The Origin of the Temporary Nurse Aide (TNA) Role
The TNA position was not a standard, pre-pandemic role in long-term care. It emerged as a direct result of the federal public health emergency declared during the COVID-19 pandemic. In March 2020, the Centers for Medicare & Medicaid Services (CMS) issued an emergency waiver under Section 1135 of the Social Security Act. This waiver gave nursing homes temporary flexibility in their staffing requirements, allowing them to hire individuals who had not yet completed the full Certified Nursing Assistant (CNA) training program. The goal was to provide a rapid solution to critical staffing shortages when many experienced CNAs and other staff were sick or unable to work. This allowed individuals to undergo a fast-tracked training program to quickly enter the workforce and provide essential support.
The TNA Training Process
To become a TNA, a candidate had to complete an abbreviated training course, typically offered online. Organizations like the American Health Care Association (AHCA) created an 8-hour online program covering core skills like infection control, positioning, and assisting with activities of daily living (ADLs) such as bathing, dressing, and feeding. Upon successful completion of the training and a final assessment, the individual would receive a certificate. This certificate then allowed them to work in a nursing home under the supervision of a licensed nurse or CNA. This was a stark contrast to the standard training for a CNA, which typically requires a minimum of 75 hours of state-approved training, along with a competency exam. The rapid nature of the TNA training was designed for emergency circumstances, and facilities were still required to ensure competency before assigning duties.
The Responsibilities of a TNA
Working under the direct supervision of a licensed nurse, a TNA's duties centered on assisting residents with their most basic needs. These included, but were not limited to:
- Assisting with bathing, dressing, and grooming
- Helping with mobility, including transferring residents to and from beds and chairs
- Serving meals and assisting with feeding
- Ensuring residents have clean linens and a tidy living space
- Taking and recording vital signs
- Responding to call lights
- Providing comfort care and emotional support
Crucially, TNAs were restricted from performing certain tasks that require the higher level of training and certification held by CNAs, such as administering medications, performing sterile procedures, or feeding residents with swallowing difficulties. The scope of practice was defined by the short-term training and the emergency waiver.
TNA vs. CNA: A Comparative Look
Understanding the TNA role is best achieved by comparing it directly with the more established Certified Nursing Assistant position. The primary differences lie in the training requirements, scope of practice, and permanency of the position.
| Feature | TNA (Temporary Nurse Aide) | CNA (Certified Nurse Assistant) |
|---|---|---|
| Purpose | Created during pandemic staffing crisis | Permanent, long-standing role in healthcare |
| Training | Brief (e.g., 8-hour) online course | Extensive (75+ hours) state-approved training |
| Certification | Certificate from online program | State certification, requires passing a competency exam |
| Supervision | Works under a licensed nurse or CNA | Works under a licensed nurse, can supervise TNAs |
| Scope of Practice | Limited to basic ADLs, no sterile procedures | Broader scope, including more complex patient care |
| Role Status | Emergency, temporary position | Permanent, non-emergency position |
The End of the TNA Program and Transition to CNA
The 1135 emergency waiver that authorized the TNA role was always temporary. As the public health emergency subsided, CMS set deadlines for facilities to phase out the TNA role and for TNAs to pursue full CNA certification to continue working as aides. Many states provided guidance and pathways for TNAs to apply their experience towards the hours needed for CNA training, offering a way for facilities to retain these trained and dedicated workers. This meant that individuals who began their healthcare careers as TNAs were required to meet the full, standard training and examination requirements to become Certified Nurse Assistants. The official pathway to become a CNA typically involves a state-approved training course that includes both classroom and clinical components, followed by passing a state competency exam.
- For facilities: This transition meant ensuring their workforce was compliant with pre-pandemic regulations, managing the training and testing of their temporary aides, and potentially adjusting staffing levels. This article from the AHCA blog provides insights on how facilities were advised to ensure temporary aides were successful in this process: How to Ensure Temporary Aides Are Successful - AHCA/NCAL.
- For TNAs: It was an opportunity to advance their career in long-term care by earning a full, recognized certification. Many were able to use their on-the-job experience and initial 8 hours of training towards the longer certification program.
The Legacy of the TNA Role in Senior Care
The TNA program, while short-lived, left a significant mark on the senior care landscape. It highlighted the critical need for flexible staffing solutions during a crisis and brought a new group of dedicated caregivers into the healthcare field. For families with loved ones in nursing homes during the pandemic, understanding what is a TNA in a nursing home was vital. It was important to know that these individuals were providing essential care, albeit with a different level of training than a traditional CNA. While the temporary role has largely been phased out, the experience for many TNAs served as a launchpad for a long-term career as a CNA, contributing to the overall strength and resilience of the senior care workforce.
Ultimately, the TNA program demonstrated the adaptability of the healthcare system in the face of immense challenges. It also reaffirmed the importance of proper, comprehensive training for all caregivers, underscoring why the full CNA certification remains the standard for skilled nursing assistance. For families navigating senior care today, it is important to know that staffing has returned to the standard, certified structure, with CNAs being the primary providers of hands-on daily care.
