Hey {{first_name|there}} 👋
A CNA passed her cert last month, gave the nursing home three weeks, and applied broadly. Days later, she had offers from both a hospital and a derm office. She picked derm: $5/hour more. There is no "CNA-to-derm" pathway. She just applied.
Plus CNA turnover just dropped, a federal bill on direct care wages, and a Nurses Week ritual you've probably lived through. Happy Nurses Week. The work counts, even when some celebrations don't. We've got one in the Break Room.
Let's get into it.
THE PAY CHECK
Money, wages, and what you’re worth.
CNA turnover just dropped. That's leverage.
The 2026 NSI National Health Care Retention Report landed last month with an unusual data point. The annual CNA turnover rate is 31.2%, still the highest of any healthcare role. But it fell 3.6% year-over-year, the largest drop of any role in the report.
Which means facilities still replace roughly one in three of you every year, and replacing one of you (training time, agency fill-in, burnout on the rest of the team) runs into tens of thousands per departure. They're holding onto more of you than last year. And they want to keep it that way.
Your move: if your facility hasn't moved on wages in over a year, you have more room to negotiate than you might think. Anchor the conversation on the cost of replacing you, not the cost of keeping you. Keeping you costs less.
SHIFT REPORT
What’s happening in CNA world this week.
A federal bill is back that could finally set a national CNA wage strategy
On April 29, Rep. Debbie Dingell (D-MI) reintroduced the Long-Term Care Workforce Support Act. Two pieces matter for you. First, it would create a National Direct Care Professional Training Standards Commission to build training that's portable across state lines, the closest thing yet to a real fix for license portability. Second, it would direct HHS to convene an Advisory Council on direct care compensation, including federal investments aimed at "livable, competitive wages." Long road from reintroduction to law. If your cert has ever been stuck at a state line or your wage floor has never moved, this is the one to track.
PHIThe federal staffing rule isn't actually dead, says CMS's former #2
The Biden-era nursing home staffing rule, which would have required a 24/7 RN and minimum nurse staffing hours per resident, was killed in December. But Jonathan Blum, former COO of CMS, told an LTC conference that "the idea of having such requirements is certainly still circulating among federal officials" and that a version could return after the November midterms. The staffing-mandate fight is the proxy fight for whether you're working alone with 15 residents or alongside enough hands to do the job safely. Don't assume the question is settled.
Skilled Nursing NewsRural nursing homes are disappearing, and the new federal budget just hit them harder
The U.S. lost 6% of its nursing homes between 2015 and 2025 (15,643 down to 14,742), and half those losses were rural, per KFF Health News. Remote-rural facilities saw resident populations drop 19%, vs. 12% in other rural areas and 8% in urban settings. The 2025 federal reconciliation law projects $911 billion in Medicaid cuts over 10 years, with $137 billion aimed at rural areas, against just $50 billion of rural transformation funding. If you work rural, expect more closures, longer drives, and tighter wage growth as employers consolidate.
Skilled Nursing News on the KFF analysis
FROM THE FLOOR
Real talk from the job.
"I love being a CNA"
A CNA in nursing school wrote this week about something most people miss until it's too late.
She wrote about the connections she makes. Laughing with patients. The way their face lights up when she walks in. She's about to become an RN, and she's already grieving the part of the job she's about to lose.
"We usually spend more time with patients than the nurses," she wrote. "I'll miss making those deep connections."
Whatever you're working through this week, that's worth holding onto. The connection runs deep because you're the one who's there. Happy Nurses Week.
YOUR MOVE
Career paths, certifications, and what comes next.
Sometimes you just have to apply
Three weeks into the nursing home that trained her, she'd had enough. She used her cert to apply broadly: hospitals, family medicine, dermatology offices. Within days she had offers from both a hospital and a derm office. She picked the derm office.
Her new pay: $5/hour more, plus commission on skin-line products. New title: Patient Care Coordinator/Clinical Assistant. Her scope grew to numbing agents, assisting with mole removals, and skin checks. All trained on the job, all under the doctor's scope.
There's no official "CNA-to-dermatology" path. There doesn't need to be. Your cert is recognized in plenty of places that don't advertise as CNA employers: hospital float pools, outpatient specialty practices (derm, cardiology, ortho), urgent care, dialysis, hospice, home health. Many pay more than SNFs. The trick isn't credentialing. It's applying outside the long-term-care pipeline you trained inside of.
BREAK ROOM
You’ve earned a laugh.
The hospital that used AI to plan Nurses Week
A Nurses Week schedule doing the rounds from a hospital ICU. Tagline up top: "Let's celebrate all week long with fun themes, snacks & self-care — made by us, for us!"
Every day has a "DIY IDEA" because the celebration is the DIY. Coffee bar where you bring the creamers. Taco bar where you sign up to bring food. Bake-off. Thursday is "What should we do? Share your ideas." Friday is the one day the hospital actually pays for anything, and the AI corrupted the bakery's name into "Beiler's Cootates" (real name: Beiler's Donuts).
Made by us, for us. (Their words.)
The nurse who posted it didn't catch it was AI until someone pointed out the clip art and the bakery name. "I didn't even notice it was AI. That hurts so much more."
You deserve better than that.
What's your facility doing this week? Hit reply.
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See you next week
The CNA Brief
A publication of thecnaguide.com