Train local teenagers as nursing assistants and everyone wins.

Beefing up nursing staff from a highly unconventional source

Ask Sandra Batdorf how to eliminate the need for temporary staffing, how to increase your bottom line and how to ensure continual quality care and she'll answer all three questions with the same reply: "TNT." Teen Nurse Trainees.

Batdorf, Director of Nursing at the Jewish Geriatric Home (JGH) in Cherry Hill, New Jersey, created an innovative, cost-saving, award-winning Teen Nurse Trainee program at JGH to help reduce temporary staffing costs. Through the program, young people, usually high school juniors and seniors interested in the health care field, are trained to become certified nursing assistants who work in the home on a part-time basis. TNT is a proactive step in creating a pool of nursing assistants who are well-trained, satisfied, and eager to continue working with the elderly. The program's goal is to retain the TNTs as full-time or part-time staff.

Overall, the results are impressive. In 1990, prior to the program's inception, JGH employed only full-time nursing staff. Consequently, two days each week were staffed by agency personnel. In the summer of 1991, just one year after the creation of the program, JGH was fully staffed because of the part-time TNT complement. By the end of 1991, due to decreased overtime and agency staffing as a result of hiring 23 TNTs, the home had realized a savings of $104,000.

"The cost savings are important to us," Batdorf says, "but the improvement in the quality of care is even more rewarding. Because we train the recruits, we are assured that they function in a manner consistent with our philosophy of providing comprehensive nursing care with a loving attitude. The residents truly benefit from that."

For the students involved in the TNT Program, the program experience has made a significant impact. For many, participation in TNT is their first opportunity to feel the joy of giving of oneself, and also the first touch of the painful reality of death. Being a teen nurse trainee gives them an opportunity for personal growth and encourages their consideration of a career in long-term care nursing.

This makes economic sense for JGH, says Batdorf, in light of the growing shortage of well-trained nursing assistants and the high turnover rate of the group in general. Industry estimates show that the yearly turnover rate for nursing assistants is between 100 and 300 percent. Long-term care administrators cite low pay, poor training, inexperience in caring for the elderly and lack of job satisfaction as the reasons most nursing assistants leave their jobs.

The TNT program directly addresses these challenges by providing training that emphasizes a nurturing attitude toward caring for the elderly and hands-on clinical experience that builds young trainees' interest and self-esteem. In addition, the program helps JGH cut costs.

Batdorf had a hunch that teenagers were the answer. "They are energetic, mentally flexible, and eager to learn skills that are meaningful, particularly when they relate to a career interest or long-range goal," she says. She was right. By finding, recruiting, training, and certifying young people interested in health care careers, JGH built a steady, dependable workforce, eliminated agency and temporary personnel and drastically reduced overtime hours. Most importantly, the TNT program improved the overall quality of care at the home by providing consistent and full staffing.

Within months of the program's inception in 1990, it was apparent that the program would become much more than a cost-saving measure. Residents loved it. Staff loved it. The teenagers loved it. And it worked.

"We took the opportunity to tap into a loyal, willing, career-minded market that is overlooked by almost all health care institutions, to solve a problem that virtually all of us face at one time or another," Batdorf explains.

"With agency personnel, much of the eight-hour shift was spent identifying the residents so that care plans could be implemented," Batdorf says. "During this time, the quality of care suffered because even the most caring professional could not develop the interpersonal relationships that are so necessary in caring for the elderly." With the TNT Program, residents and teens quickly become friends; the teens respond to residents as they do their grandparents -- and vice-versa. One of the big advantages of the TNT program is that teens become regular staff members who work consistent weekly shifts and get to know the residents and their routines.

One look at the faces of teens and residents engaged in a friendly game of checkers or cards tells the story best. The intergenerational experiences generated by the TNT Program are high points in the residents' daily lives, and TNTs get real-world career experience and a first-hand education in gerontological care. Many TNTs continue working at the home or seriously consider long-term care as a career.

How the Program Works

Through a network of guidance counselors from local high schools, nursing schools and junior colleges, young adults age 16 to 22 are sought out to participate. For junior and senior level high school students, participation is geared toward either the academic or vocational track students who have shown interest in health care, science or medical careers.

The JGH staff also visits high school open houses, participates in career day activities, makes presentations in classrooms and provides promotional materials to be distributed and posted in schools. In addition, ads are placed in local newspapers and JGH sponsors orientation night at the home to meet interested participants and their parents.

"The parental role in the program is important for teenage students," explains Batdorf. "We have found that the most successful youngsters have parents who assist them in achieving the sense of responsibility needed to be a permanent member of our nursing team."

Once a student is accepted into the program, the Home provides a no-cost 90-hour course taught by a state-certified nursing instructor to help the students prepare for the state Certified Nursing Assistant exam. Students spend forty-five hours in the classroom and forty-five hours on the floor, getting hands-on clinical training for which they earn an entry level salary. Training is arranged during school vacation periods and during evening and weekend sessions throughout the school year.

"Our success rate is exceptional," says Batdorf. Fully 99.9% of students are awarded CNA certification. The students' pride in that accomplishment carriers over into their work assignments.

"Teenagers, contrary to popular belief, take their work very seriously. They view the TNT Program as a wonderful opportunity to perform meaningful work that will be proudly displayed on their professional resume," she says.

Typically, academic students work weekend shifts and vocational students work weekday shifts while earning credits and a salary. The TNTs, once trained and certified, can work up to 24 hours per week, relieving the Home of its dependence upon agencies, and filling in for staff absences and vacations. Salaries begin at just above minimum wage and graduated increases are given for working special shifts.

In addition, the JGH sponsors an Awards and Recognition ceremony to reward students who have exhibited the most personal and professional growth each year. Exceptional TNTs who study nursing in college or vocational schools are awarded a book scholarship as reward for a job well done.

The Teen Nurse Trainee program itself won the 1992 Innovation of the Year Award from the American Association of Homes for the Aging.

As the program enters its third year, Batdorf has raised the upper limit of the age group from 22 to 99. She believes that the TNT Program can be successfully adapted to the older student who chooses health care as a second profession. Batdorf has had hunches before. Only time will tell.

Doreen Fera is a free-lance writer who covers the health care field for Heron & Young, Marketing Communications, Inc., in Bala Cynwyd, Pennsylvania. The Jewish Geriatric Home is a 173-bed nonprofit nursing facility, serving the entire Southern New Jersey community.