Steps Nursing Homes Can Take to Improve Workforce Retention

 From Ohio Kepro:

High staff turnover in nursing homes ranks as one of the most significant barriers to providing quality health care to residents. Unfortunately, this problem is pervasive throughout the industry. Nursing homes in Ohio have not been immune.

 However, high staff turnover should not be viewed as inevitable. Nursing homes can take steps to retain valued staff. In 2002, the Centers for Medicare & Medicaid Services (CMS) released a report titled What a Difference Management Makes! based on the research of Susan C. Eaton. 1 The report determined that “specific managerial practices” differentiated high and low turnover rates.

 The following five patterns were associated with lower nursing home staff turnover:

 •  High quality leadership and management offering recognition, meaning, and feedback, as well as the opportunity to see one's work as valued and valuable; managers who built on the intrinsic motivation of workers in this field.

 •  An organizational culture communicated by managers, families, supervisors, and nurses of valuing and respecting the nursing caregivers as well as residents.

 •  Basic, positive, or “high performance” human resource policies , including wages and benefits but also in areas of “soft” skills and flexibility, training and career ladders, scheduling, realistic job previews, etc.

 •  Thoughtful and effective motivational work organization and care practices .

 •  Adequate staffing ratios and support for giving high quality care.  

Eaton also determined that nursing home staff were most satisfied when they were able to give care that made a difference to residents. Conversely, when nursing home staff were stymied in their ability to provide quality care they were more likely to leave. Eaton said, “Employees generally indicated they hated to work at a place where residents and employees are miserable. . .in the low turnover facilities, a significant number of employees reported that they had worked elsewhere in the long term care system in that community or others, and believed that the place they presently worked was a better place to work and live. They could make distinctions that were rarely made by nursing staff in the higher turnover facilities, at least in this study.”

 Eaton's research also determined that high turnover homes had a gloomy managerial approach toward staff—and administrators who didn't talk with them. These homes also had a high incidence of supervisors who ignored call lights and had rigid schedules with no flexibility for employees. The high turnover involved all staffing levels—from frontline to staff management. Consequently, this high turnover led to chronic understaffing.

 On the other hand, Eaton found that in low turnover homes, management offered employees meaningful recognition, true valuing, human resource policies that supported workers in their struggles rather than those that penalized them, and real participation in decision-making about their own work.

 Changing from a high turnover to a low turnover home

Eaton's report describes differences in high and low turnover homes in the areas of resident care, workplace practices, and the environment.

 Care Practices

  Workplace Practices

Environmental Conditions

 Reference

1. What a difference management makes! Chapter 5, Appropriateness of Minimum Nursing Staff Ratios in Nursing Homes (Phase II Final Report, December 2001). U.S. Department of Health and Human Services Report to Congress.

More information on staffing can be found in the book:

DON's Handbook for Long Term Care