How Long-Term-Care Can Pivot To Appeal to Permanent Staffing

Nursing facilities can make changes in their operations that positively affect their turnover and staffing levels.

Resident-centered care depends on employee-centered companies.

What does an employee-centered organization look like? It is aware and acting on areas that cause stress to their workforce. This could include improving systems that create stress, workarounds, and frustrations. Here are some common areas that repel staff from permanent employment in nursing homes. Here are key takeaways:

Have A Buffer
- Stop staffing at the bare minimum HPPD (hours per patient day)
  - You’re losing any perceived savings in overtime and bonuses
Appreciate and Acknowledge Staff Contributions, but not with pizza.
Be A Positive Place to Work
- This starts with Leaders Attitudes towards valuing staff and meeting their needs
Salary
- Evaluate the pay for high-turnover roles and make changes as needed

Acknowledge the seriousness of open positions. They are draining your workforce. Period. Nursing leadership should have this on the radar and be acting on it every day. A consistent, daily focus on open positions is a requirement to prevent the slippery slope to a critical staffing event. Day-to-day fires take priority until the nurse managers are working nights on the floor because there is no one to cover. Nursing homes operating understaffed as a baseline contributed to the severity of the COVID-related staffing shortage.

It’s no secret, there was no margin. Well-stated in this article on the nursing facility stigma created by COVID. “In part, I believe long-term and post-acute care was ill-prepared for such an emergency. Our field was incredibly short-staffed even before COVID-19, increasing the costs significantly when providers had to look to agencies to ensure our frail and elderly had enough people to care for them during this unprecedented time.”

Increased reliance on agency staffing, bonuses, overtime, and turnover are sucking your margins dry.

Pivot by ensuring that managers understand that pizza parties don’t equate to staff retention. Ensure there is a clear approach to how issues with staff should be resolved. There has not been one given to me as a DON (director of nursing) at any facility I have been at. It requires meeting their needs so they can meet your patients' needs.

What are their needs? Understanding, flexibility and accommodation, salary, breaks, structured emotional support and stress management, being respected, valued, heard and acknowledged, commitment for career advancement. Pizza is great, but it’s none of those things. Are you empowering and even REQUIRING your facility leadership to implement solid retention efforts at facilities?

The work environment can’t be undervalued. One of the trends acknowledged in employee satisfaction in long-term care is recognizing employee needs for a positive culture, “It also involves building a workplace culture where the staff is empowered and rewarded for their efforts and where they have clear guidance and support to grow in their careers.”

Salary is an area that needs to be assessed more often. Perhaps only one area for your organization, like aides, needs attention. Look at the turnover and open positions. A sign-on bonus might get it filled, but it won’t keep an employee if a competitor offers a better wage. People understand making $2 more an hour is more long-term than a $2500 one-time sign on and they will work long enough to get the sign-on and leave.

I have seen good aides leave and go to McDonald's or the local GM factory because it pays more than the facility pays and they don’t have to get hit, bit, and spit on, they will leave for factory and fast-food jobs. These were people with hearts for the residents, not people out to get rich.

Several studies have shown the relation between turnover and salary, including this article on key workforce challenges. “Studies evaluating the effect of wage improvement policies on nurse turnover rates identified that with increased wages nurse turnover rates declined. Michigan policies to increase wages by 61 percent among nursing assistants resulted in a 21 percent decline in turnover. Analysis of compensation reform for direct-care workers in Wyoming determined that an increase in hourly wages from $9.08 to $13.74 resulted in a reduction of turnover from 52 percent to 37 percent over the first three months.”

Strategically evaluating these areas from corporate leadership to facility leadership increase profit margins and decrease labor costs. More than that, they will contribute to increased quality measures, patient satisfaction, and survey outcomes.

If your organization needs help strategically implementing these changes in the culture of your company and its leadership, schedule a call here, and let’s discuss your needs to determine if we can help. We work directly with the facility leaders to change the mindset and approach to staffing in an intentional manner with amazing outcomes for revenue and residents.