For one nursing assistant in Lorain, COVID-19 was a call to duty.

“Coronavirus was like my September 11^th,” says the nursing assistant, who asked to remain anonymous because he is not authorized to speak about his workplace. “I felt like we were in a national crisis and I just wanted to play a part.”

He’d previously worked as an Emergency Medical Technician but quit when he learned he could earn more by working at a grocery store.

He decided to re-enter the medical field to combat COVID-19 and attended a six-week course at Lorain County Community College to be a nursing assistant. Now, he spends his days working as a cashier at Costco, and his nights taking patients’ vital signs at Cleveland Clinic’s Fairview Hospital.

“The best part is feeling like I’m making a difference,” he says.

The Lorain man isn’t alone in his newfound passion. Marquita Rockamore, the director of Cuyahoga Community College’s (Tri-C) Healthcare Training program, says she’s seen enrollment in Tri-C’s State Tested Nursing Assistant (STNA) program increase since the pandemic began.

“The students we’re getting now are really dedicated,” she says.

Yet despite these increases in student enrollments, large nursing aid shortages still exist in Northeast Ohio.

“There was a need for nurse assistants before COVID hit,” says Rockamore. “But with COVID, that need increased exponentially.”

A labor report from Team NEO, a regional economic development nonprofit, found that over 3,000 nursing aid job openings were posted in Northeast Ohio between March and October 2020. Meanwhile, staff call-offs due to COVID-19 have caused staff shortages in some hospitals—with MetroHealth closing nine locations in December due to insufficient staffing. Long-term healthcare facilities and nursing homes are experiencing similar staffing needs.

The growing shortages have given new urgency to Cleveland-area workforce collaboratives, such as Workforce Connect Healthcare Sector Partnership and Senior Care Workforce Collaborative. These groups are looking to not simply inspire a sense of duty in future healthcare workers, but find ways to better incentivize, support, and compensate entry-level workers.

Long-running challenges: Hard work for low pay
Entry level healthcare positions have long been hard to fill due to the nature and compensation of the work.

Nursing assistants in Ohio, for instance, earn an average of $13.62 an hour, low enough to qualify someone with a family of four for food stamps.

“Employers are always saying that [being a nursing assistant] is ‘a career that loves you back,’” says Rockamore. “But it’s hard to feel love when your stomach is hungry.”

The work, meanwhile, can be grueling. Nursing aid shifts last eight or 12 hours, depending on the institution. And there can be little time to rest.

A morning shift, for example, begins at 7 a.m., and involves waking, bathing, and feeding patients, says a Cleveland nursing assistant. The man has 20 years’ experience in a long-term care facility and asked to remain anonymous to protect his job.

“The morning care would be a tub bath, could be a shower, could be a bed bath,” the nursing assistant says. “Breakfast comes up... around 8 a.m. Some people feed themselves, some people need to be fed.

“After or before morning care, we would check the briefs on people, make sure they are clean and dry.”

The duties are mundane but demanding, requiring constant moving and lifting says another longtime nursing assistant. He has worked in Akron and Central Ohio, and also asked to remain anonymous.

“You have to roll over a 250-pound guy, hold him up with one arm and change his brief with the other arm,” the second nursing assistant says. “Sometimes you can get someone to hold [the patient] while you change his bed, wipe him off, change the briefs, and let him roll back over."

There are financial barriers to joining the field as well. To become a STNA, the applicant must complete 75 hours of training with a state-certified program. Tuition ranges from $400 to $1500, depending on the program, and tests can cost an additional $100.

So, while the work may indeed feel meaningful, other entry-level jobs pay higher and have fewer entry requirements.

“Amazon is paying $17 an hour,” says Rockamore. “So, you know, if we don’t want people to have to choose between their passion for caring for people and their livelihood, [employers] have to consider that.”

Individual employers have begun offering wage raises in hopes of drawing people to the healthcare field.

“We [were seeing] wages go up even before the pandemic,” says Rockamore. “Two of our long-term care employers had moved wages up to $15 per hour [to compete with Amazon].”

Some long-term facilities offered other perks as well to attract new employees during the pandemic.

Lee Ann O'Brien, the chief marketing officer for McGregor, a long-term senior care facility in East Cleveland, says the facility offered sign-on bonuses, complimentary catered lunches, transportation, and hazard pay during COVID-19.

Similarly, Garfield Heights assisted living facility Jennings offered “devotion bonuses” for employees who stayed on during the pandemic, and flexible scheduling options to deal with changes in childcare.

Despite these incentives, spokespeople from both facilities said it was still difficult to attract and retain employees.

“We have people go through the entire [job] orientation, then quit after one day,” says O’Brien.

Investing in long-term talent
In response, healthcare facilities across Northeast Ohio have joined forces to provide a more structured approach to strengthening the healthcare employee pipeline.

McGregor, Jennings, and three other long-term care facilities launched the Senior Care Workforce Collaborative in December 2020, with the aim of recruiting more entry-level employees.

The Collaborative offers a landing site for individuals to find healthcare job opportunities in their neighborhoods and submit their information to all six collaborative partners. O’Brien says the website and social media accounts for the Collaborative have already generated one million views since its winter launch.

Six of Cleveland’s hospital systems, meanwhile, joined with Tri-C in fall 2020 to launch the Workforce Connect Healthcare Sector Partnership.

The goal, says the partnership’s executive director Sue Krejci, is partially to recruit new talent to entry-level positions like nursing assistants, pharmacy technicians, and phlebotomists (who draw blood for testing).

Garfield Heights assisted living facility Jennings offered “devotion bonuses” for employees who stayed on during the pandemic.Krejci says most people don’t know that these entry level positions exist, and that they don’t require a university degree.

“We’re working with [Cleveland Schools] to get positions like phlebotomist on high school students’ radars sooner,” says Krejci. The partnership has participated in career information sessions to inform high school seniors about healthcare careers through the Students Working Advancement Group.

However, the Partnership also wants to find new ways to encourage entry-level employees to advance so they can land roles which offer “family-sustaining wages.” Krejci says the goal is to get people engaged in jobs that pay at least $15/hour while encouraging progression up the payment ladder.

“Healthcare is like a highway with lots of on-ramps and off-ramps,” says Krejci. “We are looking for ways to encourage people who get on [the highway] where the wages are lower and get them on a pathway to a higher earning jobs.”

She says the Partnership is at the beginning stages of researching successful coaching and promotion strategies.

“An early win has been just getting all these different groups to the table to talk about common challenges and solutions,” says Krejci.

Some long-term facilities have already launched their own training and promotion programs. Jennings’ Rewarding Education Through Advanced Careers in Healthcare (REACH) program, for instance, offers one-to-one coaching and tuition scholarships for employees who want to go back to school. The on-site REACH coach has assisted numerous employees in improving their skills and moving up into higher paying jobs.

“We had one employee who started off in dietary services, moved into housekeeping, and then went back to school and became an STNA,” says Julie Wagner, chief human resources officer at Jennings.

She says they’ve also had several employees move up from nursing aid positions to Licensed Practical Nurse (LPN) roles.

Looking to the future
Still, some believe longer term changes are necessary to attract and retain new healthcare workers.

Rockamore says that a professional association—which would maintain records of nursing assistants’ performances at various positions—would help develop a level of accountability for the profession.

“Right now, an STNA can walk off the job and go get hired somewhere else the next day,” she says.

In addition, Rockamore believes a professional association would give STNAs a sense of greater power to effect conditions in their workplace.

“Right now, [STNAs] don’t have a voice,” she says. “If they don’t like the pay or conditions they just move on. It’s expensive for employers. They need a voice. Not just a survey or suggestion box, but a real voice in what happens in their industry.”

Rockamore says she believes a professional association that improves both accountability and empowerment of STNAs would benefit not only nursing assistants, but the quality of care for their patients, during the pandemic and beyond.

This story is sponsored by the Northeast Ohio Solutions Journalism Collaborative, which is composed of 20-plus Northeast Ohio news outlets including FreshWater Cleveland.

Sydney Kornegay is a freelance writer whose work has appeared in Aidemocracy, The Columbia Star, and Observatario Economico. She has a master's degree in International Development and Economics from Fordham University and is the director of adult programming at Refugee Response in Cleveland.

Afi Scruggs is a local freelancer and a Gerontological Society of America Journalist in Aging Fellow. Her diverse body of work spans more than 25 years and has appeared in the Cleveland Plain Dealer, the New Yorker, Cleveland Magazine, and the Atlanta Journal Constitution among many others. Visit her page for more information.