It is with mixed feelings we announce that this will be the final staff-retention tip for the time being.
We’d like to take this opportunity to, first, thank all of the professionals who joined us for our recent series of training webinars. Your efforts to stabilize homes in Missouri will have lasting benefits for patients in our state.
If you missed one or more of these webinars, there is still a chance for you to catch up. Visit our webinar page for session video recordings and supplemental material (Powerpoint slides).
Effective, stable homes actively develop every employee. For line managers and supervisors, this means developing leadership skills. Managers who spend time growing supervisors empower those supervisors to lead well.
No one-size-fits-all approach can help your supervisors improve their decision-making skills. Each person needs to be assessed individually to determine what they need to improve and fulfill their potential.
Every day presents you with learning experiences for your supervisors. Teachable moments can arise at unexpected times: They may come in the form of questions posed by your new manager, comments made by their teams, or in other situations.
Here are some tactics for helping managers develop:
For new supervisors, help them analyze their approach to the situation. Ask for their input first, along with their reasoning. Then you can suggest an idea , and the positives and negatives of each option. Spell out your thinking - why you think this is the approach to use. Make this a dialogue for learning.
After some time has passed, begin asking supervisors what they think of situations - same analysis of approach, options and gains/losses of each.
Make sure they know the parameters of their decision-making. Supervisors who work on tasks you are not comfortable with them doing can become frustrated. The opposite is also true: you may become frustrated if supervisors do not take the initiative on decisions meant for them.
Confidence is contagious. As your supervisors become more comfortable make decisions, you will have more confidence in those decisions. Eventually, middle managers will simply inform you of decisions made. While you may not have been directly involved in these decisions, you did set the foundation for their decision-making ability - and therefore were involved.
Give managers support - don't let them feel like they are out on a limb
Follow-up with them, and teach them how to do so with their decisions.
Empowering supervisors with decision-making ability is clearly a superior way of doing business than doing everything yourself. It also sets an important tone for your organization's growth: if you grow your supervisors, they in turn grow their staff. An empowered staff is better equipped to handle emerging problems as they develop and less likely to simply let those issues fester.
To paraphrase the late American business leader Andrew Carnegie and others, successful leaders find people in their organization with skills to accomplish their goals more often than they do so themselves.
You can also address staff retention by taking the following steps:
Register for our retention webinars. Continuing education credit for nursing home administrators is available. Nationally recognized leader David Farrell, will speak at the April 3 webinar.
Download and skim over the staff stability toolkit and the compendium of practices.
Visit the Advancing Excellence Web site at www.nhqualitycampaign.org for further information on staff retention.
Consider signing up for this national campaign to be counted among the top performing homes in the nation.
A potential employee’s first contact with your home can be critical. For candidates, it’s a first impression – for administrators and staff at the home, it’s an important initial opportunity to gather information about the candidate. That’s why managers need to be prepared to meet with every walk-in applicant. High-quality applicants are in demand by other facilities, so having a short on-the-spot job interview – followed by a tour of the facility – can help boost your recruitment.
Often, the receptionist or front desk staff at your facility plays a key role in the recruitment process. Having a designated area at the reception desk – with blank application forms and a checklist for staff to use when interacting with applicants – can be helpful.
Consider taking the applicant on a tour of the facility. This serves several purposes: Managers can see applicants’ impression of the facility, listen to applicants’ observations about the home, and watch how applicants respond to residents.
CNAs and other staff members in your home might recognize applicants, having possibly worked together at another location. Ask your existing employees for a “thumbs up or down” after touring the applicant. This empowers existing staff, demonstrating your trust in their valuable input.
Consider having your staff help you develop standard interview questions, including:
In your previous job, how did you improve your work environment or department (personally & professionally)?
How have you responded to an upset family member or resident?
What did you like best about your current/former place of employment? What would you have changed?
Describe the last time your were responsible for caring for another person. What did you find most rewarding and the most frustrating?
You can also address staff retention by taking these additional steps:
Register now for our series of retention webinars. Continuing education credit hours for nursing home administrators are available.
Visit the Advancing Excellence Web site for further information on staff retention. Consider signing up for this national campaign to be counted among the top performing homes in the nation.
When looking for the real reasons why staff leave your home, the best source of information is the most simple one: the departing staff members themselves. Nursing home managers who implement a firm policy of exit interviews – complete with someone to speak directly with departing staff – create a valuable source of information. Even when a direct conversation with a staff member on the way out is not possible, having a printed exit survey available can help gather pertinent information.
What factors, if any, would have made you decide to continue working here?
What, if anything, would you change in this home if you could?
Would you recommend this home to someone looking for work? Why or why not?
Good exit interviews also provide departing staff with the chance to rate, by importance, different factors that contributed to their decision to leave. A working list of factors can be developed by brainstorming with your team. The list might include common reasons like:
Commuting time
Changes in a family situation
Dissatisfaction with wages, benefits, or opportunities for advancement
Problems with a supervisor or coworker
Job stress/fatigue with the profession
More tips for a good exit interview:
Calculate turnover rates using this Drill Down Tool for each position in your home. Explore this data a little further:
Check the average length of employment among different groups.
Look for seasonal trends. Are employees leaving during a certain time of year?
Are certain age groups more prone to leave your home after a short employment period?
Of those leaving for other work: are they going to other nursing homes or other fields?
Are most employees leaving due to disciplinary action?
Using this information, ask your team to develop exit interview questions. Remember to use open-ended questions and a list of contributing factors!
If you haven’t done so already, gather this information from as many employees as possible who left within the last three months -- especially employees identified as good coworkers by their peers. Don’t ignore those employees considered difficult. You need to hear from all employees to get a complete, accurate picture
Develop a process to get this information from employees who leave in the future.
Use page 13 of the Staff Stability Toolkit to help your team learn more about the experiences of employees working in your home.
Ask your team to discuss their opinions and general findings about those experiences. Determine what actions to take – and which actions take priority over others.
You can also address staff retention by taking these additional steps:
Register now for our series of webinars. Due to popular demand, we are re-broadcasting the first session (register here). The series covers topics including: discovering your real turnover, attracting and hiring the best, training for success, and scheduling for better results. Continuing education credit hours for nursing home administrators are available. (Already caught the first session? Register for the second session here.)
Visit the Advancing Excellence Web site for further information on staff retention. Consider signing up for this national campaign to be counted among the top performing homes in the nation.
Look for other upcoming educational sessions on staff stability and retention, including:
Hiring and firing: what is in-between
Leading with respect and accountability: Getting the best from yourself and others
These sessions are offered by the Missouri League for Nursing. Find out more.
Do you know your CNA turnover rate for the last three months? What was your rate last year? Has your turnover improved, gotten worse, or stayed the same in the last three years? If you answered "yes" to those questions, then you are on your way to securing a stable workforce. If you did not, then it might be time for some education -- when it comes to retention, ignorance is NOT bliss, it's blindness.
For those of you who have been reading our R-TOP tips over the past year, you may have already taken some action to improve your staff retention, and you know that it deserves continued attention if you are going to make a positive difference. Our next set of tips and our one-hour webinar series (registration via link below) will help you drive retention practices much deeper into the culture of your home.
Make your New Year’s resolution to solve this critical issue right now by taking these steps:
Sign up now for our series of webinars starting Jan. 5. The series will cover topics including: discovering your real turnover, attracting and hiring the best, training for success, and scheduling for better results. To register, please email your name and facility to the long-term-care ombudsman at the Missouri Department of Health and Senior Services. Continuing education credit hours for nursing home administrators are pending.
Visit the Advancing Excellence Web site for further information on staff retention. Consider signing up for this national campaign to be counted among the top performing homes in the nation.
Look for other upcoming educational sessions on staff stability and retention, including:
Hiring and firing: what is in-between
Leading with respect and accountability: Getting the best from yourself and others
These sessions are offered by the Missouri League for Nursing. Find out more.
In 2006, Alexian Brothers Sherbrooke Village initiated a program to increase staff satisfaction and reduce turnover. But after six months, the program fizzled. The intent was to empower employees to find solutions to barriers encountered in their work. It is one thing to tell people they are empowered; but to accomplish it requires more than a program, form or some other quick fix.
It requires a culture that values employee involvement in decision-making such as care planning, improving quality and allowing caregivers to work with the residents to foster their daily routine choices. Alexian Brothers Sherbook Village realized this and made a bold move to create this culture.
It is one thing to talk about retaining staff, but what all of you really want to know is… can it be done? The answer is “yes” and the following tip highlights the last in a series of three RTOPs from communities who are making a significant impact on retaining staff.
Think back to your first day on the job. Were you nervous, excited, or overwhelmed? Were you greeted by friendly peers and taken under their wing, or were you given the message early on to “keep up or else”? Unfortunately, the experience of many new employees may not be positive, and, in fact, may contribute to turnover. John Knox Village recognized this and created an atmosphere where new employees were welcomed, assigned mentors, and appropriately trained. Working with the National Association of Health Care Assistants, John Knox Village implemented a formal orientation program for new employees. Key components of the program include:
Selecting mentors. Not everyone possesses the qualities of a good mentor. They may be highly skilled at providing clinical care, but that does not mean they are able to teach others in a way conducive to mentoring a person. Mentor selection should be a formal process in which candidates’ strengths determine whether they can meet the demands of the role.
Training mentors. John Knox Village used a program offered by the National Association of Health Care Assistants to train their mentors. People may have the skills and qualities to be a mentor, but training is critical to develop their potential and clarify the mentor’s role.
Greeting new employees. Do not take for granted the power of greeting new employees to start building a professional relationship when they walk through the doors their first day. Mentors at John Knox Village personally greet the employees assigned to them. Mentors want new employees to know they are not there simply to train them, but to support them throughout the orientation process.
Communication before the evaluation. Managers at John Knox Village do not use a “wait and see” approach; rather, they frequently talk with new employees about what they are experiencing, what they need help with, and any concerns or questions they may have. Exit interviews are good, but managers can prevent some turnover early by being proactive and talking with new employees early on.
Congratulations to John Knox Village for selecting mentors who help stabilize the staff, so that resident care can be consistent as well as compassionate!
Reading about steps to take is one thing—actually implementing the steps is another. Over the next three months, RTOP Tips will highlight real life, actionable steps taken from three different homes that are making a significant impact on retaining staff. Each tip will focus on their recommendations based off their experiences and will cover different elements of their staff retention approach. By having homes provide tips they have tried and found successful, you can see how homes, similar to yours, can improve retention rates too.
This month’s home is Moore-Few Care Center located in Nevada, Missouri. This 108 bed skilled nursing facility has a dedicated staff taking pride in providing quality care to their residents. In Moore-Few Care Center’s own words, the one phrase to describe their plan of action to stabilize staff and retain employees is—“living document.” Their approach to staff retention incorporates a great deal of ongoing teamwork which has assisted them in sustaining improvement. More specifically, they have taken a quality improvement approach to staff retention and have established a dedicated team in charge of assessing and responding to changes in staff retention rates.
Teamwork! A diverse team including the CNAs and nurses meet monthly to specifically review the data related to staff turnover and retention. This team has made their own by-laws and is truly dedicated to retaining employees.
Answer the Why The team collects data such as turnover rates and absenteeism, conducts exit interviews, and speaks directly with staff about topics such as the source of unhappiness or reason for leaving, terminations by length of service, and shifts. All of this data is reviewed for trends and patterns to determine system level issues that could impact turnover rates. By determining the real reason for turnover through this process, the team is able to not only know why people stay or leave but can also tailor interventions to address the issues.
Communication Is Critical The team then collects, reviews, summarizes, and shares this data with the rest of the staff. By doing so, staff becomes informed as to the reasons for turnover, patterns in exit interview comments, length or service, and shift left vacant by the departure. When people are aware of what is going, they appreciate the actions taken to address it. Also, because managers will also listen to the summaries, it encourages them to become a part of the solution as well.
Take Action After the data review, Moore-Few Care Center implements many changes based on what they find. Some of these changes include:
Preceptor program
Meet and greet for new hires
Group interview process that involves peer interviewing
Job shadow program
Close attention to make sure the staffing pattern meets the needs of resident acuity
Other homes, just like Moore-Few Care Center, can improve retention rates too! We encourage you to use their tips in your own staff retention tactics and to download and read through the Staff Stability Toolkit to implement a plan to meet your needs.
One of the best ways to keep your finger on the pulse of staff retention is to implement targeted hiring practices from the beginning. Remember that you’re hiring for today’s needs and tomorrow’s vision! Keeping in mind that you’re hiring for the future could help in retaining individuals that not only address your current needs but are also a good match for the changing demands you see in the future. This is why hiring the right person is crucial. Hiring the wrong person could temporarily fill the gap but turnover is more likely since they’re not a good fit to begin with. The U.S. Department of Labor estimates that given the costs of recruitment, selection, and training—it costs approximately one-third of a new hire’s annual salary to replace him/her. That’s money your home could put towards other things!
While focusing on the hiring process alone won’t impact your retention rates—it is one of the many steps needed to begin long-lasting improvements to staff retention. Use pages 19 through 28 of the Staff Stability Toolkit for more advice regarding hiring practices and explore the other sections such as absenteeism, scheduling and orientation to further strengthen your retention rates. In the meantime, below is a quick list of important tips to consider while hiring:
R-TOP Tips in Hiring Right the First Time!
Avoid the "Anybody Who Is Willing" approach. Be selective on who you’re considering to welcome into your staff. Remember that anybody is not better than nobody. Current staff will be more willing to mentor new employees if they feel that the new employee will stay and succeed. Otherwise, it can seem like a waste of valuable time. Having a good screening process can help select from a good pool of viable candidates.
Hire the right people. Not everyone can work in a nursing home—even more so, not everyone will be a perfect fit for your home. Start the hiring process by exploring your homes needs and why your current long-term employees decide to work there. Possible reasons include: satisfaction from the relationships established with peers and residents, a commitment to residents they take care of, and a desire to make a positive impact in the lives of others. During the hiring process, ensure that these reasons are stated in your advertising so that it appeals to the right people.
Utilize a variety of methods to publicize the position. No longer are the days where employment ads are limited to the newspaper! Expand to include places like www.craigslist.com and www.monster.com. You can also post ads in local churches and supermarkets. Why not ask your current staff where they heard about their position? Knowing this could help tailor your efforts to effective places to draw attention.
The interview starts the moment he/she walks in. When an applicant comes in for an interview, remember to utilize your receptionist to gather first impressions on the applicant as well as provide a good first impression of the home itself. Ask your receptionist to mentally take notes: Was the applicant smiling? Kind? Professional? Also, because the first contact a potential employee will have is with the receptionist, ensure that the receptionist warmly greets him/her and hospitable. Doing so gives the impression of a positive and organized environment.
Involve others in the hiring process. Helping others learn the necessary skills by teaching them the essentials of hiring can assist in acquiring quality employees. Have managers sit down and discuss their experiences, work together to develop interview questions specific to the position, practice interviews with co-workers, and develop a score sheet that captures observations before/during/after the interview. Involving managers in the hiring process helps them get to know potential staff beforehand and helps them make a good selection.
Remember that improving retention involves many steps! Refer to the Staff Stability Toolkit to implement a comprehensive plan to improve retention.
Have you kept up with your personal New Year’s resolutions? While you focused on eating healthier or shopping smarter--did you also think about setting resolutions for your nursing home community? Does part of your strategic planning for 2011 include completing a staff satisfaction survey? If not, the beginning of a new year is a great time to consider incorporating this into your Quality Improvement (QI) program and implementing a process for staff satisfaction surveys.
As the holiday season is upon us and we prepare for a new year, managers should take some time to reflect on how they recognize their employee’s individual talents. Ask yourself questions such as:
Who is the caregiver you always count on to provide orientation because of the great job he/she does at nurturing new people?
Who is the nurse you depend on to review orders and other audits because he/she is excellent at focusing on the details?
Recognizing that your employees have special talents and areas of expertise can assist in improving staff satisfaction and in turn impact staff retention. One of the challenges every nursing home faces in holding on to devoted, well-trained and compassionate caregivers is making sure that staff feel respected, valued, and supported by the management team. It’s important to praise their successes to ensure they feel appreciated but it’s also important to recognize their talent so you can utilize their strengths in achieving goals and improving outcomes of care.
Tips to Recognize and Maximize Individual Talents:
Know your staff. Getting to know your staff can significantly impact their relationship with the home, management, and co-workers.
Determine what they know how to do well and which residents, families, and staff depends on their abilities.
Make a note of their background and areas of interest.
Ask them about their goals during their evaluation periods and any of their needs in terms of education and training.
Observe them interacting with others and acknowledge what you see them doing well.
Reward staff for a job well done. Typically people want to be recognized for their contributions to the community and the lives of the residents they help.
Determine how staff would like to be recognized by asking about preferences.
If you choose to reward staff with a prize or gift, choose one you know they want. Rewarding someone with a gift that reflects his/her interests illustrates that you know and appreciate the staff member as an individual.
Praise them in front of others for specific things they have done well. Not only does this recognize their talent in a public manner but it also sets a good example for others to aspire to. You want the good behavior to spread!
Place staff in areas that best utilizes their strengths and leads to success. Once you get to know each staff member, determine which area within the home and what responsibilities he/she would be most successful in. Placing them where they feel most adept could increase their satisfaction and improve performance.
Invite or assign people to roles on teams in which their talents can be used.
Assign people to work in areas in which they like but also in which they have demonstrated a niche for.
Involve a diverse group in decision making and create an atmosphere where everyone can share their insights, questions, and even doubts or concerns.
Remember that recognizing talents is just one of many components that impact staff retention. Refer to the other aspects mentioned in the Advancing Excellence Staff Stability Toolkit to develop and implement a comprehensive plan to improve retention.
Consistent assignments or staffing is one method to help stabilize staff in your organization. Consistent assignment means having the same staff caring for the same resident at least 80% of the time. Being the foundation of person-centered care, consistent assignment can help create a neighborhood or familial living environment for your residents and can strengthen the relationships between individual residents, their families, friends, and caregivers. While achieving consistent assignment alone will not cure turnover, it has shown to have a significant impact on many outcomes, especially when used with other methods discussed in the Staff Stability Toolkit. Taking care of the same resident tends to encourage staff to stay working at the same home because they feel needed, happier, and connected to residents.
Benefits consistent assignments contribute to stabilizing staff:
Improved resident satisfaction. Strong relationships are developed when the same person is caring for another over a period of time. This allows the caregiver to know individual needs and preferences, but also provides residents with comfort knowing that a stranger is not seeing them during their most vulnerable time. None of us relish the thought of a stranger helping us meet our hygiene or other personal needs—and a resident is no different.
Improved family satisfaction. Families are comforted by the idea that the caregiver knows their loved one’s needs and preferences. Quality of care is important to families, but so is quality of life! To provide the greatest quality of life, caregivers must know the resident in a personal way and anticipate their needs.
Improved quality of care outcomes. CNAs provide 80-90% of the care provided at bedside. Being familiar with a resident’s normal routines, behaviors, and preferences allows the CNA to alert the nurse to even the most subtle changes. Doing so enables the nurse to respond quickly to any change in the resident’s condition and help improve the quality of care outcomes across the home.
Improved staff satisfaction. Creating a culture based on teamwork is critical to meet the challenges in long-term care. It’s important to encourage staff to develop strong professional relationships with each other. Encouraging staff to work together, depend on each other, and push towards a unified goal helps develop these relationships. Having strong ties to each other improves communication, attitudes, and the work environment. One of the many positive results is that call-ins are reduced because staff know that their teammate it depending on them.
Incorporate these strategies into your home:
Talk to your staff about their thoughts on consistent staffing. Present an opportunity to address misconceptions and discuss perceived barriers. Not only does this provide a sense of inclusion to staff but will also give you the chance to share your vision and explain why consistent staffing is important.
Develop an in-house float pool by asking who enjoys being available to float from one area to another. It will also help to implement a predetermined schedule for covering shifts so that extra time spent towards rearranging care assignments is eliminated. By having schedules predetermined with staff consideration, people will appreciate knowing ahead of time which shift he/she will cover and will plan out their personal life accordingly. This may help reduce the frequency of call-ins as well.
Utilize planning time to talk to staff about scheduling and assignment preferences. Based off this, you’ll need to assess who works well together and tweak the schedule accordingly. Remember to include nurses, CNAs, and auxiliary staff such as housekeeping, dietary staff, and laundry in this assessment.
Evaluate the schedule and determine if all staff must be present during a traditional shift time. You may not need everyone present! First, assess resident needs and daily patterns. Next, discuss with staff about their needs, what they’re currently doing, and their most chaotic time periods. To implement an efficient schedule, it’s important to consider these factors and be as flexible as possible.
During orientation with new staff, remember to introduce them in the same area where they will be assigned. Not only will this help them smoothly transition into their new working environment, but it will also help foster a relationship between residents and staff. Remember that goal for orientation isn’t to prepare an employee to float from one area to another—the ultimate goal is to help incorporate a new person into the home who can know the residents well and become a central part of the care giving team.
Attendance issues are a common challenge in today’s nursing home. Managers may spend a significant amount of their day dealing with scheduling rather than the direct needs of the resident. Not only does this cause a great deal of stress on the managers, but it can also frustrate staff which can impact retention. As outlined in the Staff Stability Toolkit featured on the Advancing Excellence website, one way to address high turnover rates is to invest in improving attendance and helping people meet their schedules. Remember that the basic elements to sustain good attendance are to keep scheduling fair and flexible, reward good attendance, and provide assistance and adjustments so staff can address conflicts.
Although it may seem like managers are able to temporarily fix the schedule on a day-to-day basis, the only way to truly address the problem for a long-term solution is by implementing a comprehensive approach to scheduling and attendance which includes clear communication with staff and being proactive to limit future problems.
When and How Often?
"We always work short!"
"People always call-in and they never do anything about it!"
"I don't ever get the schedule I want."
Do these statements sound familiar? If so, it means you have an opportunity to improve your scheduling process and improve attendance! First, it’s important to let your staff know just how hard you work to replace people who have called in. By communicating to staff what efforts are taken to ensure that the home isn’t short-staffed, you show them that you place their needs as a priority. There are a variety of ways to communicate with staff about attendance:
Designate a place to write notes about questions and comments that arise about call-ins. Keep a copy with the schedule so that your efforts in acknowledging issues is publically shared.
Reduce phrases that spread negativity such as “We always work short” by keeping track of just how often this truly happens. Display this in a public location so everyone can see the reality of the situation. Remember—transparency is key!
Actively involve the retention committee and encourage members to speak with their peers about conflicts. The goal is to facilitate a discussion that determines the reasons for call-ins, possible solutions, and to show that leadership cares about staff and residents.
Don’t Wait!
For a moment think about your home’s workforce—who is working in your home? What problems do they face? How can you help them? Studies show that many workers in nursing homes are single parents or grandparents who take a very active role in helping raise their grandchildren. These same workers are usually one paycheck away from a crisis and have limited support systems to turn to when their car breaks down or the babysitter is sick. In a leadership role, you have the responsibility to understand your staff’s problems and determine the best way to assist them to meet their schedule before it becomes a greater problem. Remember:
If someone calls-in sick, seek them out the first day they are back and let them know that he/she was missed. You may explain how a co-worker mentioned it was better with him/her there or share a comment from a resident about how they missed the care the person provided. Acknowledging how the home needs and depends on him/her can make the difference the next time the person thinks about calling-in.
Coach staff through attendance issues. You can’t necessarily solve a personal problem but you CAN coach people through ways to deal with barriers that impact their attendance.
Reward good attendance and promptness. Consider giving a small gift card, monetary compensation on paychecks, or some other means to show you value their attendance.
Purchase an Employee Assistance Program (EAP). These programs help workers find resources they need to maintain employment. For more information, visit: http://www.eap-sap.com/eap/whatis.htm
Consider a flexible schedule. You may not need everyone there for a traditional shift time. Flexible scheduling can allow people to meet their personal needs and be in a better position to meet the attendance requirements.
My Innerview's National Survey of Consumer and Workforce Satisfaction in Nursing Homes indicates that the top three areas for nursing home leaders to focus on to improve staff satisfaction are:
Management caring about employees.
Management listening to employees.
Management helping to reduce job stress.
Clearly, as a leader you have a tremendous responsibility to keep your staff members satisfied with their working environment. The complexities of nursing homes produce a highly challenging environment to lead, which is why making a conscious effort towards addressing these top three areas is crucial. By taking the right steps, effective leadership can in turn reduce staff turnover and improve stability at your home! As outlined in the Staff Stability Toolkit, you should ask the question, “By doing this, am I contributing to staff stability or turnover?” Gearing your actions with this question in mind will help keep staff stability a priority.
Start Rounding with Purpose! Rounding is an excellent way to demonstrate that leadership cares about staff! Touching base with each staff member can help you get information about what’s currently happening within the home. As you make rounds, remember to extend the experience from just a social connection between leaders and frontline staff to a more meaningful dialogue that can lead to staff recognition and problem solving. Through this approach, both staff and leadership can work together to create improvements!
Here are some tips for conducting rounds effectively:
Make time for rounding. It is not a race -- it is an opportunity to develop relationships which will help improve retention.
Ask questions that allow you to develop a personal relationship with the staff such as asking about children, spouses, and hobbies. Genuine concern and interest goes a long way! Insight into their lives will also help you problem-solve if and when personal problems impact their attendance or performance.
Asking about what’s working will lead to a discussion about recognizing those who are contributing to that success. Start by focusing on the positive so that staff becomes aware of what is expected.
Make sure that you recognize anyone who has demonstrated good work! Recognizing good work ethics illustrates that leadership cares and pays attention.
You also want to take this opportunity to solve problems and overcome obstacles that impair their ability to serve residents. Ask about what can be done better and what their needs are to effectively and efficiently complete their job duties.
Developing relationships by investing time and effort with staff will help create a sense of community at your home. Remember that if leadership cares enough to listen, staff will care enough to stay.
R-TOP Resources: Take advantage of upcoming educational opportunities available right here in Missouri:
MU Enhanced Leadership Academy – Columbia, MO A Certificate Program offered by the MU Sinclair School of Nursing features an innovated, evidence-based curriculum for RNs in LTC. Focusing on improving retention, this program helps prepare leaders who can create and sustain improvement by strengthening the RN-NHA relationship. Tuition assistance has been made available for participants of the Academy through a Department of Health and Senior Services Grant. On a first-come, first-serve basis, $350 is available for RNs and $150 is available for NHAs. We encourage you to enroll quickly as space and funds are limited. For registration information, please contact Alexis Roam at aroam@primaris.org or visit: http://nursingoutreach.missouri.edu/leadership1011.htm
The Southeast Missouri Regional Group of Missouri Coalition Celebrating Care Continuum Change (MC5): "Consistent Assignment: What Is It and Why Is It Important?" – Cape Girardeau, MO This presentation will feature Julie Ballard, Assistant State Ombudsman, and discuss how staffing assignments can increase residents’ quality of life while contributing to a more stable frontline staff. Join us on Nov. 11 from 9 a.m. – 11:30 a.m. at Abbey Road Christian Church in Cape Girardeau, MO. There is NO charge to attend; however, registration is requested. To register, email Dave Walker at dwalker.18@hcmfield.com or call 573-243-3101.
The first RTOP Tip, which can be found here, provided key tips on drilling down to what’s currently happening at your home. Before moving on to translating the information into actionable steps, it’s important to ensure that you have gathered as much information about your home as you can. To develop a solid staff retention program, this crucial step cannot be rushed! This is why we’ll continue to focus on the discovery period by outlining additional ways to fully understand all factors that impact turnover.
Tips:
The cycle of turnover, as illustrated on page 18 of the Staff Stability Toolkit—illustrates how factors such as feelings of resentment and lack of trust can impact stress levels, turnover rates, and financial stability. You’ll notice that these factors are qualitative in nature and unlike quantitative data like the number of vacancies and overtime—this type of information will have to be obtained by directly talking with your staff about their experiences.
We suggest you continue to use the Drill Down Tool posted on the Primaris website to calculate numerical data and then turn to page 13 of the toolkit for Retention Committee Discovery Assignments. This page will provide you with questions you should ask to learn more about the experiences of employees working in your home. As you discuss experiences, remember to:
Be objective as you listen. Becoming defensive will shut communication down.
Do not disregard negative comments. Take these comments as opportunities to move in a more positive direction.
Set people at ease by acknowledging that what they say will not be used against them and that you truly need their input to improve the work environment. They need to know it is okay for them to speak freely about their experiences and that their input matters.
Consider assessing your own management and leadership practices. One place to help you with this is the Leadership Practices Inventory developed from The Leadership Challenge by Kouzes and Posner.
Become a student. It’s important to learn from other leadership experiences as well. Visit the Primaris “Nursing Home Web Resources” website to discover a variety of retention initiatives.
Resources:
Take advantage of upcoming educational opportunities available right here in Missouri:
The DON’s Institute: Essential Tools for the Director of Nursing in Long Term Care – Columbia, MO Reserve Sept. 13–15 for this conference hosted by the Missouri League for Nursing which will dive into relevant “hot topics” such as effective frameworks for consistent assignment, techniques for better communication with employees, and addressing recurring human resources issues that arrive when dealing with staff. To register, call 573-635-5355 or visit: www.mlnmonursing.org.
MoAHA Annual Conference: The Future of Aging Services—Who Decides? - Osage Beach, MO Scheduled from Sept. 22-24, this annual conference intends to provide a thorough discussion on the varying needs of seniors and the changing landscape of providing care for them. With sessions such as “Employee Retention: What a Difference it Makes,” “Changing the Culture of Future Leaders in Aging,” and a Culture Change panel---this conference is a must-not-miss! To register, visit: http://www.moaha.org/Education/AnnualConference.aspx
MU Enhanced Leadership Academy – Columbia, MO Starting Sept. 29, this structured educational program features an innovated, evidence-based curriculum for RNs in LTC. Focusing on improving retention, this program helps prepare leaders who can create and sustain improvement by strengthening the RN-NHA relationship. For registration information, please contact Alexis Roam at aroam@primaris.org or visit: http://nursingoutreach.missouri.edu/leadership1011.htm
High staff turnover is hurtful. It hurts your home’s bottom line. It stresses out your staff. And it hurts resident care. The good news is that you can stabilize your workforce, gaining you and your home improved care, saved money, and better survey outcomes.
Over the next year, MOLANE partners will focus on retention. Each partner will offer training sessions on this important topic which will be widely publicized. You can register via this link to the first session, a webinar on July 23 from 10:30 am to 11:30 am, sponsored by DHSS (Editor's note: this session has occured in the past). We will also share practical information each month called "R-TOP Tips" – Reduce Turnover, Optimize Performance. These tips will provide key steps you can take to begin a solid staff retention program and will be posted here. Be sure to download and read the free Staff Stability Toolkit featured on this website.
What's happening
Our first tip focuses on drilling down to what’s currently happening at your home.
Primaris Retention Tips of the Month