Date of Award


Document Type


Degree Name

Doctor of Education (EdD)


Executive Leadership

First Supervisor

Mary S. Collins

Second Supervisor

Cynthia R. McCloskey


Certified nursing assistants (CNAs) are the primary caregivers with the most frequent, intimate contact with residents, influencing the resident’s quality of life. The current nursing literature does not explore how CNAs’ cultural and social capital interacts with the institutional culture of the skilled nursing home. The purpose of this focused ethnographic study was to understand the cultural and social capital of the CNA, and how a CNA interacts within the skilled nursing home institutional culture. A purposive sampling of CNAs from a skilled nursing home in Upstate New York was invited to be part of the study; 21 CNAs chose to participate. Data were collected through semi-structured interviews with the CNAs and cognitively intact residents, focus groups of the nursing staff and environmental service aides, participant observation and field work journaling. Data were analyzed using Atlas ti™, with repeated reviews to develop domain analysis, a cultural inventory and the cultural themes. Themes identified were We are like family with a subtheme of Protecting family from outsiders and We work together (Teamwork), Communication skills which build relationships, Learning caring from Home, Lessons about being a worker and We influence each other becoming family . Findings of this study revealed that within the study setting the CNA participants identified the importance of developing connections and interacting with the residents and coworkers as family. A contribution of this study to the literature was the recognition of the need to focus on the nonpermanently assigned (per diem/float) CNAs and their role in the institutional culture.

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