Raising the Profile of Nursing Assistants Through Innovative Recruitment, On-the-Job Training

The need for high-quality patient care nursing assistants (PCNAs) is on the rise, as hospitals continue to rely on ancillary caregivers to mitigate the national post-pandemic nursing shortage. Determined to prevent staffing gaps and foster the careers of this indispensable group of caregivers, Cleveland Clinic is focused on creating a supportive work environment that provides many opportunities for training and professional growth.

Cleveland Clinic nursing leaders Katy Perez, BSN, RN, and Katelyn Papagianis, MSN, RN, NPD-BC, share their strategies for hiring and retaining PCNAs and discuss what it takes to succeed in the increasingly important caregiving role. As leaders in Cleveland Clinic’s PCNA orientation program and former nursing assistants, their insights are informed by more than three decades of collective experience.

Perez serves as a Nurse Manager for two Neuro Medical Surgical units at Marymount Hospital, and Papagianis is a Nursing Professional Development Specialist and Clinical Support Caregiver for Onboarding and Development in Cleveland Clinic’s Office of Nursing Education and Professional Development.

Can you describe the value of PCNAs in the hospital setting?

Papagianis: PCNAs truly lay the foundation for basic clinical care. In many cases, they spend more time in patients’ rooms than any other caregiver, so the connections they make with patients and their families are invaluable. Without them, daily tasks like dressing and bathing patients, checking their vital signs, and helping them eat simply would not happen with the regularity patients require. A PCNA is often a patient’s main contact throughout the day, so the care they provide uniquely affects the quality of a person’s hospital experience.

Perez: PCNAs are crucial members of our med-surg teams. The work they do has an enormous impact on the patient experience and also allows our nurses to focus on complex treatments, medication administration and the critical assessments necessary for the delivery of high-quality care. They are vital to everything we do.

What qualities make someone a good candidate for a PCNA role?

Papagianis: Because it’s an entry-level position, PCNA jobs attract candidates of diverse ages and educational backgrounds. It’s always exciting to see what unique qualities and perspective each caregiver brings to the table. Although we embrace applicants with a wide variety of personal and professional experiences, an ideal PCNA has great people skills, a strong work ethic, the ability to deal with conflict, a desire to provide patient care and a high school diploma or GED.

Perez: When reviewing candidates, I like to find out about each individual’s career interests. What brought them here to interview for a hospital PCNA position? Was there something specific that sparked their interest? Is caregiving something they are passionate about? Learning about our PCNAs’ dreams and goals helps us partner with them in their journey. Maybe they don’t have experience in a clinical setting but they’ve worked in retail or customer service. If that’s the case, they may have a lot to offer in terms of problem-solving skills and creating a positive customer/patient experience. Regardless of their job history, great candidates bring care and empathy, diligence and integrity to the table.

How can the experience of being a PCNA help shape a career in caregiving?

Papagianis: Becoming a nursing assistant was the best thing I could have done for my own career, and I’ve heard many others say the same thing. Some of the best nurses I know originally entered the field as nursing assistants, which gave them the opportunity to learn the fundamentals of patient care and really explore what it’s like to work in healthcare. And because PCNAs work so closely with patients, they quickly discover how to communicate, which is a critical skill in virtually any job.

Although many caregivers use their PCNA training as a steppingstone toward becoming an LPN or RN, others take the skills they’ve learned – including efficiency and compassion – and apply them to completely different career paths.

Perez: For many of us, caregiving is a life- and career-changing experience – and that’s particularly true for nursing assistants, who are often working in a clinical environment for the first time. Being a PCNA can be a rewarding career in and of itself, but it can also be an ideal way to prepare for more advanced professional roles in healthcare.

What is Cleveland Clinic doing to overcome any difficulties related to recruiting and retaining PCNAs?

Perez: Recruitment is a well-known challenge in post-pandemic healthcare, but we’ve been lucky to have an abundance of candidates this year. We’ve adopted several strategies that have helped us attract new PCNAs.

As with any other job, being a PCNA isn’t the right fit for everyone, and we know that – so one of our chief goals is to hire and train the right people. About 50% of our PCNAs are pursuing a nursing or other medical degree while working in the hospital, and the work experience truly brings their studies to life in a practical way. Cleveland Clinic really supports the pursuit of higher education, especially degrees in nursing. We work with our PCNAs to ensure that we support them during every step of their journey, which often includes reducing their hours as they progress further into their degree programs.

In many cases, PCNAs are testing out healthcare work for the first time, so the hospital environment can sometimes result in culture shock. The physical and emotional demands of the job can be difficult for some people, but we have a number of strong support systems in place to help new caregivers adapt to their roles. We’re always here to provide the encouragement they need as they continue to grow in their career. Although some plan to pursue a higher degree, others choose to continue as PCNA caregivers. Both are worthy career choices that bring so much value to the bedside.

In addition, Marymount Hospital has built a strong partnership with Trinity High School, which has been a wonderful tool for connecting us with students who are interested in the medical field. We’ve created a paid position at the hospital specifically for high school students who want to receive training and learn more about clinical work. By exposing them to many of the tasks required of a PCNA, the program provides students with hands-on experience while they learn what it’s like to work in a hospital setting. Those who are successful in their position – which is slightly narrower in scope than the PCNA role – may be offered a PCNA position with Cleveland Clinic when they graduate.

How does your team support PCNAs and reward them for the work they do?

Papagianis: We really want our PCNAs to know how important they are. It doesn’t matter what title or letters are behind their names; every one of them is crucial to our work as a clinical team. There are a variety of ways that nurse leaders can support and coach PCNAs — from guiding them on how to select a nursing school to helping them register for classes to showing them how to take advantage of Cleveland Clinic’s tuition reimbursement program.

Supporting our PCNAs is one of the best ways we can build our future nurse pipeline. By giving them the tools and encouragement they need to do their job, we not only help them succeed, but we also build their confidence as competent caregivers. For example, we’ve created a Nursing Support Caregiver Career Path designed to support PCNAs who want to invest in their current role, explore other healthcare jobs or even assume more responsibility and earning potential.

Perez: As an investment in the growth of our PCNAs and clinical technicians, Marymount Hospital has also piloted a career-enrichment program called MAGNUS, which provides a series of guided interactive discussions on various themes over lunch. Participants, who are chosen from among our pool of support caregivers, are nominated based on their exceptional job performance. Our most recent group of MAGNUS participants are partnering with us on projects that will enhance the experience and training of PCNAs throughout the enterprise.

As nurse leaders, we are always looking for ways to support our caregivers. Sometimes the solution is as simple as connecting a PCNA with community or hospital resources; others may benefit from being connected with a nurse mentor who can help foster their career. In addition, Cleveland Clinic has developed several programs specifically designed to help PCNAs overcome any barriers to success at the bedside.

What would you say to someone who is thinking about becoming a PCNA?

Papagianis: Simply put, caregiving is meaningful work, and becoming a PCNA is an idea way to explore whether it’s the right work for you.

Perez: PCNAs are choosing a role that is intense and occasionally exhausting but also incredibly rewarding. Caregivers can go home every day knowing that they’ve made a difference in someone’s life.