Being a nursing assistant in a long-term care facility is one of the most demanding jobs in America, says a Cornell University gerontologist. These professionals require emotional strength and interpersonal skill as they confront on-the-job suffering, dementia and mortality every day.

To help nursing assistants better cope with their major causes of job stress and burn out, Karl Pillemer, professor of human development at Cornell and co-director of the Cornell Gerontology Institute, has co-authored a new book, The Nursing Assistant's Survival Guide (Frontline Publishing, 1999).

"Studies have shown that probably the most important thing in residents' overall well-being in a nursing home is their relationships with staff. And nursing assistants provide almost 90 percent of all the care residents receive," says Pillemer. "Certified nursing assistants must be expert communicators across a wide array of difficult situations."

The 87-page, easy-to-read manual, illustrated with cartoon drawings, provides practical strategies for coping with stress, death of residents/patients, difficulty in communicating, supervisors, family members, angry or aggressive residents and family demands. In 1996, Pillemer wrote a companion book for nursing home administrators called Solving the Frontline Crisis in Long-term Care: A Practical Guide to Finding and Keeping Quality Nursing Assistants (Frontline Publishers, 1996, $39). His latest book is targeted to the nursing assistants themselves.

"The shrinking population of nursing assistants is a true crisis that will devastate the long-term care system if drastic measures aren't taken soon," says Pillemer. "We need to make the job more attractive to more people. And we need to help nursing assistants do their job better. By writing this book, we're trying to help nursing assistants better cope with the stress and demands of their jobs. We hope that the end result will be lower turnover in these positions and higher quality care."

If these frontline, hands-on workers had better coping strategies to deal with the challenges and difficulties of their jobs, they would like their jobs more and facilities would retain them longer, thereby reducing the millions of dollars the high turnover rates cost the industry. Perhaps even more important, Pillemer says, is how the higher nursing assistant job satisfaction would affect the residents in long-term care facilities.

The manual is based on analysis of surveys and numerous focus and training groups to determine the root causes of the staff turnover and shortage of workers, and his publication offers numerous coping strategies for nursing assistants.

"Many nursing assistants begin with a sense of enthusiasm, sound intrinsic motivation, a desire to help others and a sense that he or she is making a meaningful contribution, yet workers get burned out," he says. "We believe that these qualities among nursing assistants can be preserved."

The book is co-authored with Richard Hoffman and Marty Schumacher, who both work with Pillemer in producing Nursing Assistant Monthly, a professional newsletter for nursing assistants of which Pillemer is executive editor. They also have just launched The Resident Assistant, a newsletter/professional journal tied to a continuing education program for and about resident assistants in assisted-living facilities. Upcoming issues include topics such as improving communication, nutritional risk and residents; working with residents' families; managing aggressive residents; and dealing with death and bereavement.