By Eleanor Feldman Barbera, PhD
According to a 2011 American Health Care Association study, the average nursing home turnover rate is 35 percent for all staff and 43 percent for CNAs. By contrast, Fortune magazine reports that the 100 best companies to work for in 2011 had a turnover rate of 3 percent or less. Clearly, most nursing homes are in need of staff retention strategies. One of these strategies is team building, which has a “long term positive relationship between employee morale and retention.” When it comes to building a team, forget corporate retreats and singing “Kumbaya” around the campfire. Here are five practical, easy-to-incorporate strategies you can use at your nursing stations starting today.
Give people a reason to show up for work beyond their paycheck. If you were asked to fill in the “X” of the statement, “We do X here,” what would your answer be? Is your facility goal getting a great survey? While that may be energizing for you, it’s not likely to be motivating for most of your staff. Generate a vision that excites the team. For example, Signature Healthcare, which ranked in Modern Healthcare’s top 100 best places to work in 2009 and 2010, states that part of its mission is to “earn the trust of every resident, family and community we serve.” A staff member can use this barometer to make decisions about how to handle situations, i.e., “Is this going to earn trust?” A vision for a company or facility dedicated to addressing the mental health as well as the physical health of its residents could be, “We treat the whole person,” giving staff the impetus to care for both the physical illness and the emotional distress it causes. Elaborate upon ways in which your “X” is accomplished through your mission statement, employee training, staff recognition programs, and other communications.
Whether or not your facility has developed a specific mission, there are certain qualities that stand out as desirable and create an environment more conducive to staff retention, such as teamwork, helping others and kindness. Staff recognition programs provide an opportunity to promote qualities that are valued within an organization. They are the “carrot” to the “stick” of disciplinary action. Schools use this technique when, for example, they discourage bullying by presenting their students with award certificates for “helping” or “caring.” Similarly, LTC facilities can offer kudos of varying types (certificates, gift certificates, parking spaces, free lunches, first choice of holiday schedule, etc.) for good customer service, going the extra mile for the team, helping a coworker care for a resident, and other valuable contributions. Employee recognition can be done on a facility-wide or unit-by-unit basis, allowing for great flexibility and the opportunity to institute this tool immediately. For example, a charge nurse inspired by this idea could ask in the next change-of-shift report: “Let’s try to encourage each other. Did anyone notice any good qualities about a coworker today?”
Given that “new hires are much more likely to leave than established employees,” efforts to connect new employees with their peers and with the organization are likely to make a big reduction in staff turnover. Connections can be made in ways large and small. Often staff members are trained for the facility, but the integration of the new person onto the specific team is less structured and doesn’t reflect a cooperative approach. When staff members arrive, even long-time employees covering a shift on an unfamiliar unit, the charge nurse could take a minute to introduce her to the other staff members and indicate that the CNAs on the floor cover for each other when others are on break, thereby discussing the norms of this particular team. Mentorship programs are a more formal means of integrating new employees, by assigning them a trained advisor who helps them navigate the challenges of long-term care. Mentors are offered special training, status and perhaps a salary increase to accompany their additional responsibilities. Mentorship programs are a great way to provide upward mobility within the CNA group, while offering new hires access to valuable information and support from their more advanced peers.
Show your staff you’re committed to the organizational values you espouse by becoming part of the team—literally. I once worked in a psychiatric center where the chief psychiatrist—who was the administrator of the hospital—moved from unit to unit, several months at a time, modeling the team approach he wanted for the facility. Imagine how much positive change could occur if the director of nursing acted as the charge nurse one unit at a time, teaching core values before moving on. This technique provides the added benefits of getting to know the employees and their strengths, weaknesses and training needs, and of observing where the day-to-day procedures need to be tweaked—all factors in creating an environment that leads to staff retention.
Decisions coming from the top of an organization will be infinitely better if they include information provided by those involved in carrying out the new directives, whether the recommendations are practical or clinical. Renovating a nursing station, for example, is a process that would benefit from the perspective of the nurses, aides and other staff members using the area. On the clinical side, when acting as team leader my chief psychiatrist never started morning report on the unit without the CNA-level staff being present. This clearly indicated that their presence was important and taught everybody that those seemingly small behavioral observations meant that something big was occurring—just like in long-term care. Employees can present feedback through inclusion in meetings, written and possibly anonymous surveys, suggestion boxes and by the opportunity to make choices such as what types of rewards to offer at the employee recognition program.
Eleanor Feldman Barbera, PhD, is a speaker and consultant on psychological issues in long-term care and author of the forthcoming book, The Savvy Resident's Guide: Everything You Wanted to Know About Your Nursing Home Stay, But Were Afraid to Ask. For more information, visit Dr. Barbera's website, www.mybetternursinghome.com.