Certified nurse assistants making meaning of direct care.

Using qualitative data from 87 focus groups with certified nurse assistants (CNAs) in 16 nursing homes in Massachusetts, we explore ways that CNAs make meaning of their work despite devaluations, such as lack of respect from management and residents, and the physical and emotional demands of such low-status work. CNAs' meaning making represents an effort to assert a positive identity rather than accept the stigmatization associated with their work. Assertions of the value help CNAs reconstitute their identities. Assertions of meaning, which depend upon providing good care to residents regardless of financial reward or management respect and support, make CNAs vulnerable to exploitation.