Urinary incontinence (UI) remains a prevalent and often under-addressed challenge in nursing homes, affecting both residents and frontline caregivers.
Long-term care facilities across the United States employ a range of healthcare professionals; however, Certified Nursing Assistants (CNAs) serve as the primary direct-care workforce, delivering essential support such as toileting, bathing, and incontinence care to more than 1.2 million older adults aged 65 and above. Despite the personal satisfaction that comes from caring for residents, CNA turnover remains strikingly high, with annual rates ranging from 23% to 28%, as shown in recent facility-level studies.
Recent findings published in the Journal of Gerontological Nursing suggest that poor urinary incontinence management is a significant contributor to CNA stress and turnover. According to a 2020 survey of over 100 Directors of Nursing (DONs), 59.2% agreed that UI care is a major factor in staff leaving their roles.
This article aims to highlight how improving UI care systems—through clinical assessments, better staff education, and optimized product use—can reduce CNA burden and turnover, ultimately leading to better care for male nursing home residents
Overview of CNA Role in Managing Incontinence
Certified Nursing Assistants (CNAs) are the cornerstone of direct patient care in nursing homes, responsible for essential tasks such as toileting assistance, managing urinary incontinence (UI), and ensuring residents' hygiene and comfort. This includes routine checks, changing incontinence products, assisting with mobility to and from the restroom, skin care, and documentation. With over half of their shift often spent on incontinence-related care, CNAs play a critical but physically and emotionally demanding role in supporting residents’ dignity and quality of life.
Survey Findings: Workload and Strain
A Pennsylvania-based study found that CNAs spend more than 56% of their shifts on UI-related tasks, changing an average of 36.6 incontinence products per shift.
CNAs frequently express frustration with inefficient workflows, lack of appropriate supplies, and inconsistent staffing, which further amplifies their burden.
Consequences of High Turnover
The consequences of high CNA turnover are multifaceted. Facilities with annual CNA turnover rates of 55% or higher report lower care quality, increased resident mortality, and reduced emotional and spiritual well-being among residents. Team morale also suffers, as remaining staff are forced to compensate for shortages, perpetuating burnout and dissatisfaction.
Moreover, a lack of continuity in caregiving staff disrupts the trusting relationships between CNAs and residents—an essential element of compassionate care. High retention, on the other hand, is strongly associated with improved outcomes, fewer care deficiencies, and enhanced patient safety culture. Thus, reducing turnover not only benefits staff well-being but significantly elevates the standard of care delivered in long-term care facilities.
Certified Nursing Assistants (CNAs) play a crucial role in managing urinary incontinence (UI) care for residents, yet a significant portion of their shifts is dedicated to this task. This extensive time commitment is not only physically demanding but also emotionally taxing, as CNAs must balance the personal care needs of multiple residents, manage time-sensitive tasks, and maintain the quality of care despite the overwhelming workload. The constant pressure to deliver care quickly and effectively without adequate support results in fatigue, job dissatisfaction, and eventually burnout.
Additionally, many residents experience mobility challenges, further complicating the CNA's role. Residents with limited mobility require more time and effort to be safely positioned for toileting or product changes, contributing to longer and more physically demanding care routines. This can extend the already significant time spent on UI management, adding to the CNAs' physical and emotional strain. These residents often require multiple caregivers or assistive devices, which can make the task more time-consuming and increase the CNA's workload. Research has found that poor management of such tasks leads to increased stress, particularly when CNAs are stretched thin and unable to provide optimal care.
To alleviate this burden, facilities should consider improving staffing ratios and adopting smarter scheduling practices that ensure CNAs are not overwhelmed. Incorporating technology, such as automated systems for tracking UI product changes or mobile platforms for communication, could streamline care and reduce the physical and mental stress associated with UI management. Ensuring better training and organizational structures also plays a key role in reducing task burden and allowing CNAs to focus on providing more person-centered care.
A critical challenge in long-term care settings is the widespread lack of knowledge among nursing home staff regarding the causes, types, and treatment options for urinary incontinence (UI). Research shows that even trained nurses often underestimate the complexity of UI and its underlying mechanisms, contributing to inconsistent care and avoidable harm such as skin breakdown and incontinence-associated dermatitis (IAD). In older adult wards, inadequate continence knowledge correlates with poor risk assessment and ineffective prevention strategies, particularly in patients with mobility issues, cognitive decline, and aging-related skin changes.
Investing in staff training is a proven solution. In a systematic review of 19 studies, all trials evaluating educational programs on UI found improved staff knowledge, although changes in attitudes and care practices varied. Still, when education focused on hands-on strategies such as bladder assessment and toileting programs, staff stress levels declined and patient continence outcomes improved in several uncontrolled trials. Education not only enhances clinical skills but fosters confidence in managing complex cases, leading to higher job satisfaction and more consistent, person-centered care.
Effective training programs should be continuous, tailored to staff roles, and embedded within institutional culture. A qualitative study on training models in educational hospitals found that identifying training needs was the highest priority, followed by defining clear objectives and measuring effectiveness. Out of 58 identified training codes, key themes included practical implementation, feedback loops, and ongoing support for staff growth. Given the prevalence of UI in older populations, incontinence-specific modules should become a standard part of CNA and nurse education—ensuring staff are prepared not just to respond, but to prevent and manage UI proactively.
To enhance incontinence care and reduce CNA stress, operational improvements must address core workflow issues. Facilities should consider optimizing schedules to prevent staff burnout, reducing peak-time workloads, and integrating efficient incontinence care systems such as streamlined toileting routines and better access to absorbent products. Innovative models like team-based care and tech-enabled tracking systems can improve patient outcomes while lowering staff burden.
Staff appreciation also plays a critical role in retention and performance. Creating a supportive environment—through recognition, improved working conditions, and safety from workplace violence—has been shown to directly influence care quality and staff well-being. Addressing the emotional toll of caregiving, especially in high-risk populations, can improve morale and reduce turnover.
A comprehensive incontinence care plan should merge clinical protocols, ongoing staff education, and policy reforms tailored to the aging population's evolving needs.
Improving incontinence care in nursing homes is not only essential for resident dignity and health but also critical for reducing CNA turnover and improving care quality. CNAs spend over half their shifts on incontinence-related tasks, and poor incontinence systems are a major driver of stress, burnout, and job dissatisfaction. As studies highlight, better workflows, access to supplies, and education significantly lower staff burden and improve outcomes.
To foster a more resilient workforce, facilities must adopt comprehensive incontinence management strategies—ones that include routine clinical assessments, hands-on training, emotional support, and safe, structured working environments. Prioritizing staff well-being directly correlates with better resident care and lower turnover rates.
Looking ahead, more research is needed on technology-integrated care models and personalized continence plans for residents with mobility and cognitive challenges. Facilities should also explore innovative product solutions like QuickChange® absorbent wraps, which allow for easier changes and improved skin integrity. Institutions can order professional sample packs to assess implementation benefits.
For those seeking support, we invite you to purchase a 10 Count Trial Pack here or request a professional-use sample pack for healthcare institutions here.
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