How Empathy for Nurse Aide Students Improves Learning and Retention
Kelly Prince
March 6, 2019
"Given that this role is so crucial and shortages abound, in order to train and retain the best CNAs, it can be helpful to look at their needs during their certification training and once they’re on the job."

It’s no secret that the key to career longevity in long-term care is healthy dose of empathy. This is especially true for Certified Nurse Aides (CNAs). Individuals working as CNAs may have been drawn to the field for other reasons (employment outlook, job flexibility, speed to certification) but ultimately, those who stay in the field, especially in long-term care, do so because they find the work fulfilling. Not everyone is suited for this demanding role, but the individuals who thrive in it find that making a difference in their patients’ lives matters. Successful CNAs need a caring demeanor and must demonstrate compassion and empathy for their patients.[1]

Given that this role is so crucial and shortages abound, in order to train and retain the best CNAs, it can be helpful to look at their needs during their certification training and once they’re on the job.

Empathy is defined as “the ability to understand and share the feelings of another.”[2] As trainers and supervisors, given our own backgrounds and experience, we do have the ability to empathize with their current state.

Putting ourselves in their shoes can help us teach and supervise CNAs in a way that encourages them and builds them up. Just as we teach CNAs to be aware of their patients’ need according to Maslow’s hierarchy, it can be helpful to do this same thought exercise with our students and newly certified CNAs.



Credit: Teo Yu Siang and Interaction Design Foundation, 2019

Think for a moment about the needs of CNA students. They are likely looking for financial security (safety) as they bravely embark on a new career. They are also seeking a sense of community both in their classroom and later, whilst on the job. The more you can meet these needs and create a sense of belonging, the more engaged and committed your learner will be to the course of study, and to the job itself. Finally, there’s a great opportunity to meet your students’ esteem needs by providing a learning environment that recognizes achievements and allows for mastery.

So how can we specifically apply this to leaning and on-the job training?

The Self-determination theory of motivation can provide guidance here, developed by professors Edward L. Deici and Richard M. Ryan. The theory has been refined and employed in several learning environments, including health and medicine and holds that learners have three needs and if you can meet them, the learner’s intrinsic motivation will increase, resulting in higher-quality learning.[3]These needs are:

  • Competency—we can create learning that allows for challenge and mastery. This leads to a feeling of confidence and competence. “I can do this!”
  • Autonomy—structure learning such that learners feel confident to question and explore the content. Having a sense of autonomy reinforces the value of what they have learned, because they are in control.
  • Relatedness—this is not only important for the learning environment, but on the job as well. Make sure your students and CNAs feel listened to and have a sense of how they fit into the mission of your facility. Create a sense of community within your classroom.

According to a study published in the journal Academic Medicine, we know that learning environments that lack these three elements, “[those] in which students act under pressure and anxiety, are likely to be rote, short-lived, and poorly integrated into students’ long-term values and skills.”[4]

Furthermore, this study found that autonomously motivated learning resulted in improved student performance outcomes, both in and out of the classroom. “There is evidence that medical students who learn in autonomy-supportive environments act in more autonomy-supportive ways in their interactions with patients.”[5]

Final thoughts

Creating a learning environment that encourages students to express themselves, allows them to connect with others, and provides them opportunities for self-directed mastery can lead to better training outcomes and higher competency with patients.

For more on this topic:





[4] The importance of self-determination theory for medical education. 
Williams, G C; Saizow, R B; Ryan, R M
[Article] Academic Medicine. 74(9):992-5, September 1999.

[5] Ibid

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