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

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

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

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

Why are staff members leaving?

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)

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

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

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

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”

Recommendations for 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

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

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.

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

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

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