Wound Care Training and Education for Certified Nursing Assistants

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Nursing Skills


As a wound care consultant, I receive many requests to conduct ongoing in-services of various topics with "all" nursing staff. This request is intended for the LVN/LPN and RN staff. My definition of "all" nursing staff is licensed nurses AND certified or state tested nursing assistants.

I am usually the one to ask if I could possibly include an in-service for the nursing assistants, since they are the caregivers working the front lines. The most frequent answer I receive is "NO, we will just do it later or another time." Every time I hear this my heart sinks. I am so passionate about my work, and want to spread my knowledge to every nurse and nursing assistant I can.

What Certified Nursing Assistants Do

Thinking back to the days of when I was a brand new CNA, I remember it being quite overwhelming. I remember my CNA training being crammed into a short span of time with me thinking, "This is it?" There's a lot to learn and cover in those first few days at work. Skills such as bathing/showering, personal hygiene, and skin care were covered briefly.

Although CNAs do not assess, nurses depend upon nursing assistants to report timely data each shift. Nursing assistants are to report what they see, smell, hear, feel, and touch. The nursing assistant in all corners of the world is probably the most undervalued staff member. Nursing assistants are truly the backbone of LTC.

Education for Certified Nursing Assistants

I decided to research the different CNA course offerings. Nursing homes often times will offer free classes if they are facing nursing assistant shortages. Course costs can start from $395 and up. The CNA curriculum is divided into an average of 18 units, which include objectives, vocabulary and suggested content. The content varies from state to state, but they are close in comparison. Classroom and laboratory work time must be a minimum of 60 hours. A trainee shall complete a minimum of 16 hours training before being allowed to work in a facility. These 16 hours should include the following: Define vocabulary, describe the purpose of the skin, discuss age-related skin changes, and describe common skin injuries.

As I reviewed the topics/skills checklist, I noticed there wasn't much focus on pressure ulcer prevention. I was looking for HOW pressure injuries form, what conditions increase the RISK of pressure injuries, WHY prevention is so important, changes in skin color, positioning, and the pressure points. There were very few course agendas that compiled these topics. The list below is what the average CNA course consisted of for topics/skills:

  • Vital Signs
  • Transfers
  • Hand Washing
  • Bed Making
  • Body Mechanics
  • Mechanical Lift
  • Intake & Output
  • Side Lying Positions
  • Nutrition & Fluids
  • Admission/Discharge
  • Perineal Care
  • Shower & Tub Bath
  • Partial Bath
  • Oral Hygiene
  • Shaving
  • Catheter care
  • Nail Care
  • Resident Feeding
  • Apply PPE
  • Documentation
  • Dressing a resident
  • Specimen Collection
  • Height & Weight
  • Range of motion
  • End of Life Care

If we refer to the National Pressure Ulcer Advisory Panel guidelines, over half of the pressure ulcer prevention points mentioned fall under the nursing assistant job description. There is a significant need for more comprehensive CNA education. The CNA's ability to do their job effectively is also hindered by administrative staff's tolerance of understaffing, lack of peer mentors, and informal education.

Further Education for CNAs

There are several wound care certifications now offered to CNAs and Nursing Assistants. The coursework consists of basic wound care and prevention. CNAs, Nursing Assistants, Home Health Aides and Medical Assistants can sit for the national board certification. Each certifying body has different criteria that must be met to sit for the examination. The links are provided below.

Healthcare & Legal Education Resource Group, LLC - Wound Prevention Certified (WPC)
CNA-MA Skin Management & Wound Prevention Course is offered to Certified Nursing Assistants, Medical Assistants, Personal Care Assistants, and Certified Home Health Aides.
*Examination is offered by the National Organization of Healthcare & Legal Professionals
Website: http://www.healthcarelegaleducation.com/cna-ma-training/

American Board of Wound Management - Certified Wound Care Associate (CWCA)
Offered to RN w/Associates, LVN/LPN, Sales and Marketing, CNAs, Nursing Assistants, Home Health Aides and Medical Assistants.
*Examination is offered by the American Board of Wound Management
Website: www.abwmfoundation.org/online-courses/

Empowering Colleagues in Health Care

Providing nurse or CNA mentors is just one way long term care facilities can help support newer CNAs with skin and wound care education. Retaining nursing staff is difficult, especially within the long term care arena. The lack of mentorship programs has contributed to high turnover, average quality of care for residents, and poor satisfaction surveys.

Nurse Managers need to provide CNAs with a strong support system along with the opportunity to learn and grow. Those who are empowered and confident are therefore more committed.


About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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i applaud you in wanting good training for our nursing assistants. In the end, it's all about the best care for our patients. Education is always the best approach for obtaining that goal.

Wow Cheryl! I learned so much from this post. I founded a non-profit organization for nurses with disabilities ExceptionalNurse.com. I will be sharing this widely with our groups.
Keep up the great work!
CNAs are critical to care in many areas of practice. Thanks for shining a light on them!

I agree CNA's are our first line of defense and should be well educated.... But, it should stop at prevention. It is completely out of their scope to identify/differentiate wound types. I have spent many years throughout my various roles educating CNA's concerning all areas of prevention and maintaining healthy intact skin; with mixed results. Educating LPN's and RN's have provided similar experiences. Scope of practice and definitive roles in the care of patients are a must, in my experience and opinion.

Proper education, within the boundaries of their roles, for everyone involved in the care of patients is absolute and should be on-going. There is a fine line at times when we educate for early warning signs of ulcers vs identifying or diagnosing them. I prefer a well educated staff member, no matter what title. Continuity of care for the patient is only increased when everyone speaks the same language and understands the importance of the responsibilities.

I am witness to a growing problem with a deficit of wound care knowledge by many nurses combined with others who overstep their roles and scope to work around physician orders or blatantly disregard them. So we battle overlapping issues at times; educate everyone to understand, prevent and treat the patient (and their wounds) within their perspective scopes, but have them not develop the ego allowing them to mistake their bit of knowledge as absolute.

In summary to this winded response: I applaud you for helping educate some of the most important people involved in patient care, but add caution with.. (copied from http://www.healthcarelegaleducation.com/education/cna-ma-pca-wound-manag... )
*skin assessment (the term assessment is clearly out of their scope)
*wound healing (do I want them to know it's healing.. you bet ya, but again their understanding of this should follow the lead provided by the nurse or physician)
*other types of wounds/ venous, diabetic and arterial ulcers (basic understanding referencing back to prevention, not assessing or diagnosing)
*pressure ulcer stages, identification and prevention (same as above)
*treatment options (absolutely not, this one subject has caused many, many issues over the years)

Wound Prevention Certified, yes
Wound Care Trained, no. They are two completely different areas.

I learned more about wounds working as a CNA than I learned in nursing school. Your comment was condescending and dismissive. I have worked in LTC for 22 years, and the lack of wound care knowledge from some of the Licensed Nurses was less than subpar. Not sure where you live, but where I'm at cnas do skin assessments all the time. Most of the time I don't even need to instruct them on what steps to take. On occassion, depending on severity, they already know. I quiz my aides on every reported wound.

@Steven; I'm sorry you have you see my comment as condescending and dismissive. "I learned more about wounds working as a CNA than I learned in nursing school" Really...:-/
I have only described a situation that I currently see. No matter where you live CNA's are NOT allowed under the law to assess a patients' skin. They are allowed to inspect the skin and note any new issues, then report to the nurse. LPN's are NOT allowed to assess. Please direct me to a reference if I am incorrect, only RN's are allowed to assess under their scope of practice. Any assessment that is completed by a LPN must be co-signed by a RN. Is it a play on words.... you bet ya... do CNA's know more than some nurses....absolutely, Is this what happens in the real world...usually not. If you care about your license, you should attempt to adhere to your scope of practice and the law.
As I stated "Proper education, within the boundaries of their roles, for everyone involved in the care of patients is absolute and should be on-going. There is a fine line at times when we educate for early warning signs of ulcers vs identifying or diagnosing them. I prefer a well educated staff member, no matter what title. Continuity of care for the patient is only increased when everyone speaks the same language and understands the importance of the responsibilities."

I'm a CNA and in my facility there are TWO nurses who know wounds. Two. Why not train CNAs to care for wounds? The CNA would CONTINUE to be UNDER the nurse as always, and yet be able to better lessen the load of the nurse, because, as it was mentioned earlier, LTC is facing a HUGE deficit of licensed nurses. CNAs are trained to care for the LTC resident/ patient. Some states offer a license or certification to be a Medication Aide/ Tech, why should that be allowed but not a CNA who performs wound care? And frankly, CNAs perform skin assessments on a daily basis. Brief changing, SHOWERS, we asses the skin almost constantly. How are we supposed to know when to start preventing a wound if we cannot assess the skin? That brings me back to the Med Aide example, Med Aides/ Techs are usually CNAs or equivalent to it, how can they legally assess their patients on meds? Because they were trained and are recognized for that training. Allow CNAs like me to show we are smart enough to hold on to the information. It sounds like you don't think we're capable of doing so. CNAs are more useful to their Charge Nurses when they have actual usable knowledge in as many of the aspects of patient care as possible. I'm became a CNA so that I could know nursing from the bottom up.

@Mario and to all who may read this... wound care/healing can be a very straight forward process....but it usually isn't ! Clearly I am biased, I have concentrated primarily on wound care throughout my career as a LPN and a RN. There is a large multi-disciplined knowledge base required to fully understand the patient (including lifestyle/diet/activities/limitations/cultural aspect/etc.) and their wound (including cardiac/endocrinology/ vascular/ rheumatology/pressure gradients/etc.). I like to tell people that wound care is the accumulation of medical knowledge/disciplines. Yes I have simplified this and I am certain many will argue opposing views... Instead of focusing on one body system or discipline wound care clinicians must a have a general and ever expanding knowledge of all. When we lack knowledge in any one area we consult someone from that discipline to not only help heal the patient but also educate us so we may continue to grow in our understanding. This intern will lead to better outcomes for the patient.
I have a limited understanding of medication aid/tech. It is my understanding that they are limited to residential and assisted living facilities which are non-skilled. They do not have the ability to "legally assess their patients on meds".
Please read http://www.nursingcenter.com/journalarticle?Article_ID=797640 and review my reply to Steven above.
I educate and elevate any CNA I work with, and any staff member for that matter. I hold CNA's in the highest regard for a variety of reasons. I want them to be confident enough in themselves, their knowledge, and their position with me to be proactive and voice what the see. Yes you are correct, many facilities need more nurses who care about and are more knowledgeable in wounds.

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