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Retaining great CNAs and nurses is difficult, and with COVID, it’s even more difficult. Here are a few ways you can manage nurse turnover in your facility.

The Problem:

Right now, many nursing homes & assisted living facilities are short staffed and it’s getting worse every day. It was difficult before the coronavirus pandemic hit, and now with COVID-19 it’s even harder to recruit and retain nurses.

Because of the nursing shortage and the low patient to nurse ratio, when nurses and nurses aides are stretched thin, they end up cutting corners. This is bad for business, bad for revenue, and worse for the residents and the facility. Pair this with unexpected patient surges and you see managers scrambling to ensure appropriate coverage on CNAs and licensed nurses.

Virtually all NAs report they continued to work at their current job because they like caring for others (99%) or feel good about the work that they do (97%). Almost two-thirds of all NAs continue to work because of the work location (69%), flexible schedule or hours (69%), or because they liked their co-workers (77%). Over half of NAs report their supervisor (62%), opportunities for career advancement (52%), pay (50%), or opportunities for overtime (51%) as reasons for staying on the job. Thirty-six percent of NAs reported they continued to work because of the benefits.

 – Department of Health & Human Services

Financial Assistance

CMS has a waiver for long term care facilities to help reduce The strain for the nursing and the nursing shortages and staffing requirements for long term care. The following initiatives have begun for various states:

  • Massachusetts and Colorado have launched websites to match jobseekers up with open long term and residential care positions at facilities that have signed up for the system.
  • Massachusetts is additionally providing $1,000 bonus for those nurses or CNAs, who stay on for the job for a month.
  • Arkansas recently boosted their pay for nurses and other direct care workers through the end of May.
  • Illinois is one of the other states that are letting facilities hire nurses with an out of state license or if they recently expired credential or allowing them to temporarily hire unskilled workers to basically helping feed and clothe residents.

Your state probably already has a number of initiatives build to help you, with a short Google search, you would be able to find resources.

Thinking Out of the Box To Manage Nurse Turnover

It takes more than just a little finesse to get past the huge barriers we have in long term care right now. Here are some creative ideas that can get your team involved, take some stress off of you, keep your team happy, and make sure you are maximizing hours for everyone.

Flexible Schedules

Your CNAs are often more often than not working more than one job. Allowing them to flex schedule is very important today. Whether you’re a small facility or large enterprise, offering flex schedules four hours on one shift and four hours on another or being able to have let the staff have input in their scheduled hours helps benefit so it gives them a sense of control.

Nursing homes that offer flexible or nontraditional schedules to the employees allows facility staff to attend to personal matters. These schedules enable staff to pursue advanced degrees such as Registered Nursing as well. Of course flex staffing is also going to be dependent upon your set your current census and your current staff load.

The most important thing is understanding how your team works. If you offer or operate two 12-hour shifts for your nursing staff, you may want to instead address a typical three eight hour shift or even allow your staff to work two 16 hour shifts on the weekends.

If you can move away from traditional set hours, you will find that the staff will actually help you with the scheduling since this allows them to work those extra days or have time off for family in the afternoons that they need it and that’s critical to their lives.

Mentorship Programs in Long Term Care

When hiring a CNA, normally you go through the new hire process, they sit down with a DSD, and then they’re thrown into the frenzy of long term care. This kind of introduction to our field is blunt and difficult. A much more elegant method is to ensure both CNAs and nurses have the right mentorship.

A great facility we worked with identified a very experienced and knowledgeable CNA. They gave her a 50 cents to $1 an hour raise with the goal of guiding new CNAs. Through the onboarding process, new hires would work with her directly for a week and then be released to the floor. They found that when they have a mentor to go to about a problem, or if someone needs assistance, the company was substantially more apt to retain that CNA. The same thing applies to licensed nurses. Having a mentorship program can increase retention by more than 50% versus just hiring the person and putting them straight to work.

Training Resources

Some facilities have reached out to their regional RLP and community resources and they help design mentorship systems. But it can start right at the CNA or the nursing school in your neighborhood on being able to offer educational ongoing in servicing additional training. Through your RPS, for example, think about opening up your doors for volunteerism after COVID-19.

Share The Decision Making Load

One of the primary methods for involving your staff in decision making in long term care today is to bring the nursing staff into your QA programs.

Once you assign or ask them to be part of that decision-making process for this QA QA inviting them to meetings, they start to take ownership. Once your staff starts to take ownership, they start taking an interest. The more interest the staff have, the less likely they are to leave.

Below is the 12-step process available on the CMS website in regards to your QAPI program that addresses adding staff members as part of the decision making process:

  1. Leadership Responsibility and Accountability – Support must come from the top/ Provide resources for your staff.
  2. Develop a Deliberate Approach to Teamwork – Have a clear purpose/ have defined roles/ have a commitment to active engagement.
  3. Take Your QAPI “Pulse” with Self-Assessment – Use the CMS self-assessment tool to determine areas you need to work on.
  4. Identify Your Organization’s Guiding Principles – This will unify the facility by tying the work being done to a purpose or philosophy.
  5. Develop Your QAPI Plan – Tailor your plan to fit your facility/ Scope will be based on the unique services you offer.
  6. Conduct a QAPI Awareness Campaign – Inform everyone about QAPI and your organization’s QAPI plan.
  7. Develop a Strategy for Collecting and Using QAPI Data – Effective use of data will ensure that decisions are made based on full information.
  8. Identify Your Gaps and Opportunities – Use this time to observe for any areas where processes are breaking down.
  9. Prioritize Quality Opportunities and Charter PIP – Prioritize opportunities for more intensive improvement work.
  10. Plan, Conduct, and Document PIPS – PIP teams should use a standardized process for making improvements.
  11. Getting to the “Root” of the Problem – Determine all potential root cause(s) underlying the performance issue(s).
  12. Take Systemic Action – Implement changes that will result in the improvement of overall processes.

Looking Forward

This pandemic won’t last forever. But for now, we all have to be creative about the ways we’re helping our teams stay motivated and available.

We hope this set of ideas has been helpful. Please let us know in the comments if there are any other things you recommend for other long term care facilities!

For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast.