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Nursing
Journal of Gerontological Nursing
March 2008 - Volume 34 ! Issue 3: 26-35
DOI: 10.3928/00989134-20080301-02
FEATURE ARTICLE
CNA Empowerment: Effects on Job Performance and
Work Attitudes
Cynthia M. Cready, PhD; Dale E. Yeatts, PhD; Melissa M. Gosdin, MA; Helen F. Potts,
PhD
Abstract
In this analysis, the effects of empowerment were examined among a sample of certified
nursing assistants (CNAs) representing a wide range of empowerment levels. On the
basis of survey responses from 298 CNAs and 136 nurses in five nursing homes where
CNA-empowered work teams had been implemented and five nursing homes with more
traditional management approaches, the results indicated that CNA empowerment had a
variety of effects. CNAs with high empowerment and the nurses who worked with them
tended to report better CNA performance and work-related attitudes. Both were also less
likely to be thinking about leaving their jobs. With the help of lessons learned from new
culture change initiatives, and with commitment, effort, and attention, nursing homes and
other health care providers can reap the benefits associated with employee empower-
ment strategies, such as CNA-empowered work teams.
Dr. Cready is Assistant Professor, Dr. Yeatts is Professor and Chair, and Ms. Gosdin is
Teaching Fellow, University of North Texas, Department of Sociology, Denton, Texas;
and Dr. Potts is Lecturer, University of North Texas Dallas Campus, Sociology, Dallas,
Texas.
This research was supported by The Commonwealth Fund. The views presented in this
article are those of the authors and not necessarily those of The Commonwealth Fund,
its directors, officers, or staff. The authors thank C.C. Young; Christian Care Centers,
Inc.; Evangelical Lutheran Good Samaritan Society; Mariner Health Care; Nexion Health,
Inc.; and Pacific Retirement Services, Inc. for participating in this adventure. They also
thank those who participated in an advisory group that helped direct the research,
including Dr. Barbara Bowers, Dr. Susan Cohen, Dr. Susan Eaton, Dr. Linda Noelker,
and Dr. Robyn Stone.
Address correspondence to Cynthia M. Cready, PhD, Assistant Professor, University of
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North Texas, Department of Sociology, PO Box 311157, Denton, TX 76203-1157; e-mail:
cready@unt.edu.
Many providers of nursing home care are shifting their focus from a medical model of
care to a person-centered model. This change in focus is the result of a desire among
nursing home managers to make their nursing homes more attractive, enjoyable, and
beneficial places to live (Kane, 2001; Kane et al., 1997). To achieve this new focus, a
variety of initiatives are being used to change the culture of nursing homes. Among these
are the Eden Alternative

(Thomas, 1994), the Green House

Project (The Green


House

Concept, n.d.), the LEAP: Learn, Empower, Achieve, Produce training program
(Hollinger-Smith, 2003), the Wellspring Model (Fagan, 2003), and others (Gilster,
Accorinti, & Dalessandro, 2002; Pillemer, Suitor, & Wethington, 2003; Shields, 2004).
Most of these include, in part, the empowerment of certified nursing assistants (CNAs).
Because CNAs provide the overwhelming majority of the one-on-one, day-to-day care of
nursing home residents (Institute of Medicine, 1986), their empowerment is considered
by many in the culture change movement to be key to affecting such change (Barba,
Tesh, & Courts, 2002; Beck, Ortigara, Mercer, & Shue, 1999; Eaton, 2000).
However, although most of these new culture change efforts emphasize the importance
of empowering CNAs, little empirical research has examined the job performance and
attitudes associated with their empowerment. This analysis addressed this gap by using
data from 10 nursing homes located in North Central Texas. Specifically, in this analysis,
the job performance and attitudes of highly empowered CNAs were compared with those
of less empowered CNAs. The perceptions, performance, and attitudes of the nurses
with whom the CNAs worked were also examined. In addition, comparisons were made
among CNAs representing a wide range of empowerment levels, as approximately half of
the CNAs and nurses worked in nursing homes with CNA-empowered work teams, and
the other half worked in nursing homes with more traditional, management approaches.
Employee Empowerment and Its Effects
The idea of empowering workers for the purpose of improving their job performance and
attitudes is not new. In fact, as early as the 1980s in the manufacturing industry,
employee empowerment motivated the adoption of quality circles, in which laborers
were asked by managers to share opinions on how to improve the work process (Lawler,
1986). These quality circles soon evolved into empowered work teams (also known as
self-directed work teams, self-managed work teams, and autonomous work groups),
which promised to take fuller advantage of what laborers had to offer (Wellins, Byham, &
Dixon, 1994; Yeatts & Hyten, 1998).
No longer a novelty in the work-place, empowered work teams consist of employees with
similar job titles and responsibilities. Team members typically make decisions about
some aspects of their jobs and recommendations about others. However, employee
empowerment is more than having autonomy in decision making; it is also perceiving
ones work as having important effects and meaning and feeling competent to do it (Ford
& Fottler, 1995; Kirkman & Rosen, 1999; Spreitzer, 1995; Thomas & Velthouse, 1990).
Team participation is expected to empower employees in each of these dimensions and
have other beneficial effects.
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Studies of empowered work teams in the manufacturing industry have found a variety of
such beneficial effects, including better performance, higher job satisfaction, and less
turnover (Kirkman & Rosen, 1999; Lawler, 1986; Pasmore, Francis, Haldeman, & Shani,
1982; Wellins et al., 1994; Yeatts & Hyten, 1998). In addition, studies have observed that
the decisions of team members can be more ingenious than those of managers, as team
members tend to be more intimately familiar with the work process (Hitchcock & Willard,
1995). Nevertheless, studies have also shown that the effects of empowered work teams
depend on how well they are implemented. Indeed, where teams are poorly implemented
(e.g., inadequately supported by management), performance may occasionally worsen
and turnover may actually increase (Lawler, 1986; Yeatts & Hyten, 1998).
The few studies of empowered work teams in health care settings, primarily hospitals
(e.g., Becker-Reems, 1994), have reported similar findings. Only recently have
empowered work teams been implemented in the nursing home industry (Robinson &
Rosher, 2006; Yeatts & Seward, 2000). Yeatts, Cready, and colleagues have described
the implementation of 21 such teams among CNAs in five nursing homes and examined
their effects (Yeatts & Cready, 2007; Yeatts, Cready, & Noelker, in press; Yeatts, Cready,
Ray, DeWitt, & Queen, 2004). As in other environments, members of the empowered
work teams in the five nursing homes all had the same job; that is, all were CNAs. The
CNA teams in a nursing home tended to be organized by shift and service area. Thus,
the largest nursing home in the study had approximately 200 residents and 7 teams, and
the smallest had approximately 50 residents and 2 teams.
Each CNA-empowered work team held a scheduled sit-down meeting once per week
for approximately 30 minutes, as well as impromptu stand-up meetings lasting
approximately 5 minutes, as needed, during the week. The scheduled weekly meetings
typically followed a set agenda and included discussions of work procedures, reviews of
and recommendations for resident health conditions, and consideration of other work-
related issues. In some cases, issues to be addressed were identified by nursing
management, and in others, by the team members themselves (Yeatts et al., 2004). For
example, in one nursing home, a family member complained and one of its teams was
subsequently asked by nursing management to recommend a solution to avoid future
complaints. In another instance, a CNA was concerned that a particular resident seemed
agitated and used the team meeting as an opportunity to seek advice on how to help the
resident. Each week, the team provided written notes from its scheduled weekly meeting,
including any CNA suggestions, recommendations, and concerns, to nursing
management. Members of nursing management, in turn, reviewed the teams notes and
provided written feedback. Impromptu stand-up team meetings were used to discuss
issues of immediate concern, such as when a CNA became ill and decisions had to be
made about how to distribute his or her work responsibilities until another CNA could be
called in.
More than 270 of the scheduled weekly meetings of the CNA work teams were observed,
and the minutes from these meetings were examined, as well as corresponding written
responses from the members of nursing management (Yeatts & Cready, 2007). In
addition, the CNAs, nurses, and family members of residents in the five nursing homes
were surveyed before the teams were established (Time 1) and again approximately 16
months after their implementation (Time 2). Survey responses from the five
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experimental or team nursing homes were compared with those of CNAs, nurses, and
family members of residents in the five comparison nursing homes in which CNA work
teams were not implemented.
Analysis of both qualitative/observation data and quantitative/survey data revealed that
the CNA work teams had positive effects (Yeatts & Cready, 2007; Yeatts et al., in press).
Most significantly, they increased CNA empowerment. For example, according to the
survey data, both the CNAs and the nurses in the experimental nursing homes perceived
more CNA empowerment and its dimensions of autonomy, impact/meaningfulness, and
competence at Time 2 than at Time 1, whereas the CNAs and nurses in the comparison
nursing homes did not perceive any change in CNA empowerment. Other beneficial
effects of the CNA-empowered work teams included better resident care; enhanced CNA
performance; improved CNA procedures, coordination, and cooperation with nurses;
higher resident empowerment; and some evidence of reduced CNA turnover.
The teams appeared to have somewhat mixed effects on job attitudes (Yeatts & Cready,
2007). On the positive side, analysis of the observation data indicated the CNAs in
empowered work teams were often able to realize their work preferences. In addition,
many of the CNAs appeared to appreciate the nurses listening to and sometimes
implementing their teams suggestions. On the negative side, some CNAs were worried
that the weekly 30-minute team meeting kept them from completing their work. Some
CNAs had difficulty attending a meeting when it was scheduled before or after their
regular shift, and others expressed frustration when a team member repeatedly brought
up an issue or personal problem or when, on occasion, members of nursing management
failed to read and respond to the teams notes.
Thus, on the one hand, given these opposing effects of the teams, it is not surprising that
the survey data showed no differences between Time 1 and Time 2 for either the
experimental or comparison nursing homes with regard to a number of work-related
attitudes, including general job satisfaction. In addition, it is reasonable to suspect that
the relatively modest increase in CNA empowerment, found between Time 1 and Time 2,
was not sufficient to improve work-related attitudes. On the other hand, it seems
somewhat premature to conclude that CNA empowerment per se does not have an effect
on the work-related attitudes of CNAs and nurses in nursing homes. Further examination
is needed.
Therefore, the purpose of this analysis was to examine the relationship between self-
perceived CNA empowerment and work-related attitudes, as well as its relationship with
CNAs views of their job performance. In addition, the analysis examined the
relationships between nurse perceptions of CNA empowerment and job performance and
work attitudes. On the basis of previous studies in manufacturing settings, higher
empowerment among CNAs in nursing homes should be associated with higher levels of
performance, better work attitudes, lower absenteeism, and less turnover among both
CNAs and nurses (Kirkman & Rosen, 1999; Lawler, 1986; Pasmore et al., 1982; Wellins
et al., 1994; Yeatts & Hyten, 1998).
Method
Sample and Data Collection
Data for this analysis were obtained from the Time 2 self-administered questionnaires of
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CNAs and nurses in the larger study conducted by Yeatts and Cready (2007), described
briefly above and in detail elsewhere. These questionnaires typically were distributed and
collected by the research team at an all-staff meeting. Absentees were later contacted by
a member of the research team and invited to participate. Response rates were 78% for
CNAs and 71% for nurses. Samples for the analysis were 298 CNAs and 136 nurses.
The questionnaires primarily contained statements to which CNAs and nurses indicated
their agreement using a 5-point, Likert-type scale ranging from strongly disagree (1) to
strongly agree (5). When available, the statements were taken from previous studies (see
Yeatts & Cready, 2007, for details). Statements were sometimes modified to reflect the
uniqueness of the nursing home environment (e.g., changing recipients to residents in
burnout items [Maslach, Jackson, & Leiter, 1996]). A pretest at a nursing home not
included in the study was used to assist with developing reliable statements not taken
from previous studies.
Data Analysis
The majority of concepts in this analysis were based on multiple survey items. For
example, one of the independent variables (CNAs perceptions of their global
empowerment) is represented by an index constructed from 19 items, including those
measuring its dimensions of autonomy (e.g., I sometimes provide solutions to problems
at work that are used.), competence (e.g., I am given regular updated information on
any changes that have occurred with the residents.), and impact/meaningfulness (e.g.,
The charge nurses listen to the suggestions of CNAs.).
The other independent variable (nurses perceptions of CNA global empowerment) is
also represented by an index composed of a smaller, although similar set of items. Each
of the indexes was constructed by taking the average of its items responses, thus
keeping scores on the index in the original response range of its items (1 to 5), with
higher scores indicating higher empowerment. Cronbachs alpha coefficients were 0.84
for the CNA index and 0.85 for the nurse index. These figures are well over the usually
recommended cutoff of 0.70.
To examine differences between high, medium, and low CNA empowerment, CNAs with
the highest scores on the CNA index (scores at the 75th percentile value or higher) were
placed in one group, those with the lowest scores (scores at the 25th percentile value or
lower) were placed in a second group, and the remaining CNAs were placed in a third,
middle group. The highest empowerment group was subsequently compared with each
of the other groups with regard to demographic characteristics, perceived job
performance, work attitudes, self-reported absenteeism, and intent to quit. All of the CNA
variables except absenteeism were indexes and were constructed in the same manner
as the empowerment indexes, with higher scores indicating more of the characteristic.
Cronbachs alpha coefficients typically were greater than 0.70, with the lowest being 0.55
(for the CNA Time for Care index).
Similar procedures were used to examine differences between high, medium, and low
CNA empowerment from the nurses perspective. Using the nurse index of CNA
empowerment, nurses were placed into three groups on the basis of how empowered
they perceived the CNAs they worked with to be. As for the CNAs, nurses in the highest
group (scores at the 75th percentile value or greater) were compared with each of the
other groups. Like the CNAs, the nurses were compared on their perceptions of CNA job
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performance in the nursing home. The nurses were also compared on their perceptions
of their own job performance, satisfaction, absenteeism, and intent to quit. Like the CNA
variables, all of the nurse variables except absenteeism were indexes and were
constructed in the same manner as the empowerment indexes. Cronbachs alpha
coefficients were greater than 0.70 for all of the nurse indexes except one (0.66 for the
CNA Time for Care index).
For almost all of the comparisons between the highest empowerment group and each of
the other two groups, independent t tests were used and reported in the tables to
evaluate statistical significance. The only exceptions were the comparisons on CNA
gender and CNA race/ethnicity. Chi-square tests were used and reported for these
comparisons.
As a check for the large number of comparisons being made, a multivariate analysis of
variance (MANOVA) was also performed for each related set of job performance and
work attitude outcomes (e.g., CNA perceptions of CNA job performance, nurse
perceptions of CNA job performance). Results of each of the MANOVAs (not shown)
indicated a significant empowerment effect (p < 0.05).
Results
CNA Empowerment and Demographic Characteristics
The top portion of Table 1 presents the samples and mean scores on the indexes
measuring CNA perceptions of CNA empowerment (i.e., global empowerment and each
of its dimensions of autonomy, competence, and impact/meaningfulness) for the three
CNA empowerment groups (i.e., low, medium, high). As expected, with mean scores
from 3.9 to 4.3, CNAs in the high empowerment group tended to agree that they were
empowered. CNAs in the medium empowerment group tended to be relatively uncertain
that they were empowered. CNAs in the low empowerment group tended to be more
uncertain or to even disagree that they were empowered.
Table 1: Levels of Certified Nursing Assistant (CNA) Empowerment and
Demographic Characteristics
Examination of the demographic characteristics in the bottom portion of Table 1 reveals
no differences between the three CNA empowerment groups related to gender,
race/ethnicity, education, and difficulty paying bills (p > 0.05). However, significant
differences were found related to age (p < 0.01) and tenure (p < 0.05). CNAs with high
empowerment tended to be somewhat older and have longer tenure at the nursing home
than did less-empowered CNAs.
CNA Empowerment and Job Performance
A comparison of the three groups of CNAs with regard to CNA perceptions of job
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performance found many differences (top portion of Table 2). CNAs with high
empowerment scored significantly higher on all three of the performance measures than
did those with lower empowerment. Highly empowered CNAs were more likely to agree
that they have effective work procedures (p < 0.001); enough time to feed, turn, and
assist residents (p < 0.01); and support for each other (p < 0.001) than were CNAs with
lower empowerment.
Table 2: Levels of Certified Nursing Assistant (CNA) Empowerment and
Job Performance
A similar pattern was observed among the nurses. As shown in the bottom portion of
Table 2, the nurses assessments of CNA job performance tended to differ depending on
how empowered they perceived the CNAs in their nursing home to be. Nurses who
perceived the CNAs in their nursing home to be highly empowered tended to rate them
higher on five different aspects of their performance than did nurses who perceived the
CNAs in their nursing home to have relatively low empowerment (p < 0.001). Nurse
ratings for CNAs with high empowerment were higher on average regarding their staffing
levels and time available to provide resident care. Nurses also tended to rate these CNAs
slightly higher on the effectiveness of their work procedures, their coordination with other
CNAs, and their cooperation with other nursing staff.
The nurses were also asked about their own job performance. Specifically, they were
asked to share their opinions about having enough time to complete their paperwork. As
shown in the bottom portion of Table 2, nurses who perceived that they worked with
CNAs with the lowest levels of empowerment tended to disagree (2.4) that there was
enough time for them to complete their paperwork. Nurses who perceived that they
worked with highly empowered CNAs were less certain (3) about the lack of time for this
task. However, this difference was not statistically significant (p > 0.05). Therefore,
according to the nurses, working with highly empowered CNAs did not tend to free up
more of the nurses time, at least not related to completing their paperwork.
CNA Empowerment and Job Attitudes, Absenteeism, and Intention to Quit
Table 3 presents job attitudes, absenteeism, and intention to quit among CNAs and
nurses by levels of CNA empowerment. As predicted, CNA empowerment was strongly
associated with both CNAs and nurses attitudes toward their jobs. For example, CNAs
with high empowerment tended to feel more strongly than did CNAs with medium or low
empowerment that they had high self-esteem, experienced less burnout, were satisfied
with their job and schedule, and were committed to the nursing home (p < 0.01) (top
portion of Table 3). CNAs with high empowerment were also less likely to be thinking of
leaving their job (p < 0.01).
Table 3: Levels of Certified Nursing Assistant (CNA) Empowerment and Job
Attitudes, Absenteeism, and Intention to Quit
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Results were similar for the nurses. Nurses who viewed the CNAs in their nursing home
as highly empowered appeared to be the happiest. As shown in the bottom panel of
Table 3, these nurses tended to score higher on job satisfaction than did nurses working
with medium or low empowered CNAs (p < 0.01). In addition, the nurses in the high CNA
empowerment group were the least likely to be thinking of leaving their job (p < 0.01).
The only variable that showed no significant difference between the three empowerment
groups was self-reported absenteeism (p > 0.05). Regardless of their perceptions of the
levels of CNA empowerment in their nursing home, both CNAs and nurses tended to
respond about 1 day every 2 months or more when asked how often they missed work
for reasons other than vacation. However, it is important to note that of all the survey
questions used in this analysis, this question was the one with the lowest response rate
among the CNAs. In addition, the response rate for this question was lowest among the
CNAs with the lowest empowerment and highest among those with the highest
empowerment. Therefore, it is possible that lower absenteeism was associated with
higher levels of CNA empowerment, at least among the CNAs, but that this was
obscured by the differential response rates.
Discussion
The purpose of this analysis was to examine the effects of CNA empowerment on job
performance and work attitudes among a sample of CNAs representing a wide range of
empowerment levels. On the basis of survey responses from CNAs and nurses in five
nursing homes where CNA-empowered work teams had been implemented and five
nursing homes with more traditional management approaches, the results indicated that
CNA empowerment had a variety of effects.
According to the perceptions of both CNAs and nurses, highly empowered CNAs tended
to perform their jobs better than did other CNAs. Compared with less empowered CNAs,
highly empowered CNAs were perceived to have effective work procedures, to have
enough time and staff to provide care, to support and work well with other CNAs, and to
cooperate with the nurses. However, these higher levels of CNA performance did not
seem to increase the amount of time available for the nurses to complete their
paperwork.
Collectively, both highly empowered CNAs and the nurses who worked with them
seemed to be happier on the job. Highly empowered CNAs reported higher self-esteem,
less burnout, more satisfaction, and more commitment to the nursing home. The nurses
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who worked with these CNAs also reported more satisfaction. Both were less likely to be
thinking about leaving their jobs.
Although the job performance findings of this analysis were consistent with the results of
a pretest to posttest study of CNA-empowered work teams (Yeatts & Cready, 2007), the
job attitude findings were not. It is reasonable to suspect that the teams lack of effect on
job attitudes in the pretest to posttest study were because the modest increases in CNA
empowerment observed after the teams were implemented were not large enough to
cause significant improvements in job attitudes. In addition, review of the teams weekly
scheduled meeting minutes and nurse managers responses revealed mixed effects on
satisfaction and related attitudes. The CNAs were happy with the fulfillment of CNA
preferences related to resident care that the teams made possible. This result is
especially significant because CNAs tend to consider the role they play in the lives of the
residents they serve as one of the most valued aspects of their jobs (Castle, 2007).
However, some CNAs expressed concern about the time the team meetings took away
from direct care and disappointment with inadequate feedback from members of nursing
management.
Limitations
This analysis had some limitations. First, because the CNAs and nurses in the sample
were employed by 10 volunteer nursing homes in North Central Texas, the results may
not apply to all nursing homes. Second, although the data for the analysis were drawn
from a larger study that included Time 1 and Time 2 surveys of CNAs and nurses, the
analysis used only the Time 2 surveys. This decision was made to ensure a larger
sample and a wider range of CNA empowerment. Only approximately 52% of the CNAs
surveyed at Time 1 still worked at the same nursing home at Time 2. Because the
analysis was cross-sectional, the associations between CNA empowerment and job
performance and attitudes may not reflect underlying causal effects. Finally, it would
have been useful to compare staff self-reports of absences from work with nursing home
records.
Conclusion and Implications
Despite the limitations described above, it is clear from this analysis that CNA
empowerment is associated with positive work-related attitudes among CNAs and
nurses. These findings, together with those of earlier studies (e.g., Yeatts & Cready,
2007), suggest that CNA empowerment can be used as a management approach to
increase morale and job performance among CNAs and nurses, lower their intent to quit
their jobs, and improve quality of care and life for nursing home residents. However, as
noted above, the effectiveness of an employee empowerment strategy, such as CNA-
empowered work teams, depends on how well it is implemented. Like other empowering
strategies, CNA-empowered work teams will be most effective when they have the
necessary support from management (Robinson & Rosher, 2006; Yeatts & Cready,
2007). One challenge for members of nursing management who are seeking to improve
their nursing homes work and care environment by implementing such teams is finding
the time to ask for and listen to CNAs suggestions about how to modify the work and to
provide consistent feedback. Another challenge is involving CNAs in the decision making
process in situations that require immediate attention, such as when a complaint must be
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addressed quickly. Still other challenges include allowing CNAs time to learn how to work
together in a team meeting, accepting the possibility that they will sometimes make
mistakes, and ensuring their direct care responsibilities are covered while they attend the
weekly scheduled team meetings.
Thus, nursing homes and other health care providers, such as assisted living facilities
(Sikorska-Simmons, 2006), interested in empowering their workers face some significant
challenges. Fortunately, they can learn from the successes and problems experienced by
the few who have pioneered various empowerment strategies, including empowered
work teams, in nursing homes. Yeatts et al. (2004) provided some preliminary findings on
how to effectively establish CNA-empowered work teams in nursing homes, and both
Hollinger-Smith (2003) and the Eden Alternative

(n.d.) provide training on how to


empower nursing home staff. Yeatts et al. (in press) provide training materials and a
detailed description of what must go right and what can go wrong when establishing
empowered work teams in long-term care settings, such as nursing homes. With the help
of lessons learned from the new culture change initiatives, and with commitment, effort,
and attention, nursing homes and other health care providers can reap the benefits
associated with employee empowerment strategies, such as CNA-empowered work
teams.
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Empowered CNAs
Cready, CM, Yeatts, DE, Gosdin, MM & Potts, HF. 2008. CNA Empowerment:
Effects on Job Performance and Work Attitudes. Journal of Gerontological Nursing,
6/28/14 3:47 PM CNA Empowerment: Effects on Job Performance and Work Attitudes | Journal of Gerontological Nursing
Page 12 of 12 http://www.healio.com.hsl-ezproxy.ucdenver.edu/nursing/journals/jgf%7D/cna-empowerment-effects-on-job-performance-and-work-attitudes
Authors
Dr. Cready is Assistant Professor, Dr. Yeatts is Professor and Chair, and Ms. Gosdin is
Teaching Fellow, University of North Texas, Department of Sociology, Denton, Texas;
and Dr. Potts is Lecturer, University of North Texas Dallas Campus, Sociology, Dallas,
Texas.
Address correspondence to Cynthia M. Cready, PhD, Assistant Professor, University of
North Texas, Department of Sociology, PO Box 311157, Denton, TX 76203-1157; e-mail:
.cready@unt.edu
10.3928/00989134-20080301-02
343, 2635.
Employee empowerment strategies, such as empowered work teams, are
designed to allow direct care workers to participate in decisions related to their
work so work processes may be improved, employee performance and attitudes
enhanced, and turnover reduced.
This study found that feelings of high empowerment among certified nursing
assistants (CNAs) were associated with more positive assessments of personal
performance by CNAs, more positive assessments of CNA performance by
nurses, and better work-related attitudes of both CNAs and nurses, including
increased job satisfaction and less intent to quit.
CNA-empowered work teams are effective only when given routine attention and
support from nursing management. Without routine attention, empowerment
and its positive effects is reduced.

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