Brynley Whitekiller clocks in three to four times a week for 12-hour shifts at Cearu Medical Resort, a skilled nursing facility in Tulsa. She enjoys that schedule because of the balance it gives her to take care of herself after she spends long days caring for others.
Her work as a long-term care certified nursing aide (CNA) started under a waiver in the depths of the pandemic at a COVID-19 facility run by her mom. It’s a memory she’s blocked out, but it prepared her to find success and fulfillment in her current role. Now, she trains potential CNA hires, and she’s made meaningful friendships with her residents.
“I was lucky enough to work on the job and learn a lot from my mom,” Whitekiller said. “But I got lucky.”
Entry-level workers like Whitekiller receive fast-food wages, but provide 80% of the direct care seniors receive. She said entering the field and transitioning into working with residents can feel overwhelming and unappealing for some, especially those coming straight out of CNA school.
“I remember, even when I started here, I got trained for three days, and then they were like, 'OK, you get your own patients, you're good to go.' And I thankfully am confident and able, but I don't think everybody is able or educated enough to just go ahead [and get started],” Whitekiller said. “And you have your nurses, and they're responsible for you, but they have their own responsibilities. … They can't be your teacher all the time.”
Recruiting long-term care CNAs can be challenging, and fighting consistent turnover is costly. But groups in Oklahoma are finding ways to invest in these workers’ education and futures.
Investing in early education
Oklahoma requires 85 hours of training to get a long-term care CNA certification, and it can be packed into a few weeks or span a few months. Programs must include 16 hours of training in certain areas, 16 hours of supervised practical training and 10 hours of Alzheimer’s training.
Brianna Elkins, a recent CNA school graduate from Green Country Technology Center in Okmulgee, said she loved caring for seniors during her nursing home clinical. Her mom helped her overcome financial barriers by covering the more than $500 it cost to enroll in the center’s FLEX program. She juggled her high school courses and extracurriculars to obtain the certification.
“It is a hard job, but it’s definitely worth it. And it’s definitely worth the wait on the education too,” Elkins said.
She hopes to get a CNA job to help her to save money for college down the road. Although she’s interested in long-term care in the future, she said she doesn’t feel ready to start in an understaffed facility without mentors.
“There's not a lot of CNAs at certain nursing homes around the Okmulgee area,” Elkins said. “I would want to work in a hospital where I have someone that could also help me and teach me more, rather than me just go and do it.”
In response to a shortage of health care workers across the board, Tulsa Technology Center is working to invest early with a Nursing Transitions program that’s free for high school seniors.
They work through their long-term care CNA training and transition into nursing classes through the remainder of that semester into the next. Dana Chandler, Tulsa Tech’s practical nursing coordinator, said the first semester spent obtaining their CNA certification helps students decide if nursing is for them.
“At that point, sometimes we see students step away, which is good. I say we've accomplished a goal too, because their education that they've gotten to this point has been free. They haven't paid for those textbooks, they haven't had to pay tuition, they haven't had to pay a lot of things,” Chandler said.
Nursing Transitions instructors Quincee Smith and Melissa Peterson spend their class blocks teaching everything from hands-on skills in a lab, like range of motion and positioning residents, to more classroom-based topics like health care documentation. Students prepare at Tulsa Tech to eventually complete clinicals in area nursing homes, which often offer them jobs.
“Clinical is never what they thought it would be,” Peterson said. “It’s hard to prepare you for something like clinical because you never know what kind of day you’re going to get. But I think that they're always relieved after those first days. It's not as scary as they thought it would be.”
Although she tries to be upfront about the role's challenges, she said a positive educational experience with hands-on learning and without financial barriers can impact CNAs’ attitudes toward the role.
“If you're coming to school and your instructors are excited that you're here, and your instructors are excited that you're learning, then you're excited to learn and to do more,” Peterson said.
By the time they graduate from the program, students can apply for the CNA to licensed practical nursing (LPN) bridge program, where they can become LPNs in six months. The center hopes this could encourage students to enroll in higher education afterward to pursue degrees in health care.
Chandler, whose master’s-level career started with getting a CNA, said an entry-level foundation helps students become better, more empathetic professionals.
Students like Aya and Jaydn. Both high schoolers plan on pursuing further education outside of the Nursing Transitions program, but they’ll both graduate with free education and a clearer idea of what it’s like to work in long-term care. It’s an opportunity they want other young people to know about.
“I think it's good to work in [long-term care] because not a lot of CNAs do work in long-term care,” Aya said. “You're seeing people that can't take care of themselves and you're understanding what it's like for them, to take care of them, but then … you feel for them, and once you feel for them, you become more empathetic about people around you.”
Finding the right fit
Alayna Thomas is a workforce retention strategist at Magnet Culture, which primarily works with long-term care facilities. Its programs train managers on how to reduce turnover among frontline workers, like CNAs.
She said sharp onramps and lacking financial and emotional investments in employees can turn facilities into revolving doors. And most don’t realize how much they’re spending on turnover.
“We had an organization that we just talked with … and we ask them, how much are you spending on recruiting? How much are you spending on staffing agencies and for your on-call [short-term nurses]? … They were spending $300,000 a year on just turnover and recruiting,” Thomas said. “They had no idea.”
Thomas said guiding and supporting employees individually can help combat turnover. Groups like Voyage Long Term Care are finding creative ways to do just that.
Its former director of human resources, Michael Summers, said the company’s five long-term care facilities are bringing Oklahomans into foundational positions like housekeeping or dietary aides to see how they work in a facility.
During COVID, Summers said if someone was “breathing and wanted a job,” they could probably be hired in a nursing home. Summers said he thinks that was part of the problem.
Now, at Voyage Long Term Care, if the person is the right fit for an entry-level role, they’ll offer to pay for their CNA school.
He said this has reduced the company’s turnover rate by double digits.
“Our turnover rate … has decreased because we are so selective,” Summers said. “I think the empowerment of getting good, trained, solid people in that foundational role is very important.”
At the state level, Care Providers Oklahoma is using $4.5 million in ARPA funding to connect Oklahomans to CNA jobs. Through the Care Careers Oklahoma program, people can start in an entry-level role at a nursing home of their choosing, enter a training program and get to work as a CNA once they obtain their certification.
Tanecia Davis, Care Providers Oklahoma’s director of workforce development, said 650 people have been reimbursed for their CNA or certified medication aide training.
“Our role is to help facilitate interested candidates to enter the field, and if they choose to enter the field, to make sure that they have the resources to receive their education and testing fees as they walk this pathway,” Davis said.
The ARPA grant will come to an end in 2026, but Care Providers Oklahoma CEO Steve Buck said the group has had preliminary conversations with the Oklahoma Health Care Workforce Training Commission to continue this level of investment.
He said the seeds they’re sowing now could eventually fuel the long-term care workforce at higher levels.
“Oklahoma is on the verge of what is being coined the silver tsunami. … This conversation about helping people navigate from that first level of engagement, work all the way through what may be their terminal degree,” Buck said. “We need to have those conversations consistently.”
Buck said other barriers, like lacking child care and transportation, need to be addressed to ensure longevity for emerging health care professionals central to the future of the long-term care sector. Voyage Long Term Care has found success in prioritizing those needs by offering employees a portion of their paycheck in advance so they can cover expenses.
Buck said state-level investments in the needs of direct-care workers like CNAs are how Oklahoma can weather the tsunami.
“When an employee calls you and says that they need help, not just cash, but specifically, ‘I need tires for my car.’ If we can do something that's going to make it where we know that person's going to come to work safe so that they can take care of residents, that's an investment that we're willing to take,” Summers said.
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