Get rid of those lazy bums.

"They don't make 'em like they used to."

How often have we heard that said about cars, movies, TV shows, movie stars, TV stars, athletes--and now, more and more, certified nursing assistants (CNAs).

At least I'm hearing it more frequently of late: nursing home staff leaders telling me that a big reason staffing is so difficult is that "people these days just don't want to work anymore." You can threaten them, discipline them, fire them, and replace them, they tell me, but it makes no difference; the work ethic is dead. One CCRC nurse writing me recently along these lines concluded with, "Looking for suggestions!"

Hmm, that's tough one. I know for a fact that some people--and they come from all walks of life--will never do an honest day's work if they can help it. They'll do what they have to do to scrape by, perhaps even pretend to work hard for a while, but they will be ever on the alert for the easy way out. They're the ones for whom the phrase "gone in 60 seconds" was coined.

Let's face it, too--entertainment is big biz in this country, and some people see life off the job as a never-ending party. The more quickly and painlessly the job gets them to that blissful state, the better.

Having said all that, I have to admit that in my lifetime of having met a rather broad socioeconomic scale of humanity, I have encountered few true goldbrickers. Call me crazy, but I think most people have at least the potential of being good workers--it's just that the potential isn't always realized. The ideal employee, of course, is the one who looks at a job--any job--as a demand for excellence, no matter what, with quality performance being its own reward. There are such people. More likely, folks have to be nudged in that direction.

How about in long-term care? I don't doubt that there are some perfectly fine people who try the CNA's job for a few days or weeks and decide it just isn't for them. It's strenuous and sometimes dangerous, it is frequently dirty and unpleasant, and it is often perceived as dead-end; it is always relatively low-paid. When you look at nursing home jobs that way, flipping burgers isn't such a bad deal.

So, what would it take to make these jobs look more attractive? We could go on and on about salary, employee recognition, career ladders, staff empowerment, improved communication, etc., etc.--you've heard it all before. But try this: Imagine yourself as a CNA in your facility. What would it take to make you want to do this job, to do it well, and to stay with it?

Maybe you'd want to go as far as Charles H. "Chip" Roadman II, MD, did shortly after he assumed leadership of the American Health Care Association (and who concludes his tenure this year). Roadman became a CNA for a month as part of his preparation for the AHCA position. He told me in a soon-to-be-published interview. "As a doctor, I used to write orders like 'a.m. cares' and see them done the next day, as if by magic. Then I became a CNA and found out that, psychologically, emotionally, and physically, this was very difficult to do. This was all very high-acuity, high-touch, and highly time-consuming. My low level of experience and the sheer number of people I had to take care of only compounded my problem. I came away with a very strong appreciation of what it takes."

Fortunately for Dr. Roadman, he knew the experience would end soon and that he would assume a job that was safer, cleaner, more prestigious, and higher-paying (if not less pressured). Your CNAs won't have that expectation. What sort of expectations would you want as a CNA?

Ask yourself about how life as a CNA would be, apply the answers, and then see how many lazy bums you still encounter.

BY RICHARD L. PECK, EDITOR-IN-CHIEF

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