Reducing Turnover in Long-Term Care

1. Reducing Turnover in Long-Term Care Eleanor Feldman Barbera, PhD MyBetterNursingHome.com

2. Turnover rates • 55% to 75% for nurses and aides • Sometimes 100% for aides alone

3. Cost of turnover • Per-worker turnover cost in the general US economy is about 20% of the worker’s annual compensation amount.

4. Costs of turnover • Increased hospital readmission rates • High employee replacement costs • Increased overtime costs • Increased accident and absenteeism rates • Loss of productivity • Poorer quality of care • Decrease in staff and resident morale • Increased work stress • Job dissatisfaction • Resident and family dissatisfaction

5. Why are staff members leaving?

6. Research: Factors associated with turnover • For-profit homes • Deficiencies in pay • Deficiencies in benefits • Age (younger workers were less satisfied than older workers) • Length of experience (those with less experience more likely to leave their jobs) • High workload • Poor staffing • Poor working conditions • Work schedule not meeting needs or expectations • Lack of role clarity • Low sense of control over job performance • Lack of appreciation • High self-esteem (for those who felt unappreciated)

7. Research: Factors associated with retention • Length of experience (those with more experience were more likely to remain on the job) • Older workers (who tended to have more stable family situations) • Opportunities for professional growth • Performance of exemplary care demonstrated through performance of restorative care (for aides) • Supervisory training • Sufficient orientation • Perception of being valued by nurses and supervisors • Being considered an important part of the care team • Involvement in interdisciplinary care plan meetings • Working as a team • Positive relationships with coworkers • Permanent assignments • Motivating positive feelings between aides and residents

8. Recommendations:For New Employees • Attract employees for whom it is an occupation of choice • Increase the amount of initial training to meet the needs of new staff • Provide a senior mentor or point person for new staff members • Hire multiple staff members simultaneously • Creates a more cohesive peer group • Addresses issues around staff shortages in departments

9. Areas of additional training • Survey experienced and new staff to find out what else they think is important for orientation. • Possible topics • Working with families • Handling challenging residents • Customer service skills • Prioritizing job demands • Stress management • Info about particular illnesses • Coping with loss

10. Coping with loss • Discuss the issue of death and dying in the orientation period • Train peer mentors to be aware of this as a potential issue and to provide support • Offer resources such as EAPs or chaplaincy services • Consider offering a bonus for staying 6 months to help motivate newbies to stay through the acclimation period • For more on this, see my McKnight’s article, “Absenteeism and turnover in LTC? Death anxiety could be the cause”

11. Recommendationsfor all staff • Create environments that encourage retention through opportunities for professional growth • Additional training in-house • Incentive for continuing education • Peer mentorship • Supervisory training such as teaching supervisors coaching techniques • Setting boundaries • Speaking with authority and respect • When and how to address problems • Call aides by name

12. Increasing staff control • Employee involvement in decision-making • Allow staff participation in care planning • Implement self-scheduling

13. Motivating positive feelings between residents and workers • Minimize time spent on activities other than direct resident care • Help staff cope with work stress • Increase the number of workers per resident • Increasing the number of aides per resident from 33 per 100 to 41 per 100 reduced CNA turnover from 41% to 65% and also lowered LPN and RN turnover.

14. Team Building • Clearly communicate work expectations and performance against objectives • Address underperformance issues that affect others on the team • Build teams and increase coworker support • Mission • Hands on leadership • Employee recognition programs • Specific results/behaviors • Peer-to-peer • Easy and frequent • Tied to company values

15. Easy first steps • Permanent assignments • Offer management skills training for supervisors • Include aides in care planning • Improve staff dining room if needed • Establish employee recognition programs • Increase the number of staff • Self-scheduling – allow staff to express scheduling preferences

16. Eleanor Feldman Barbera, PhD MyBetterNursingHome.com Twitter: @DrEl DrEl@mybetternursinghome.com Available on Amazon: