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Lessons Learned in Creating a Successful CNA Retention Program

April 1, 2001
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Guidelines drawn from Integrated Health Systems' new career ladder program by Richard Hoffman

In Creating a
Successful CNA Retention Program
By Richard Hoffman One organization's solution to the problem of turnover

For some time now, nursing homes have been staggering under the high cost of turnover, especially among CNAs. Ironically, this is one of the few costs that can be controlled in today's regulatory environment. One recent study placed the cost of recruiting and training at $4,000 per new CNA. Combine that figure with a nationwide CNA turnover rate of 93%, and you're talking a major financial burden on the industry as a whole.

While providers agree that CNA retention is critical to both fiscal health and the quality of care residents receive, few can agree on what an effective retention program includes and how it can be successfully implemented. Recently, one large provider, Integrated Health Systems, along with curriculum specialists at Frontline Publishing, decided to make retention their first priority. The program they developed, IHS CareWorks, resulted in a savings of $14 million during a nine-month period, even before complete corporate implementation of the program.

In planning IHS CareWorks, Frontline and IHS focused on developing programs to keep CNAs through the first 90 days and to construct a clear career path for them to follow in the coming months and years. Rooted in an industry-wide study of best practices, IHS CareWorks addresses orientation, mentoring, career growth, recognition, supervision and compensation in an integrated and comprehensive attempt to thoroughly transform the entire work life of the nursing assistant.Several valuable lessons can be gleaned from Integrated's successful launch of IHS CareWorks.

Lesson #1: Know what turnover is costing you.

Believe it or not, there are providers-both individual facilities and larger organizations-that neglect to measure the cost of their turnover. A full understanding of turnover's financial consequences is sometimes just the shock a provider needs to fully commit to a retention program. Knowing the cost of your turnover also provides a benchmark for cost-benefit analysis, since a retention program, like any major problem-solving initiative, costs money. The first step for IHS was a detailed analysis of what their turnover rate was costing them annually across the organization.

Lesson #2: You must have buy-in from the top.

Whether you are a single facility or a larger organization, without buy-in from the top-and enthusiastic buy-in, at that-any changes needed will meet with resistance. Most people find change threatening. Unless top management makes it clear that this is company policy and not merely a shift in rhetoric, most people will go on with "business as usual," which will weaken and devalue your program.
IHS launched its program at a national meeting of its administrators, where the company president himself, John Heller, articulated the company's goal of becoming the provider of choice by becoming the employer of choice. "Our employees' success is our success," stated Heller.

Lesson #3: Offer salary increases to CNAs who participate.

Skeptics who doubt the impact pay increases will have are at least partly right: Increased compensation by itself will not slow turnover. Increased compensation tied to professional development, however, is a one-two combination that has again and again proven effective in bringing attrition down. The aim of a retention program is not only to keep CNAs on the job, but also to make them the best caregivers they can be. Salary increases based upon participation in career ladder and mentoring programs provide your CNAs with a tangible demonstration of your gratitude and respect. So as your staff gains in knowledge and skills, acknowledge their growth appropriately-in their pay envelopes.

Lesson #4: You need a champion.

Memos won't do it. Announcements on bulletin boards won't do it. You need an evangelist, an apostle who believes in the program wholly and will work to create and maintain enthusiasm. This person is a trainer (generally training those who will administer the program's various components in their facilities), a trouble-shooter, a coach, an indefatigable advocate for change.This champion must be equally comfortable with top-level management and frontline staff. To be effective, this advocate must be credible and approachable by staff, and he or she must be given the time and resources to make implementation of the program top priority. IHS's Director of Training Paul Wray is well suited to this role, having been a CNA, an LPN, an RN, a staff development coordinator, a DON and an administrator (see profile). Charged with the implementation of IHS CareWorks, Wray logged thousands of miles piloting the various curricula and training staff development coordinators to implement the program at the facility level. "I believe in this program. I guess I'm a bit of an evangelist," he says.

Lesson #5: Reinforce the value of the program by publicly recognizing the achievements of participants.

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