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CNA Empowerment: Effects on Job Performance and Work Attitudes

Certified nursing assistants (CNAs) who feel empowered tend to perform their duties better, have a higher morale and job satisfaction rate, and are less likely to consider leaving their jobs, a Commonwealth Fund-supported study finds.

CNA empowerment also leads to greater job satisfaction rates and a lower intention to quit among those nurses who worked with the CNAs, according to the study "CNA Empowerment: Effects on Job Performance and Work Attitudes" (Journal of Gerontological Nursing, March 2008). The research centered on 10 nursing homes in Texas.

"This study found that feelings of high empowerment among CNAs were associated with more positive assessments of personal performance by CNAs, more positive assessments of CNA performance by nurses, and better work-related attitudes of both CNAs and nurses, including increased job satisfaction and less intent to quit," wrote a team of University of North Texas researchers led by Cynthia M. Cready, Ph.D. Although CNA empowerment can be a beneficial management tool, implementation challenges confront nursing home operators.

Empowerment Boosts Job Performance

Empowered work teams, also known as self-directed or self-managed work teams, have long existed in manufacturing and other sectors, with studies observing a variety of benefits. Empowered work teams include employees with similar job titles and responsibilities who make decisions and recommendations on aspects of their jobs and perceive their position as being meaningful.

While the strategy is new to nursing homes, its appeal has increased as more nursing home providers shift their focus from a medical model to a resident-centered model of care. The researchers studied data from surveys fielded at 10 Texas nursing homes—five that had implemented CNA-empowered work teams and five traditionally managed facilities—to determine the effect on performance of empowered CNA work teams. Researchers compared the job performance and attitudes of highly empowered CNAs with those of less empowered CNAs.

In measuring CNA perceptions of their own job performance, the group with the highest empowerment (as measured by responses to survey questions on variables like autonomy in doing work and perceived meaningfulness of work) scored "significantly higher" on all three of the performance measures than those with lower empowerment. In rating their own job performance, highly empowered CNAs said they have: more-effective work procedures; enough time to feed, turn, and assist residents; and the ability to support each other.

This pattern was mimicked in the nurses' assessments of CNA job performance. Nurses who perceived the CNAs in their nursing home to be highly empowered rated them higher in five different aspects of performance: effective work procedures; work well together; staffing adequate to do a good job; enough time to provide care; and cooperation with nurses. However, the study found that nurses did not feel having highly empowered CNAs freed up more of their time, especially concerning time to complete paperwork.

Effects on Job Morale, Retention

In examining the relation between CNA empowerment and job attitudes, absenteeism, and intention to quit among both CNAs and nurses, the study found that highly empowered CNAs brought greater satisfaction for both CNAs and nurses. CNAs with high empowerment said they had high self-esteem and greater satisfaction with their job and schedule. These CNAs experienced less burnout, felt more committed to the nursing home, and were less likely to be thinking of leaving their job.

Nurses who worked with highly empowered CNAs also reported greater job satisfaction and were less likely to be considering leaving their job. However, the study found that both nurses and CNAs self-reported about the same level of absenteeism regardless of the level of CNA empowerment.


Nursing home operators can use CNA empowerment teams to boost morale and job performance among CNAs and nurses, as well as lower their desire to leave their jobs and raise the quality of care and life for their patients. Previous studies, however, have found that employee empowerment is most effective when supported by management policies and procedures.

Therefore, the researchers conclude that nursing home managers can overcome the many challenges of successfully implementing empowerment teams by finding the time to ask for and listen to CNAs' suggestions, providing consistent feedback to those suggestions, and allowing CNAs to be part of the decision-making process in situations requiring immediate action. Other recommendations include allowing CNAs to have the time to learn how to work together as a team, accepting the possibility that CNAs will sometimes make mistakes, and ensuring CNAs direct care duties are covered while they attend weekly scheduled meetings.

Levels of Certified Nursing Assistant (CNA) Job Performance

  CNA Perceptions
  Low (n=100) Medium (n=140) High (n=58)
CNA Perceptions fo Job Performance
CNAs have effective work procedures 3.4 3.7 4.2
CNAs have enough time to provide care 3.4 3.7 3.9
CNAs support each other 3.3 3.7 4.1
  Nurse Perceptions
  (n=32) (n=72) (n=32)
Nurse Perceptions of CNA Job Performance
CNAs have effective work procedures 3.6 3.9 4.3
CNAs work well together 3.3 3.7 4.2
Adequate CNA staffing to do a good job 2.7 3.3 4.1
CNAs have enough time to provide care 2.9 3.4 4
CNAs cooperate with nurses 3.7 4.1 4.5
Notes="Low," "Medium," and "High" refer to levels of empowerment; scores ranged from 1 (strongly disagree) to 5 (strongly agree).
Source: Adapted from C. M. Cready, D. E. Yeatts, M. Gosdin et al., "CNA Empowerment: Effects on Job Performance and Work Attitudes," Journal of Gerontological Nursing, March 2008 34(3):26–34.



Publication Details



C. M. Cready, D. Yeatts, M. M. Gosdin et al., "CNA Empowerment: Effects on Job Performance and Work Attitudes," Journal of Gerontological Nursing, March 2008 34(3):26–35.