Another approach to increasing overall job satisfaction among direct-care workers is to expand their roles and responsibilities and to enhance their ability to develop new skills. The term “lattice” refers to how some workers move laterally in their careers (i.e., through the development of specialized skill areas) while others move linearly up the career “ladder” (e.g., advancement from CNA to LPN to RN) (CAEL, 2005). There have been many efforts to encourage the development of lattices for direct-care workers, sometimes in concert with the ability to move up a career ladder. For example, the Office of Apprenticeship in the U.S. Department of Labor (DOL) awarded grants to the Council for Adult and Experiential Learning (CAEL) and PHI with the goal of creating apprenticeship opportunities for direct-care workers to develop special skills through on-the-job training, related instruction, and mentoring (DOL, 2008c). The increased skill development associated with apprenticeships often leads to increases in wages as well (CAEL, 2005).
Council for Adult and Experiential Learning (CAEL) The CAEL has implemented the nursing career lattice program in nine sites (including both acute and long-term care settings) to develop more CNAs, LPNs, and RNs (CAEL, 2008; DOL, 2008c). As a first step, many apprentices are recruited from auxiliary areas such as housekeeping, clerical staff, and food service to be trained for CNA certification. Next, CNAs are encouraged to develop enhanced skills in specific areas including geriatrics, dementia care, and peer mentoring. CNAs are given flexible training schedules and wage increases in alignment with their increased responsibility. In this manner, the program prepares CNAs to take the required examination to become LPNs. LPNs also receive additional training based on specific competencies. For the next step on the career ladder, LPNs receive online education along with clinical training at local community colleges that prepares them to take the required examination to become RNs. This program has resulted in increased retention, reduced recruitment costs, and decreased worker shortages (CAEL, 2005, 2008).
PHI Under its grant, PHI developed the Home Health Aide Registered Apprenticeship at five sites to help home health aides gain basic skills and develop skills for specialty areas, such as hospice and palliative care, geriatrics, dementia, and peer mentoring (DOL, 2008c). As in the CAEL program, the training programs are based on specific competencies. Apprentices are required to demonstrate competence in basic skills as well as the skills needed for two specialty areas. They also receive mentoring from experienced home health aides.