WED AM News: Research illustrates role of CNAs in nursing homes; SHINE announces agreement aimed at reaching Asian markets

April 9, 2025

— More nursing home staffing leads to fewer hospitalizations and deaths, with the greatest impact seen from the workers providing day-to-day care, according to research presented during a UW-Madison seminar.

David Grabowski, a professor in the Department of Health Care Policy at Harvard Medical School, spoke yesterday during an event organized by the UW School of Medicine and Public Health.

He discussed a study that explored the effects of short-term staffing reductions on patients, looking at three types of workers: registered nurses, or RNs; licensed practical nurses, LPNs; and certified nurse aids, or CNAs. While prior research has found RNs and LPNs contributed more to improvements in quality, this study found the lower-ranked CNAs are playing an important role, Grabowski said.

“Staff hours have the impact we would expect, more staff lead to fewer hospitalizations, less mortality, fewer hospital days and less hospital spending … this is largely being driven by CNAs,” he said.

Specifically, an extra nursing staff hour per resident day was linked to a 15% lower chance of hospitalization, a 15% lower chance of death, an 11% reduction in hospital days and 14% reduction in hospital standing.

“These are huge effects,” he said, adding the outsized role of CNAs shown by the data can be explained in part by the study model. Researchers were looking at short-term and sometimes unexpected staffing losses, rather than long-term shortages, he noted.

“CNAs are really the ones doing the assistance with the activities of daily living. They’re doing most of that hands-on care, LPNs and RNs are sort of working at a different level,” he said. “We would argue CNA losses are particularly harmful to the residents when you have these unexpected losses.”

He explained RNs are typically tasked with developing and overseeing implementation of plans for patient care, meaning their brief absences would have a relatively smaller impact compared to the CNAs. Grabowski said consistently higher staffing for administrative-focused RNs “might improve care over the longer term” but he emphasized the short-term impacts of CNA absences.

While LPNs are doing much of the medication work in most U.S. states and providing nursing care with residents, the CNAs are providing up to 90% of the direct care to residents, Grabowski said. He said CNAs are largely women, and many are recent immigrants or minorities.

“They’re paid very close to minimum wage, and less than half have health insurance through the nursing home,” he said. “This is a very fluid workforce.”

Researchers used data from various sources to conduct this analysis, including information on staff vacation time. By focusing on vacation time, rather than a more simple “outcomes versus hours worked” assessment, the team was able to explore variations in staffing that weren’t linked to patient characteristics.

That’s important because looking only at the number of hours worked could lead to “paradoxical” results, he said. As an example, facilities may “staff up” in order to provide adequate care for particularly sick patients, who will likely have worse health outcomes, leading researchers to the incorrect conclusion that more staff hours worsen health outcomes.

The study comes as the national nursing home workforce has “finally returned” to pre-pandemic levels nearly five years later, after it initially lost more than 400,000 workers, Grabowski noted.

“RNs, LPNs and CNAs all have different training and certification requirements, obviously the RNs and LPNs have their degrees, CNAs go through 100 hours of certification, but they have very different roles in the nursing home,” he said. “And you might imagine that all are important, but they might be important in different ways.”

Watch the video.

— SHINE Technologies has announced a new partnership with Sumitomo Corporation of Americas aimed at helping the Janesville company reach Asian markets.

SCOA, the largest subsidiary of the Japanese Sumitomo Corporation, is a global trading and investment company. SHINE says the partnership will focus on establishing reliable supply chains for its products and services, ranging from widely used medical isotopes to advanced inspections and testing services.

The partnership, formalized under a memorandum of understanding, also “lays the groundwork” for logistics and legal considerations for transporting radioisotopes and related materials between the United States and markets in Asia, such as Japan.

SCOA will be promoting SHINE’s offerings under the agreement, and will act as its sales agent in the defined territories “if market studies prove successful,” according to the announcement.

SHINE CEO and founder Greg Piefer says the effort “opens vital channels” for introducing the company’s fusion-based technologies.

“Combining their deep market knowledge and established distribution networks with our innovative production methods strengthens international supply chains for nuclear medicine, neutron imaging, and irradiation services while advancing our long-term vision of harnessing fusion to solve humanity’s most pressing energy challenges,” he said in a statement.

While the company’s imaging and inspection services have applications across advanced materials, aerospace and defense industries, its radiosotopes are used in medical imaging and in treating cancer.

See the release.

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— Assembly Republicans have unveiled a new version of a heavily lobbied transmission bill opposed by some conservatives, adding provisions addressing farmland preservation and touting nuclear energy to win over previous GOP holdouts.

Lawmakers dubbed the new bill the “Wisconsin Energy Reform Act” and said the previous legislation — known as right of first refusal, or ROFR — wouldn’t be brought to the Assembly floor.

Still, the new version would maintain provisions that would give existing utilities that own transmission infrastructure a leg up in building new lines expected in the state.

The original ROFR has been opposed by some conservative groups and talk radio, who knocked it as anti-competitive.

Still, the revisions have won over some Assembly Republicans, including Rep. Travis Tranel. The Cuba City Republican was sharply critical of the bill during a joint legislative hearing last month. But he praised the farmland preservation provisions included in the new bill, and Assembly Republicans said he “spearheaded” the effort to include them.

Those provisions include a requirement that owners of large wind or solar projects along with battery storage systems purchase conservation easements if they use “prime farmland” for the renewable projects.

Those easements prohibit the land from being developed in any way that would make it unsuitable for agricultural use. For every acre of prime farmlands used for one of those renewable projects, the owner would have to purchase an easement on four acres of prime farmland.

“I worked hard to strike the right balance to protect prime farmland for generations of farmers to come, while still recognizing the need to protect private property owners and the reality that energy generation in Wisconsin will likely always include renewable sources,” Tranel said.

The release quoted four Assembly Republicans, along with Speaker Robin Vos, R-Rochester, saying he hoped to have the new bill on the floor yet this month.

While opponents have argued the ROFR provisions would drive up construction costs, backers have argued it would allow the operational expenses of coming projects to be spread over a larger area rather than being borne just by Wisconsin customers.

The new draft includes provisions in the original ROFR legislation introduced this session. Proponents, including Senate Majority Leader Devin LeMahieu, R-Oostburg, have pushed the bill as the Midcontinent Independent System Operator, a regional authority, has moved forward with new transmission line projects in Wisconsin and other member states.

That includes an amendment that LeMahieu introduced along with five Assembly Republicans that would declare void the rights granted to incumbent transmission facilities if the federal government repeals a provision that allows the owners of transmission facilities to spread costs over the region.

The new bill draft also calls for:

Expanding a competitive bidding requirement for some pieces of projects to require owners of proposed transmission facilities to go through the competitive bidding process for contracts to design, construct or furnish materials for the project.
Requiring the Legislative Audit Bureau to review 15% of transmission facility construction contracts subject to the competitive building requirements.
Requiring those seeking to construct energy battery storage systems to get a certificate of public convenience and necessity from the PSC. The requirement would apply to those systems that are one acre or more and store energy. Under current law, those seeking to build generation facilities of at least 100 megawatts must obtain such a certificate.
Establishing a state policy that nuclear energy is a high-priority option, second only to efficiency and conservation, to be considered in meeting the state’s power demands. Current law states all new electric generation should be based on renewable sources to the extent that it’s cost-effective and technically feasible. The provision would add nuclear energy to that focus.
Requiring new lighting requirements for wind systems and high-voltage transmission lines. Rather than constantly flashing lights that serve as a warning to aircraft, the system would only turn on after detecting an aircraft in the area.

Rep. David Steffen, chair of the Energy and Utilities Committee and a proponent of nuclear energy, praised that provision. Assembly Republicans said the Howard Republican’s committee will hear the bill in the coming days.

“By prioritizing low-carbon-emitting nuclear energy as a strategy in energy generation, we will help position Wisconsin to meet the increased electricity demands of today and lay the groundwork Wisconsin needs to be able to attract large electricity technology companies looking to locate their operations in Wisconsin,” Steffen said.

Today’s version is the latest incarnation of the bill circulated in the Capitol in recent days. GOP state Sen. Steve Nass, R-Whitewater, on Friday emailed his legislative colleagues with a different version the lawmaker said he received from a lobbyist.

Nass, an opponent of the legislation, wrote in the email he was sharing the draft in the interest of transparency since most legislators hadn’t been given the opportunity to view it personally. He added there were already rumors of a different version than the one he had, “but we will all have to wait until the lobbying corp gets their copies first.”

— Harley-Davidson’s board of directors has begun the search for the Milwaukee motorcycle manufacturer’s next CEO.

The company yesterday announced the ongoing CEO search process, which began late last year after current CEO Jochen Zeitz said he wanted to retire in 2025. The release notes Zeitz will keep the position until his successor is identified “to ensure an orderly leadership transition.”

Yesterday’s announcement touts Zeitz’s “significant contribution” the company including executing its five-year strategic plan from 2021 to 2025, “reinvigorating” the brand and leading Harley-Davidson “during one of the most challenging operating environments in the history of the Company.”

Zeitz joined the company’s board in 2007 and was later brought on as interim CEO in February 2020 and became CEO that spring.

See the release.

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