LAUSR

Knowledgeable certified nursing assistants (CNAs) who provide integrated, comprehensive, and safe team-based care are essential to the care outcomes of roughly 1.5 million older adults residing in nursing homes (U.S. Bureau of Labor Statistics, 2022). CNAs typically know residents best and often recognize a change in residents' conditions before any other member of the healthcare team. There is no question that CNAs have demanding jobs, yet they lack the support and resources necessary to perform their jobs efficiently and effectively. Although residents' care needs have grown in complexity, CNA training standards have not changed (National Academies of Sciences, Engineering, and Medicine, 2022). The minimum training required for CNAs is often difficult to obtain due to associated costs (Hawk et al., 2022). CNAs often work in difficult conditions with a high resident load or for longer hours due to continued staffing shortages and high turnover rates. The wages and benefits offered to CNAs are subpar, preventing them from being able to live comfortably and from accessing the assistance necessary to optimize their health and well-being (PHI, 2021). Additionally, there are limited opportunities for CNAs to advance their careers, which also deters individuals from entering the profession (Campbell et al., 2020; Institute of Medicine Committee on the Work Environment for Nurse and Patient Safety, 2004). To this end, it is critical for policy and practice to align with the needs of CNAs to strengthen this workforce. The second goal of the National Academies of Sciences, Engineering, and Medicine's (NASEM) report is to create a well prepared, empowered, and appropriately compensated workforce. Nine recommendations were specifically developed to achieve this goal, with an emphasis on CNAs. These recommendations include (a) ensuring competitive wages and benefits to recruit and retain all types of fulland part-time nursing home staff; (b) enhancing the current minimum staffing requirements for every nursing home; (c) funding research to identify and rigorously test specific minimum and optimum staffing standards for direct-care staff; (d) enhancing the available expertise within a nursing home; (e) advancing the roles of CNAs; (f) establishing minimum education and national competency requirements for nursing home staff; (g) enhancing education and training; (h) collecting and reporting data to the Centers for Medicare & Medicaid Services (CMS) regarding demographics, training, and expertise; and (i) funding research on systemic barriers and opportunities to improve the recruitment, training, and advancement of all nursing home staff. The rationale for these recommendations can be found in Table 1. Received: 23 January 2023 Accepted: 23 January 2023