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Reducing Turnover in Long-Term Care
Eleanor Feldman Barbera, PhDMyBetterNursingHome.com
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Turnover rates
• 55% to 75% for nurses and aides• Sometimes 100% for aides alone
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Cost of turnover
• Per-worker turnover cost in the general US economy is about 20% of the worker’s annual compensation amount.
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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
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Why are staff members leaving?
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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)
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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
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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
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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
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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”
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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
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Increasing staff control
– Employee involvement in decision-making– Allow staff participation in care planning– Implement self-scheduling
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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.
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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
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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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Eleanor Feldman Barbera, PhD
MyBetterNursingHome.comTwitter: @DrEl
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