8 things that make nurses want to work at your nursing home
Beat the federal nursing staff mandate by making your long-term care or skilled nursing facility irresistible to prospective nursing home staff. 8 tips to make your nursing home more appealing to new nurses and retain the skilled staff you have.
Everyone's talking about the recent federal rule standards regarding minimum staffing requirements in nursing homes. While some long-term care facilities might remain unfazed by these new requirements, for others, it'll feel like another impossible task for providers amidst ever-changing federal requirements.
So how many could be affected by this mandate and what can nursing facilities do about it to ensure they're protected against the staffing struggles of the future? One thing you can do to help batten down the metaphorical hatches is to ensure that you are appealing to prospective nurses as a provider and that you're effectively working to retain the staff you have.?
Who does the nursing home staffing mandate affect?
A recent KFF study (1) found that "fewer than 1 in 5 (19%) nursing facilities currently meet the minimum staffing standards set out in the final requirements of the federal rule". According to a 2022 report from The American Health Care Association (2) “87% of nursing homes have moderate to high levels of staffing shortages and hiring new staff has been challenging for 98% of nursing homes.”?The American Health Care Association (3) predicts that "Nursing homes would need to hire an estimated 102,154 additional full-time employees (80,077 nurse aides and 22,077 RNs)" to meet these requirements and that "the proposed mandate would cost nursing homes approximately $6.8 billion per year."
Whether this suggested difficulty in maintaining safe levels of staff is largely due to a shortage of qualified caregivers in general, scarcity of training provision, or a reluctance for nurses to choose to work in long-term care over other sectors, the outcome for long-term care communities is the same: difficulties in recruiting and retaining.
It's thought that rural and smaller facilities are likely to be greatly impacted, specifically due to the requirement to have a registered nurse working 24 hours per day. Particularly in small facilities, that's going to get expensive in terms of payroll. Skilled Nursing News (4) writes that rural nursing homes “face an ongoing battle for survival [with] the finalization of the nursing home staffing mandate”. ?
While we all want the same thing in terms of delivering high-quality, patient-centered care to our nursing home residents, the financial burden may prove too great for some care homes that are already struggling to break even and/or find it particularly challenging to recruit.?
So, what's to be done except to make sure your skilled nursing or long-term care community is as appealing as it can be to new staff while working hard to retain the ones you have??
What can nursing homes do to appeal to nursing home workers?
When you're marketing your long-term care community to potential residents, you'll no doubt put yourselves in the non-slip shoes of those you're trying to appeal to. In that case, you ask what older adults want in a residential or rehab care facility and also what their children or those with power of attorney want for them.
Knowing your audience and being equipped to give them what they want is the key to successful marketing and we ought to consider how we can also do this for prospective nurses, nurse aides and caregiving staff. If we want to retain and attract staff over the competition, then we have to know what they want. The best way to do that is to keep engaged with your staff and ask them explicitly and frequently what they want but here are some suggestions of talking points to get you started.?
1 - Pay the piper
Sadly, no matter how hard your HR department drives for free fruit in the break area and yoga classes for employees, or how many times the DON tells you that you're just plain awesome, goodwill alone won't keep a worker working indefinitely. Maslow’s Hierarchy of Needs outlines how survival needs must first be met before other more emotional and intellectual fulfilments can be actualized. Financial provision is paramount to our survival and safety so it’s more than a little important. The nursing home industry is no different to any other, in the respect that all jobs have to provide a monetary incentive to employ and keep staff around.
Indeed, the trends may speak for themselves as a 2022 report from AHCA (2) outlined that 95% of nursing homes had increased wages to try and retain staff within the previous year and 92% had offered bonuses. So, perhaps the lesson is that if you want your nursing facility to produce the melody of quality care and content staff, paying the piper ought to be a top priority.
In short, you should take steps to make sure your "competitive salary" is precisely that, because people may stay for how you make them feel valued and fulfilled, but that's not why they come in the first place. A healthy payroll allocation is one of the surefire ways to make you stand out from other nursing homes and don't forget that it's more expensive to replace staff than to retain them.
If you aren’t sure what the going rates are in your area, this guide from teach.com can help give you a benchmark for the mean salary for Registered Nurses and Nurse Practitioners. This page at nurse.com shows the hourly and annual wage by state for Certified Nursing Assistants so you can check your own offerings and adjust them accordingly.
2 - Train up
Some nursing homes have found success in recruiting Certified Nursing Assistants by creating them in their facility. We don't mean molding them out of clay or building them like Frankenstein's monster, of course. We mean that if you allocate resources for non-medical employees or local people to complete CNA training at your facility then you're one step closer to solving the lack of employable nurses in your area. Boston-based Hebrew Rehabilitation Center (6) as an example, has a Nurse Aide training program that they describe as an “Earn while you learn […] grant-funded program.”
Lack of access to training and funding for it, particularly in rural areas, can make the nursing route inaccessible to a lot of people who might make great caregivers. So, if you're in a position where you can train from within and fund that certification then you might want to consider it. If there aren't enough nurses out there, then perhaps you could make your own to future-proof against insufficient staffing. There's also the added benefit, just as in the case of vocational nurses, that training them in your own nursing home will mean they already know how things work here so once qualified, they'll have a head start at getting stuck in at your facility.
3 - Nurture their skills
Research (6) into what appeals to licensed nurses in a job role indicated that "a match between education and actual work" is important to them. So, what could this mean in practice? Well, the word "training" can have different connotations depending on context and conditioning. If someone says to you that you have "mandatory training" to complete today, is it going to make you feel thrilled? What if someone said that your "training opportunity" or "investment in education" session is scheduled for you today? One term can dredge up stress-inspiring PTSD from nursing school or vocational learning and the other implies that substantial resources are being invested in that person's progression and skills.?
Training is vital, we know, but language can assist in presenting it as something positive and drive thoughts toward a positive association with the education you are providing for them. Sometimes it's a matter of branding as to whether training is seen as a box-ticking exercise or an opportunity.
Megan Cunningham of Ziegler writes (8) that “Offering opportunities for employees to upskill can be as simple as pairing them with a more experienced mentor, or as comprehensive as offering training programs on-site. Staff benefit by having a clear career path, and providers can benefit from filling internal workforce gaps.”
Apart from routine training, some nursing home providers offer additional opportunities for learning and development which can be an attractive benefit for health care workers. It's always a good idea to ask your nurse workforce what they want the opportunity to learn more about in terms of continued education. Then provide education accordingly whether through bringing in external educators or allowing them the opportunity to view one of the free, on-demand learning sessions on our Webinars page to top up their knowledge.?
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4 - Show appreciation
Of course, you already know that employees in any kind of sector, including healthcare aren't going to perform to their best level or feel valued if they aren't shown explicit and frequent appreciation. Alongside the constant demand of resident needs, regulatory changes and budget strain, it's easy to unintentionally push giving regular props to the back burner. Still, appreciation is vital for retention and reducing the recruitment and training costs associated with employee churn.?
A recent LinkedIn article (5) states, "Recognition is relationship glue, reputation repair, and retention relief." What person ever quit a job from feeling too supported, valued and appreciated? Anyone? No? So, if retention is something you'd really like to see improve in your facility, then start by ensuring there are ample opportunities for staff to be and feel recognized for the work they do. This could entail a Starbucks voucher incentive each month won by the nurse or caregiver voted "most caring" by their peers or by the residents. A little recognition for things we do, especially when we think no one notices, can go a long way in making someone feel seen and appreciated.
5 - Lead with positivity
If you're in a nurse leadership role then we encourage you to take stock of how often you speak or express a word of praise or recognition to colleagues on the lower rungs of the career ladder. Keep a tally for just one day of how many times you opened your mouth to make a nurse or caregiver feel good, then try and beat that number the next day. Some people love to keep it competitive even if you're only competing with yourself, so think about how best you are equipped to keep feeding positivity in your team.?
Wellness Wednesdays can be a fun thing to observe to keep your team engaged. Maybe you could take it upon yourself to send inspiring or encouraging sayings or affirmations to your team every Wednesday or just once a month. It's free, all it takes is a little effort and consistency.?
6 - Optimize your image
There's one thing you can start assessing and working on immediately to improve the chances of success while recruiting. We eat with our eyes before any other senses, right? So, you need to make sure what you're offering is presented to look appealing. We're not talking about perks and benefits here although, you'll certainly want to think about the meat of what you're offering as well. What we mean is that one of the first things nursing professionals will do when thinking of applying for a job is to do a little online stalking...we mean, research.
By this, we mean that they'll look for where information about your company is online such as the website and social media platforms to get a visual flavor of the kind of workplace vibe they could potentially expect. When your digital resources are put together, we'll bet that the first thought regarding content and communication veers towards occupancy and move-in. It's intended to look good to a potential resident or their family but you should also look at this image you're presenting through the eye of a prospective job applicant. What do they see??
One explorative study in the Journal of Long-term Care (7) found that one key thing that affected whether registered nurses wanted to work at a particular facility was whether there was "a positive image of working in nursing homes". Of course, this could refer to a more general perception of the pros and cons of working in nursing, which is largely out of your control, but you can optimize your subacute care facility's online presence to look appealing to nurses. That is within your control. So, start by searching for your facility online to see what your prospective nurses see. Then take it from there.?
7 - Be honest and clear
When recruiting for an open role in your long-term care community, it's important to be transparent and clear when defining the role. If you haven't changed the job description of what a CNA or a Practical Nurse is in your facility in a few years, then it may be time to look again. Medicaid requirements for nursing homes and guidelines are changing all the time, so what were the expectations of a job title once, may no longer be achievable now.?
In a study in the Journal of Long-Term Care (6), Ramona Backhaus indicates that “Role clarity and a supportive practice environment (e.g., supportive managers, nurse participation in decisions) might contribute to attraction and retention of RNs in nursing homes.” So, while you want the position to appear attractive, it's not the time for poetic license.
There's more room for disaster if you play fast and loose with the truth about what a nurse's duties are going to be. Keep the role description concise, clear and consistent with what will realistically be expected of them and don't promise what you can't deliver. Offering high-quality care amidst ongoing challenges with nursing home staffing levels can result in changes in job roles and duties. It happens. Just ensure you're communicating truthfully.?
8 - Re-evaluate sufficient staffing levels
We've all heard the recent announcement regarding the new minimum staffing levels mandate. The amendments to what is considered sufficient staff will be more demanding in terms of the nursing hours per resident per day. Of course, we all want to ensure we have sufficient direct care workers to give the quality of care required for those in Skilled Nursing Facilities, but the upcoming federal government rule may add further strain to an industry already struggling with nursing staff levels. While this mandate won't be enforced for some time yet, it may be as well to address staff ratios now to avoid further stress.?
Nurse or caregiver-to-resident ratio can also be a real consideration for healthcare professionals when deciding whether to accept a job offer. It speaks of more than just the acuity of the population or the commitment to upholding minimum standards according to CMS, but a healthy resident-to-nurse ratio can indicate a supportive leadership infrastructure and a genuine care for nursing home staff wellbeing that is going to be attractive to direct care staff.?
Final thoughts
In this post COVID-19 pandemic work world, nursing homes are having to compete with other jobs that offer hybrid working and flexibility, so workplace culture has to be key in attracting skilled and non-skilled staff. Hopefully, this article has given you some ideas to chew on, more than just financial incentives and the occasional donut windfall in the break room.
Everyone wants to work somewhere they feel appreciated and valued and what's more, because of the nature of health care, the majority of the direct care workforce will have entered the profession because of a deep-rooted desire to heal, care and improve the lives of others. That's an amazing thing and it's up to leadership to allow them to deliver excellent resident care while assuring their wellbeing and equipping them with the tools they need for success.
Sources
7 - Backhaus, R., Jochem, I., Reijnders-Paffen, H., & Meijers, J. M. (2021). How to Position, Attract and Retain Registered Nurses in Nursing Homes: A Qualitative, Explorative Study. Journal of Long Term Care, 0(2021), 192–200. https://doi.org/10.31389/jltc.80