CNA Retention Strategies for Long-Term Care

I have spent the past decade in healthcare staffing. That means I have spent a lot of time on the other side of the CNA retention problem.

When a nursing assistant leaves a building for agency or contract work, they tend to tell the recruiter why, and they are often more honest with the recruiter than they were with their director of nursing. After enough of those conversations you notice that the reasons repeat, and that the hourly rate is only one of them.

I am President and COO of Uniti Med and GQR Healthcare and COO of Nebula, and I speak to long-term care audiences across the country, from state health care associations to LeadingAge and AHCA events. This is the honest version of what I would tell an administrator or DON who asked me how to keep their CNAs. Some of it will sound obvious. The buildings that keep their aides are the ones that actually do the obvious things, every shift.

Why do CNAs leave for agency work?

Pay is part of it, and pretending otherwise does not help anyone. But agency work offers more than a higher rate. It offers control over when you work, the ability to walk away from a building that treats you badly, and a fresh start somewhere nobody has written you off yet. When a CNA chooses that over a permanent job with benefits, they are usually telling you something about the permanent job.

The reasons that come up again and again are not complicated. The first week was chaos. The charge nurse was short with them in front of residents. They were always the one floated or asked to stay over. Nobody learned their name. The schedule changed with no notice. They could not see any future beyond the same assignment. Every one of those is something a building controls.

That is not a criticism of long-term care leaders. Most of them are doing heroic work with too few people. It is a reminder that the fix for CNA turnover lives mostly on the floor, not in the recruiting budget.

What should a CNA’s first week look like?

The first week is where a lot of CNA turnover is decided. A new aide who is handed a full assignment on day two, with a preceptor who is also carrying a full assignment, learns that this building will burn them out. Some of them never come back for day three.

Have a real preceptor. Pick experienced CNAs who want to teach, give them a lighter load while they precept, and thank them for it. Your preceptors are your retention program.

Start on a predictable unit. Keep new aides on the same hall and the same shift for their first stretch, so they learn residents and routines before they get floated.

Introduce them to people. The charge nurse, the DON, the dietary lead, the unit secretary. Being known by name in the first few days matters more than any welcome folder.

Check in at the end of every shift for the first week. Two minutes: How did today go? What was hard? What do you need tomorrow? It is the cheapest early-turnover prevention there is.

Why is the charge nurse so important to CNA retention?

Because for most CNAs, the charge nurse is the boss they actually experience. The administrator may be wonderful, but a CNA works next to the charge nurse every shift. If that relationship is respectful, aides will put up with a lot. If it is not, nothing else you do will hold them.

People quit people, not companies. It is the title of one of my keynotes, People Quit People, Not Companies, and nowhere is it truer than in a nursing home. Many charge nurses were promoted because they were excellent clinicians, and nobody ever taught them how to lead a team of aides under pressure. Give them that training. Teach them to correct in private and thank in public, to ask before assigning the hardest residents to the same person every day, and to stand up for their aides when a family member is out of line.

Then measure it. Look at CNA turnover by unit and by shift. If one hall loses aides at twice the rate of the others, the problem is rarely the residents on that hall.

How do schedules affect CNA retention?

A lot of CNAs are juggling children, second jobs, school and transportation. A schedule that changes every week, or a culture where the reliable people are always asked to stay over, pushes them straight toward the flexibility of agency work.

You do not have to match agency flexibility to compete with it. You have to be predictable and fair. Post schedules well in advance. Let staff trade shifts without a pile of approvals. Spread mandatory overtime evenly instead of leaning on the same people. Consider shorter shifts or self-scheduling options for people who need them. And protect the things people tell you matter, like a standing night off for a child’s activity. A promise kept on the schedule is worth more than a bonus.

What kind of recognition works for CNAs?

Recognition that is specific, quick and from someone who saw the work. Not a pizza party when the building is short-staffed, which tends to land as an insult, but a charge nurse saying “the way you calmed Mrs. Johnson down during her shower made her whole morning” in front of the rest of the shift.

That is the heart of my keynote The Power of Small Moments. Culture is not built in the big moments. It is built in the ones nobody thinks are important. Share notes from families with the aide who earned them. Let residents and families nominate staff. Have leadership walk the night shift once in a while. None of it costs much, and all of it tells a CNA their work is seen. For more ideas, see Employee Recognition Ideas That Cost Almost Nothing.

Do career ladders keep CNAs?

Yes, when they are real. Many CNAs want to become med aides, LPNs or RNs. If the only way to grow is to leave, they will leave, and they will take their experience with your residents with them.

A simple ladder helps: CNA, senior CNA or preceptor, med aide, then support toward nursing school. Attach a small raise and real responsibility to each step. Offer tuition help or flexible scheduling around classes. Even when someone eventually leaves for nursing school, a building known for growing its people becomes the place others want to start.

How much is CNA turnover costing you?

More than most buildings track. Each departure means recruiting, orientation, preceptor time, overtime to cover the gap and often agency shifts at a premium. It also shows up in resident experience, because residents notice when the faces caring for them keep changing. Use the free Employee Turnover Cost Calculator with your own CNA headcount, turnover rate and wages, and bring the number to your next leadership meeting. For the nursing side of the same problem, see Nurse Retention Strategies That Actually Work.

Where should a nursing home start?

Pick one unit. Fix the first week, train and back the charge nurse, post the schedule further out and start naming good work out loud. Then watch that unit for 90 days before you roll it out. Small, visible changes on one hall are more convincing to staff than a building-wide initiative announced in a memo. For the broader version of this playbook, see How to Reduce Employee Turnover.