Give Your CNAs — and Your Facility — An ‘Edge’ (Episode 38)

August 8, 2018

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Darcy Grabenstein: Hello from SmartLinx. Our guest for today’s podcast is Mike Mutka, CEO of Straightaway Health, which provides employers with online training and retention services to prevent shortages of healthcare support staff. Our focus today will be on certified nursing assistants. Welcome, Mike.

Mike Mutka: Well thanks, Darcy.

DG: Staffing shortages as we all know are plaguing the senior care industry, often exceeding 50% when it comes to CNAs. So Mike, I think our audience will be particularly interested in your CNA Edge program, which provides the tools to qualify, train, and retain a team of committed, certified nurse assistants to help facilities reduce their annual turnover costs. Your website has a calculator to estimate those costs. So what would you say are average costs associated with CNA turnover, and how does training help promote retention?

MM: Great questions, and the reason for the calculator to estimate turnover cost is, it really does depend and very tremendously from building to building, based on their pay policies, how they recruit, how they handle overtime versus agency, etc. So one of the things that’s most valuable, we find, is it’s really helpful if we don’t come in and tell them what the costs are, that we give them a tool where they can plug in numbers they believe. If they don’t have the numbers they can plug in what they think is reasonable, and they can run the numbers for them. And so then they don’t see us giving them numbers that they wonder, are they hyped up or something like that. Generally speaking, real good rule of thumb, if you look at hard costs—so real cash that’s going out of your organization each week—and soft costs, it’s about $1000 per vacant position per month in hard costs. And that’s just a real simple number. If you have a vacant position for a month at 40 hours a week, and somebody makes $12 an hour, now you have to pay overtime, time and a half, that’s a shift differential of $6 an hour, times 40 hours a week is $240, times 4 weeks, $960. So at a minimum that’s real incremental overtime cost paid while you’re getting somebody hired, on-boarded, trained, and ready to do it. So real simple true cash, $1000 per month per vacant position. There’s been tons of research out there that’s looked at the total cost of turnover, and usually pegged it at a minimum of $2500 per position per turnover. And that’s all those things you would expect—recruiting, advertising, hiring, on-boarding, all of the time as well as the cash. So if you really want to think about a thousand bucks a month cash for a vacant position, $2500 per turnover position, generally are pretty good numbers.

DG: So I’m going to go back to my second part of that question. So since we all want to boost retention, how does training help do that?

MM: That is a great question, and in lots of cases unfortunately training has not helped do that. And our argument would be that that’s because most CNA training focuses on the wrong things when it comes to turnover. So we’re not looking—we didn’t launch CNA ads because we thought Monsbey’s or ACA or anybody else didn’t adequately teach the skills required to be a CNA. They do a great job, they’ve got all of the skills down and everything. But CNAs don’t quit the job because of skills issues. They don’t quit the job because they go, I can’t get this vital sign thing down or this transfer from a chair to a bed. They quit because of emotional related reasons with the job. It is an emotionally brutal job, and most of the time they come in and they’re not really prepared for the really gutting things that happen on the job. Like, they start to take care of an elderly resident and build a bond for two months, and that person dies. And that person is on something called a DNR, which means this person I’ve grown to love over the last two months, I’m supposed to sit here, my job is to sit here and do nothing while this person passes. And I’m supposed to do that. And then, after that happens, and the person passes, and I go talk to my nurse supervisor, she says, you need to suck it up buttercup, we’ve got seven other of your residents that you’ve got to get up into PT in the next half hour, so you know, put that aside and go. So you know, death and dying, when it becomes a reality and not just an abstract thing that’s talked about in a class, it’s crushing.

Likewise, Alzheimer’s related things like sundowning. So you take great care of a resident all day, have a wonderful day, doing Bingo, activities, dining, talking about family, and then at 5:00 that person’s personality changes from Dr. Jekyll to Mr. Hyde. And what did I do wrong? Why did they lash out at me? I was doing a great job, why did they feel that way? What’s wrong with me? And then just simple things like just dealing with very intimate personal bodily fluids and cleaning and hygiene issues. So these are the kinds of things that you can talk about them in a class, you can kind of simulate them in a skills session with dummies and other stuff. But you need to emotionally be put there. So the key to our training is a very emotional storytelling approach that tries to put the trainee in that position emotionally before they start the job. So nothing prepares you for the first time you lose a resident, but at least you’ve been through that rollercoaster of emotions, watching a story unfold with CNA Edge before, so you’re a little better prepared. What we’re after is the deaf and dying, the Alzheimer’s, bodily fluids kind of things, those are the things that produce what we call the “oh hell no” moments. The moment where that person just goes, oh hell no, I’m not doing this, I’m going to go work at Costco or restaurant or whatever, I didn’t sign up for this, this is just too much. And so we have to prepare them for those kind of moments, and make them a little bit more ready for them. And if we do that, we can have fewer people kind of go, oh hell no, in that first 90 days. And if they can hang in there longer, it’s enough time for the job to grow on them and them to see the really rewarding things about the job and maybe give them a chance for it to take root and get them to stay in the profession.

DG: Right. So as you mentioned, storytelling is really a powerful way to get a message across. And I would say whether it’s used in marketing, which is what I do, or training materials, so I have to tell you, I watched the trailer of The Residents, and that’s your miniseries that helps trainees understand the challenges and the rewards of becoming a CNA, including as you mentioned the emotional rollercoaster that comes with being a frontline caregiver. So it as just three minutes long, but I tell you, I was totally brought into the drama. So tell me how storytelling differs from other types of training, and how you use it in CNA Edge.

MM: Absolutely. So one of the key things to remember is, you know, we have shortages and turnover problems of CNAs today. Over the next ten years, the position of CNA is going to be one of the five fastest growing positions in all of healthcare. So we already have shortages and we’re going to need a ton more people to enter the profession.

DG: All the boomers out there?

MM: All the boomers out there, absolutely, and also that, you know, more healthcare trying to be pushed to post-acute, delivered in the lowest cost setting by the least costly staff. So all of those dynamics. So we’re going to need hundreds of thousands of more CNAs on top of what we need. And the really challenging part is, 75% or more of those people that we’ve got to go get and enter the workforce as a CNA are millennials. Millennials don’t absorb information or learn the way baby boomers, generation Xers, or others do. If I am putting something together, having a problem with my refrigerator at home, I start leafing through my drawers trying to find the instruction manual. Millennials would never do that. They’re going to go online and say there must be a YouTube video that explains this. They’re not going to share information and learn in a traditional textbook classroom way. They share information and learn by YouTube, Instagram, SnapChat, sharing, graphics, short videos, podcasts, etc. and learning and sharing ideas in 180 characters or less, short segments that hold their interest, and keep them engaged. So the key here for us is using storytelling that almost affects them like—we want them to feel like they’re binging Netflix when they’re watching our stuff. And we’ve actually had students that have said, oh my gosh, what do you think is going to happen with Frank next week, I just know something bad is going to happen, and how is Mercy going to handle it. That’s what we want. We want to engage them in a way that makes them so intrigued to understand what’s happening, they almost don’t feel like they’re taking a course. But we’re tying all of the training and the education they need back to these little novellas, if you will. And that’s super super important. And that’s going to be key over the next ten years, because that’s the way millennials want to learn.

DG: It’s funny you said they don’t want to go for the product brochure. However, my husband would reach for the product brochure, I would Google for the answer.

MM: Absolutely.

DG: So everybody learns differently, right.

MM: That’s right.

DG: So the first step in CNA Edge is to qualify prospective CNA candidates. So what would you say are the qualities and the skills that are needed for a successful career as a CNA? And what kinds of screenings do you do to determine whether a candidate is qualified?

MM: Yes, so our first phase of CNA Edge that we launch is the training component. it provides the classroom requirements on a state level to be able to sit for the certification exam, and it provides a structure for lab skills and the clinical skills then the building actually has their instructor do all of that. But the second piece that we’re working on now and getting ready to launch is a prep component. And this is really all about trying to make sure that everybody who considers being a CNA understands what the job is really like, the good, the bad, and the ugly. So we want them to understand it’s a very rewarding job, it’s a very special job, you get to have unique relationships and really make a difference in a very powerful way. But it is a very hard job. And we don’t sugarcoat that at all. And so part of what we want to do is make sure that we share that with people before they apply and join a class. Because we don’t want them to get a weekend and go ah yikes, no. We don’t want them to be going, I used to take care of my grandmother in the summers, I used to volunteer at a senior center, this will be fun, it’ll be easy, seniors are polite, they’re quiet, they’re going to nap a lot, I’ll probably be able to play games, it’s going to be a really easy job. So we want to give them a real understanding of what the job is like so that people who aren’t ready for that or aren’t cut out for that will self select a little bit. And then over time we will develop some assessments, our own assessment tools on the things that we think are most important. If I had to put it down to two things that we’re looking for, I would call one of them grit, the ability to hang in there and persevere when things get hard; and then true empathy, the ability to really understand and appreciate what the residents are going through, what their families are going through and really feel that empathy. If you don’t have a certain amount of grit and a certain amount of empathy you are not going to be very happy in this job.

DG: No, I would agree with you. My mother was in a long-term care facility, and the aides that had the empathy are the ones that touched me and touched her as well. So it’s so important.

MM: It’s really everything, and if people quit, again, it’s because emotionally or in terms of the grit, they’re just not cut out for just the devastatingly hard emotional things that are happening around death and dying and memory loss, and you know health deteriorating and all of those things. And we just have to find people that can survive in that, and not find that crushing, and then prepare them for what it’s really like. And then the last thing is support them during the first 90 days.

DG: So Mike, your training is designed to prepare new hires for both the job and for the state certification test. Tell me how your online training helps prepare them for on-the-job situations. I’m going to bombard you here with a few questions. You offer both online and instructor-led training, correct?

MM: Our program is an online program, so the classroom hours are all delivered online. So in a typical state for example, let’s just say to sit for the CNA exam, you need to complete 60 hours of classroom training on the topics specified by the state and another 15-20 hours of hands-on clinical skills. So our program, CNA Edge, will completely cover that 60 hours of classroom. We will provide checklists, guidelines, syllabus, instructor guides, etc. for the bedside clinical piece too, but we don’t do obviously that piece. Now we have live videos in our classroom stuff that shows video examples of all of the hands-on clinical things you’re going to be asked to do later in the clinical skills. So they see them being done correctly, in video clips during the classroom training before they have to go through the clinical skills.

DG: Got it. So is this all on demand, or is any of it live at a set time?

MM: It’s all on demand. We have clients that are looking to use it in a variety of ways. Many people initially are going to use this as their classroom curricula and still have a class full of CNA students with an instructor, and they’re going to deliver CNA Edge’s content, and then the instructor is able to spend more time facilitating and supporting rather than having to actually deliver the content. But in other cases we’re starting to see approvals come through in some states to be able to use this independently 24/7 where somebody who wants to be a CNA can sign up for the course, and they can work on it on their own pace.

DG: That was my question. Broken up like that, how long would you say it typically takes someone to do those 60 hours?

MM: Well, in most onsite programs, they typically will expect about two to three weeks to do the classroom stuff. So I would say if you’re doing it on your own, it really ends up depending on your work schedule and how much you’re able to put into it and work on getting done. So you know, if it’s the kind of thing where you’re able to an hour or a day during the week and a couple hours on the weekend, so you’re getting seven or eight hours a week done, then it can take a couple months to do it independently on your own. Really that’s the great thing about it is it can be set up to match whatever a person’s circumstances are.

DG: Right. I have a question about the certification test. How do they vary from state to state? Are they very different, are they similar?

MM: It’s amazing how different the training requirements and the testing is from state to state. There are a number of states that have very similar requirements, but every state is generally kind of a snowflake, and there are a couple of organizations that administer testing and certification in most states. So every state is kind of different, which is really challenging for us right now. We will have our program ready to be used in about 45 states or more by the end of the year and probably have been through the approval process in 20 states by the end of the year. But that’s something that’s painful for us now but it’ll be a big advantage to us later, because once we’ve got all of the states certified, then that’s a huge advantage because it’s a lot of work to do that.

DG: Sure. Studies show that about 20% of employee turnover happens in the first 90 days of employment. How does CNA Edge support newly hired employees during their first 90 days?

MM: It’s a great question, and we actually hear sometimes even higher turnover in the first 90 days, although that’s been more anecdotal than the specific research. But we hear a lot of people say it’s not uncommon for them to find half of their turnover happens in the first 90 days or so, and that’s those, “oh hell no” moments that take place. So one of the things that we’ve learned, you know, we’re not trying to sell a class. The product we want to provide to skilled nursing facilities is a well trained CNA that will stick on the job. That’s the product we want to get to them. So in addition to the training piece, once they complete the training and start working, we have a product called CNA Edge Support. And during that first 90 days, we’ve found there are a number of things that cause a new CNA to not feel very comfortable or supported typically. And we hear a lot of jokes, a lot of people say hey, us nurses, we tend to eat our young. A lot of times, people who are in nursing management, many times they may have initially been promoted there because they were outstanding at a clinical level, they are extremely good nurses, they may or may not have had exposure to a lot of management and leadership training. Some may, but many times that’s a very new area for them. So our CNA support during the first 90 days, we have a module of training for new clinical managers, who are managing new CNAs. We’ve created it, it’s specifically for somebody who is a clinician who is managing and has new CNAs starting, how to keep them, how to get them to survive the first 90 days. So we have a training like that that’s really really very very interesting. Then on top of that, what else we hear is CNAs often will say, I have questions, I get confused, I don’t remember how to do this or that, I need help, or I’m just having a bad day, I’m having a hard time managing my time, but I don’t know who to go to ask for help and I’m embarrassed to ask for help. We give them a way that they can go on to their site, and push “I need help.” And the building can designate who that goes to in the building confidentially, that person can reach out to them and give them help. On top of that, they will get a text on a regular basis during the first 90 days that asks them just two or three questions, typically in terms of how are you doing, how are you feeling about the job, how are you feeling about life, how are things going. And we use these very interesting emoticon system so we don’t ask them to rate yourself on a 7 is great, 1 is terrible, and 3 is average. It’s a smiley face to frowny face kind of thing. They’ll get this thing and they can actually move this emoji along a scale infinitely and say how they’re doing. Takes them 20 or 30 seconds. And what it allows us to do is compile how are the residents in this building feeling generally versus the residents over here, so that hopefully the administrator of the team can try to take action if they see that their folks are struggling before it’s too late. So a way to get feedback, some coaching training for clinical managers, a way to ask for help. We also have a mentoring support program in our system. And the some diagnostics that are in there, so that at a building or a corporate level you can look from building to building and see again how the CNAs are doing in the different buildings. So all of that stuff is there with the goal of trying to be training wheels and a hand to hold on to during the first 90 days.

DG: I love it. So we talked about the first 90 days. What about after the first 90 days? What types of ongoing training and support do you offer?

MM: Right now, we do have people who will most likely continue to use some of the elements of the support system on an ongoing basis. Access to help, the training of clinical supervisors, the check-in surveys, all of that kind of stuff. But that’s really at the option of the building or the organization if they want to continue to do that, or if they are doing additional training with our sister company Relias or in some other fashion. Our goal is really to get somebody qualified to become a CNA, get them to be able to pass the test, set them up for success in the first 90 days, and then they can use us to support them as long as they want to. But we don’t specifically do additional training beyond there. That’s really where a Relias or somebody would come in.

DG: Right. So I have one more question for you, Mike. Could you share with us a success story from one of your trainees?

MM: Yes, a couple of them, we have a faith-based CCRC in Kentucky, they’ve been using us for close to a year now. Prior to us they had a local clinical consulting group that did CNA training. And they averaged a 21% pass rate on the state exam. After putting us in, their pass rate went to 75%. And the level of satisfaction with the instructors and everything has been great. We had another group where we were putting some people through a CNA training via a vocational program affiliated with a local high school. And we were able to take these folks who were going through, and we had 96% pass rate on the classroom portion of the exam. This was tied to a vocational program so not everybody necessarily was going to go be a CNA right away. But they were doing it to learn about it. But we had a 96% pass rate on the exam, and this was the place where the students were coming in and acting like they were waiting to see what happened in the next episode of a Netflix show. So people just really fascinated by that. So that’s what we’re after.

DG: Well it sounds good. Thank you, Mike, so much for letting us know more about Straightaway Health and the CNA Edge training program. And to all our listeners, thank you for tuning in. If you’d like to learn more about the program, visit And if you’d like to learn more about SmartLinx and our fully integrated suite of workforce management solutions, visit us online at

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