Help Wanted: Oklahoma works to reduce barriers to long-term care careers

Brynley Whitekiller clocks in three to four times a week for 12-hour shifts at Cearu Medical Resort, a skilled nursing facility in Tulsa. She likes this program because of the balance it gives her to take care of herself after spending long days caring for others.

Her work as a certified long-term care nurse (CNA) began under a waiver in the midst of the pandemic at a COVID-19 unit run by her mother. It’s a memory she’s blocked out, but has prepared her to find success and fulfillment in her current role. Now, she trains potential CNA employees and has made meaningful friendships with her residents.

“I was fortunate enough to work on the job and learn a lot from my mom,” Whitekiller said. “But I was lucky.”

Entry-level workers like Whitekiller earn fast-food wages but provide 80 percent of the direct care that seniors receive. She said entering the field and transitioning to working with residents can be overwhelming and unappealing for some, especially those coming straight out of CNA school.

“I remember, even when I started here, I trained for three days, and then they said, ‘OK, you get your own patients, you’re good to go.’ And luckily, I’m confident and capable, but I don’t think everyone is capable or educated enough to go ahead (and start),” Whitekiller said. “And you have your nurses, and they are responsible for you, but they have their own responsibilities. … They can’t be your teacher all the time.”

Recruiting long-term care CNAs can be challenging, and battling turnover is costly. But Oklahoma groups are finding ways to invest in the education and future of these workers.

Investing in early education

Oklahoma requires 85 hours of training to earn a long-term care CNA certification and can be packed into weeks or months. Programs must include 16 hours of subject-specific training, 16 hours of supervised practical training and 10 hours of Alzheimer’s training.

Brianna Elkins, a recent graduate of the CNA school at Green Country Technology Center in Okmulgee, said she enjoys caring for the elderly during her clinic at the nursing home. Her mother helped her overcome financial barriers by covering the more than $500 it cost her to enroll in the center’s FLEX program. He juggled his high school and extracurriculars to get his certification.

“It’s hard work, but it’s definitely worth it. And education is definitely worth the wait, too,” Elkins said.

She hopes to get a CNA job to help her save money for college in the future. While she is interested in long-term care in the future, she said she doesn’t feel ready to start in an understaffed facility without mentors.

“There aren’t a lot of CNAs at certain nursing homes around the Okmulgee area,” Elkins said. “I’d like to work in a hospital where I have someone who can help me and teach me more than just going to do it.”

In response to the shortage of healthcare workers, the Tulsa Technology Center is working to invest early with a healthcare transitions program that is free for high school seniors.

They work through their CNA long-term care training and move on to nursing courses through the remainder of that semester into the next. Dana Chandler, Tulsa Tech’s practical nursing coordinator, said the first semester spent pursuing CNA certification helps students decide if nursing is for them.

“At that point, sometimes we see students moving away, which is good. I say we also served a purpose because their education to this point was free. They didn’t pay for those textbooks, they didn’t have to pay tuition, they didn’t have to pay a lot of things,” Chandler said.

Nursing Transitions instructors Quincee Smith and Melissa Peterson spend their class blocks teaching everything from hands-on skills in a lab like range of motion and resident positioning to more classroom-based topics like documentation on health care. Students prepare at Tulsa Tech to eventually complete clinics in area nursing homes, which often provide them with jobs.

“The clinic is never what they thought it would be,” Peterson said. “It’s hard to prepare for something like a clinic because you never know what kind of day you’re going to have. But I think they are always relieved after those first few days. It’s not as scary as they thought it would be.”

While she tries to be honest about the challenges of the role, she said a positive educational experience with hands-on learning and no financial barriers can affect CNAs’ attitudes toward the role.

“If you come to school and your instructors are excited that you’re here, and your instructors are excited that you’re learning, then you’re excited to learn and do more,” Peterson said.

By the time they graduate from the program, students can apply for the CNA bridge program for licensed practical nursing (LPN), where they can become an LPN in six months. The center hopes this could encourage students to enroll in further higher education to pursue health degrees.

Chandler, whose master’s career began with a CNA, said an entry-level foundation helps students become better and more empathetic professionals.

Students like Aya and Jaydn. Both high school seniors plan to pursue further education outside of the Nursing Transitions program, but both will graduate with free education and a clearer idea of ​​what it’s like to work in long-term care. It’s an opportunity they want other young people to know about.

“I think it’s good to work in (long-term care) because not many CNAs work in long-term care,” Aya said. “You see people who can’t take care of themselves, and you understand what it’s like for them, to take care of them, but then… you feel for them, and once you feel for them, you become more empathetic. about the people around you.”

Finding the right fit

Alayna Thomas is a workforce retention strategist at Magnet Culture, working primarily with long-term care facilities. Its programs train managers on how to reduce turnover among frontline workers such as CNAs.

She said sharp ramps and a lack of financial and emotional investment in employees can turn facilities into revolving doors. And most don’t realize how much they spend on turnover.

“We had an organization that we just talked to … and we’re asking them, how much are you spending on recruiting? How much do you spend on recruitment agencies and your on-call care (short-term nurses)? … They were spending $300,000 a year just on turnover and recruiting,” Thomas said. “They had no idea.”

Thomas said mentoring and supporting employees individually can help combat turnover. Groups like Voyage Long Term Care are finding creative ways to do just that.

Its former human resources director, Michael Summers, said the company’s five long-term care facilities bring people from Oklahoma in key positions, such as housekeeping or dietary aides, to see what it’s like to work in a facility .

During COVID, Summers said if someone was “breathing and wanted a job,” they could probably be employed in a nursing home. Summers said he thinks that’s part of the problem.

Now at Voyage Long Term Care, if the person is a good fit for an entry level role, they will offer to pay for CNA school.

He said this reduced the company’s turnover rate by double digits.

“Our turnover rate … has gone down because we’re so selective,” Summers said. “I think the empowerment to get good, trained, solid people in that foundational role is very important.”

Statewide, Care Providers Oklahoma is using $4.5 million in ARPA funding to connect Oklahomans to CNA jobs. Through the Care Careers Oklahoma program, people can start in an entry-level role at a nursing home of their choice, enter a training program, and begin working as a CNA once they become certified.

Tanecia Davis, director of workforce development for Providers Oklahoma, said 650 people have been reimbursed for CNA, or certified nursing, training.

“Our role is to help interested candidates enter the field and, if they choose to enter the field, make sure they have the resources to receive their education and testing fees as they go down that path,” said Davis.

The ARPA grant will end in 2026, but Care Providers Oklahoma CEO Steve Buck said the group has had preliminary conversations with the Oklahoma Health Care Workforce Training Commission to continue this level of investment.

He said the seeds he’s planting now could eventually fuel the long-term care workforce to higher levels.

“Oklahoma is on the cusp of what is coined the silver tsunami. … This conversation about helping people navigate from the first level of involvement, working up to what might be their terminal degree,” Buck said. “We have to have those conversations constantly.”

Buck said other barriers, such as lack of childcare and transportation, must be addressed to ensure the longevity of emerging health professionals, central to the future of the long-term care sector. Voyage Long Term Care has been successful in prioritizing these needs by giving employees a portion of their salary in advance so they can cover expenses.

Buck said statewide investments in the needs of direct care workers like CNAs are how Oklahoma can weather the tsunami.

“When an employee calls you and says they need help, not just money, but mostly, ‘I need tires for my car.’ If we can do something that gets to where we know that person is going to come to work safely so they can take care of the residents, that’s an investment we’re willing to make,” Summers said.

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