The heart and soul of every long-term care facility is the staff. But we know that hiring and keeping the best nursing home staffing can is an industry-wide challenge. We understand the staffing struggle most long-term care facilities face. Improving turnover rates and having quality long-term care staffing has a big impact on your facility’s finances, the care you provide, and even your CMS rating.
The state of LTC staffing
Employee turnover is costing LTC facilities billions of dollars every year. When an employee quits or is let go, the long-term care facility has to cover LTC recruiting, hiring and training costs. As you know, current turnover rates are high in long-term care, with an average between 55-75%. That means, on a team of 100 employees, 55-75 of them were fired or quit in the last year. CNA turnover rates are the highest and can often be as high as 100%.
A number of financial impacts stem from turn overrates when running a nursing home. There is the direct costs of recruiting, including advertising, temp. agency costs, training new employees and even costs surrounding an increase in injuries as employees learn safety skills. In fact, it is estimated that losing a nurse costs between $37,700 and $58,400. High turnover can result in reduced revenue and increased business development costs due to lost residents. When turnover is high, the quality of care declines, and residents and their families take notice. A study by the Upjohn Institute for Employment Research looked at the impact of nurse turnover. They found a significant decrease in care quality as staff turnover increased.
So, how can your facility lower turnover rates and find quality staff? We talked to experienced HealthDirect Client Service Specialist, Sandra Reeser to glean insights on LTC staffing. Reeser worked as an LTC facility director for 9 years before joining the HealthDirect team. In her role she actively recruited, hired, training and managed to reduce turnover. Here are her tips for finding and retaining high performing teams.
What are the biggest challenges you faced surrounding long-term care staffing?
One of the biggest challenges I saw was the temporary nature of many of the roles. CNAs move on to become nurses and then nurses move on to become practitioners, finding positions at new facilities on the way. These shortages, even CNA turnover, impact everyone in a facility. For example, a director of nursing can’t properly complete their duties if they are covering the floor and working night shifts. Plus, if state regulators find your facility understaffed, fines may be issued.
In addition, the cost and the time spent hiring was costly. When it came to the hiring process, I was constantly scheduling interviews for potential employees where the candidate would no-show or reschedule. Time was regularly wasted setting up interviews that never even happened.
How did you work to improve retention among your staff?
First and foremost, I worked to make sure my leadership style was open and teaching-focused. When mistakes were made, I tried to create learning opportunities before writing an employee up. Also, I was always available to talk, especially for personal issues. If a team member was having family issues, for example, I always tried to be a supportive, listening ear. I provided resources whenever possible, such as directing them to United Way’s 2-1-1.
Part of talking to my team was learning about the schedules that worked best for their lives and being as flexible as possible. I tried to accommodate important times outside of work to make their lives a little easier. I had one team member who had to drive her kids to school, making it impossible for here to arrive for the 6 a.m. shift time. So, I would work with her and the rest of the time to find times that worked. Balancing schedules made a big difference in retaining qualified team members.
I also tried to empower staff by letting them make decisions. For example, some facilities won’t allow staff to fax the doctor’s office due to grammar and spelling. But, most doctor’s offices actually understand. Staff feel valuable when they are given responsibility, leaving them more content in their roles. We also assigned weekly or monthly tasks to keep staff engaged and empowered. Sometimes I had to get creative to find the right task to match the staff member, but once I did, they owned it! Tasks ranged in importance and complexity from checking first aid supplies and defrosting freezers to checking the med carts for expired medications. If there were mistakes, we worked to help them improve. Plus, when I trusted my staff more, it made my job easier. I couldn’t be at the facility 24/7 to handle every little thing. It is critical that staff are empowered enough to how to handle resident falls and illness when department leadership is not on duty.
It’s not always easy to handle, but if someone isn’t cut out for the job, they have to be let go. If an underperformer isn’t pulling their own weight, they are ultimately pulling the whole team down. You have to find that balance of being open and understanding, while still holding staff accountable.
Finally, I tried to show staff they were appreciated – which they were! We had an appreciation board where team members could leave positive notes about other team members. In monthly staff meetings, I read all appreciation notes aloud and even pulled one name for a prize. I chose useful prizes, such as gas cards, gift cards or even cash. Everyone also received a personalized holiday gift, which demonstrated how we valued their individual contributions to the team.
In what ways have you seen other facilities successfully lower turnover?
Facilities that are able to think creatively and outside the box have the most success in keeping employees. Perks such as more time off, benefits and more all show our current team members that they are appreciated. You can tell the management thinks about what would be most helpful for their staff.
For example, I remember one facility that had a really healthy culture. The team was all very upbeat and they had little turnover. I listened to all of the team share how many years they had been there and that is shocking. The positive culture and openness among the administration had a big effect on lowering turnover.
When it comes to running a nursing home, pay is always an issue. Talk with the team about the value of their benefits package to help team members appreciate the additional perks. If you don’t have benefits available, you need to find a way. Employee assistance programs can be a good option. Benefits seem expensive, but you have to take care of the staff you have. You can also offer other fun benefits such as birthdays off. If you weigh the cost of hiring and training a new employee versus offering an extra day of PTO, the time off probably costs less.
Another way to lower costs is to steer away from staffing agencies. They are even more expensive than actually caring for the staff you already have, and they don’t have the quality. Find team members through referrals and other online job postings. Referrals from other employees is the best way to find staff you can trust.
Training your team takes time and money, but it is effective. Almost all CNAs are kinetic learners, so just watching a training video usually doesn’t help. Find ways to host interactive training that works with a number of learning styles. Also, be proactive now with retaining staff by offering long-term incentives for those continuing their education. If a CNA is becoming a nurse, consider offering a bonus if they stay with you for a certain length of time after getting their degree. Or, provide an incentive for each semester of school they complete.
In addition, teams with the tools needed to do their jobs efficiently are always more engaged. Invest and provide access to the things they need. For example, if your internet doesn’t work throughout your facility, for example, fix it. The team may need it to look up medications or other resources on the floor. Since your team is very busy, they won’t have the time to abuse the internet, especially if they know how valuable a tool it is for their jobs. HealthDirect’s pharmacy software, FrameworkLink is another helpful tool many facilities use. It allows team members to easily look up many pharmacy-specific information without making phone calls. Teams using this tool say it makes a big difference in their work.
Finally, I have always seen success when long-term care facilities work together. Reach out to other facilities you trust and invite them to a brainstorming session. As a team, collaborate and share strategies for finding and keeping quality staff. With multiple forward-thinking leaders at the table, new ideas are sure to emerge.
How can we combat absenteeism?
Absenteeism is tough when you’re already combating staff shortages. You have to be strict about attendance to hold the team accountable.. If someone is regularly absent, the entire staff feels the pain. Even excessive excused absences may mean the job is not the right fit.
I always tried to offer help and resources if there’s a real barrier preventing a team member from making a shift or getting in on time, while not playing into any drama. Childcare is often a challenge for parents so I always encourage facilities to look at ways to help. Is it possible to bring child care in to your facility? What is the cost of keeping employees versus hiring new employees? The cost difference may be enough to begin developing child care solutions.
What are 3 small action steps facilities can take now?
- Look at scheduling and staffing needs. How can you use job-sharing or get creative with scheduling? Get staff input when planning the monthly schedule.
- Consider other value-added perks. Can you give each staff member free scrubs or the first uniform free? Can you get personalized scrubs in their favorite color with the facility logo? Can you add snacks in the office once a week? What inexpensive perks can be added to make the day a little brighter and better? Small efforts make a difference for staff members.
- Increase opportunities for recognition. A recognition board is always an easy and effective tool to start empowering the team to share appreciation within the team. Being able to see the thanks and praise helps everyone feel like they are making a difference.
When you care, so do your staff.
Finding and retaining nursing home staffing is an industry-wide challenge, but strides can be made by investing in your team with care, accountability, recognition and proper training and tools. Learn more about how HealthDirect’s pharmacy services can play a role in your team’s job satisfaction. Our personalized care approach and unique solutions can make their jobs easier, more efficient and safer, leading to a higher level of care for your residents.