State Regulatory Oversight of Certified Nursing Assistants and Resident Outcomes


This study aimed to describe state regulatory certified nursing assistant (CNA) oversight in two domains—use of registry or licensing for credentialing and initial CNA training and continuing education (CE) requirements—and to evaluate whether CNA oversight is associated with resident outcomes in nursing homes. This cross-sectional secondary analysis combined 2004 data on state-level regulatory requirements for CNA oversight, training, and CE with nursing home resident outcomes data collected in 2004 from 16,125 U.S. facilities in 49 states. Though 26 states required CNAs to have more initial training hours than the federal requirement of 75 hours, only four states required additional yearly CE hours to maintain CNA certification. The combination of increased initial training and annual CE hours was significantly associated with nursing homes reporting lower antidepressant and antipsychotic use and lower average medication use. Use of a registry or licensing board for credentialing was significantly related to lower catheter use, and CNA licensure was significantly associated with lower odds of falls. Findings suggest that regulatory modifications could be beneficial to improve resident care outcomes in nursing homes.

Alison M. Trinkoff, ScD, RN, , Meg Johantgen, PhD, RN, Nancy Lerner, DNP, RN, Carla L. Storr, ScD, Kihye Han, PhD, RN, & Kathleen McElroy, MS, RN
Trinkoff, A.M., Johantgen, M., Lerner, N., Storr, C.L., Han, K., & McElroy, K. (2013). State regulatory oversight of certified nursing assistants and resident outcomes. Journal of Nursing Regulation, 3(4), 53-59.
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NNAAP, Practice, Research
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