Medicine, the professional association of medical directors, attending physicians, and others practicing in the long-term care continuum. In the pandemic era, Mr. Laxton believes that medical directors who work at nursing homes have an increasingly important role to play, particularly with regard to creating work environments where frontline staff, including certified nursing assistants (CNAs), feel safe and protected. 
 
Q: How can medical directors help address the concerns that many CNAs have about the COVID-19 vaccines?
 
A: Medical directors, especially the most engaged ones, know the direct care staff well and have a trusting relationship with them. Medical directors have always viewed CNAs as critical members of the clinical care team. Essentially, the CNAs are the people who know the patients best because they're at their bedsides the most, and they know the families best. Medical directors rely on CNAs for good information about patients, and, in turn, the CNAs rely on medical directors to be their advocates and help them problem solve.
 
CNAs are under a great deal of stress under the best of circumstances, and that’s gotten much worse during the pandemic. Medical directors can act as calming voices. They can help CNAs who are experiencing high levels of anxiety around the virus, and they can also be really helpful and persuasive in addressing the anxieties that CNAs have around the vaccines.
 
We’ve had a lot of headwinds to fight on the misinformation front, mostly from social media, which is where many CNAs get their information, and most of it frankly is wrong. The medical directors can speak to the evidence, and they have credibility with CNAs. They can break through the resistance that administrators and others sometimes encounter when trying to persuade frontline staff to get vaccinated.
 
Q:  What are medical directors doing to help increase vaccination rates among direct care staff?
 
A: Some medical directors around the country have been quite active, participating in webinars for large audiences and town halls for the facilities they work in, where people gather in a room for questions and answers, and even having one-on-one conversations with those staff members who are most resistant and afraid of the vaccine or don’t believe it’s effective or safe. These are the folks an engaged medical director can sit down with one-on-one to talk through their concerns.
 
Q: How do these one-on-one conversations work best?
 
A: When a CNA has a concern, no matter how irrational it might sound—like this vaccine is going to mess with my DNA or it’s going to micro-chip me or make me lose my baby—they need someone who will listen to them and meet them where they are. A medical director can say, “I hear that’s a concern you have, but here’s what the real story is. We’ve done studies on pregnant women, and we found that the vaccines are not harmful to either the mother or the child.”   Or, “This is a messenger RNA vaccine that essentially disappears after it passes its message along to your immune system, so it can’t affect your DNA.” These are the sorts of things that a medical doctor can discuss with the CNA because they already have a trusting relationship.
 
Q: What do you see for the future?
 
A: This won’t be our last pandemic, and even people who are fully vaccinated will likely have to get booster shots to protect them against new viral variants.  Medical directors can work with their clinical teams on these issues, in much the same way they do around seasonal flu vaccines, to persuade frontline staff to get vaccinated.
 
COVID, for all the tragedy and suffering and death that it’s caused, has revealed the degree to which trained and engaged medical directors can make a difference in the care of frail older adults and in the work environments that the clinical teams operate in. They can be good problem-solvers and they can be good advocates because there are not on staff themselves; they’re contracted to provide medical oversight and quality assurance as the law requires, so they’re viewed as honest brokers. I hope that this pandemic will give nursing homes a better appreciation for what medical directors can do and how they can use them more effectively.

Additional Resources

  • The Agency for Healthcare Research and Quality has developed resources to help nursing home staff track COVID-19 vaccine administration data for residents and staff, support efficient data collection on vaccination rates,  identify vaccine hesitancy, and coordinate next doses. These tools can aid in data compilation for reporting to the National Healthcare Safety Network. Check out the resources here.
  • Healthcare providers have been overwhelmed with the unprecedented experience of providing care during the COVID-19 pandemic. Many are dealing with mental, physical, and emotional burnout from being on the frontlines. The Emotional PPE Project is a platform that connects healthcare workers with licensed mental health professionals free of charge. Click here to learn more.
  • The U.S. Department of Labor Occupational Safety and Health Administration released updated guidance this month on mitigating and preventing the spread of COVID-19 in the workplace, including protections on unvaccinated and otherwise at-risk workers and encouraging COVID-19 vaccination.