Martie L. Moore, RN, MAOM, CPHQ

I will admit that I have never seen “Lord of the Rings.” Yes, I know I am an oddity. Yet, I do know that the words were used by King Théoden for an ominous, foreboding warning of what was coming…  

Because it has an ominous connotation, like the thing that’s beginning is bad and you’ve been fearing it for a while, it is many times said with a sense of wary and heaviness. The saying came to my attention during a briefing on the rising case counts of SARS-CoV-2 nationally. One of the other participants did not realize they were not on mute and muttered loudly with the tone of frustration and fatigue, “And so, it begins.”

There was a pause as each person on the Zoom call looked at the other, wondering what to say, then finally an acknowledgment of the statement. What happened next was an explosion of discussion about the statement of “And so, it begins…” The discussion expanded to what the winter months might mean in face of variants, outbreaks and severity of illness. We all went down the highway quickly to a dark tunnel with no light at the other end. 

That night I pondered the statement. Why did it elicit a feeling of impending doom? Why was it so easy to drive quickly on the highway of being overwhelmed and frustrated? As I continued to think about it, I said out loud with a lift in my voice, “And so, it begins.” As I changed the tone from one of heaviness to one of excitement, so did my feelings and perceptions. 

Beginnings are exciting! The wonderment of what is ahead, the sense of learning and discovery. Think of the beginning of a road trip, the sense of anticipation and excitement. 

That is how new hires feel about their first day as your employee. If they don’t, you have a serious hiring problem. In face of the labor shortage, creating an environment that people want to be there and will stay there has to be a key strategy. You must design not only the beginning of the experience but how their career with you will be. 

Many healthcare settings have put programs in place with actions to do at hire, then at 30 to 60 days afterward. Those are tactics, good to do, but if not conveyed authentically will not retain. They will leave and they are right now, in record numbers. 

It is easy to rationalize that they are leaving for more money. The market has exploded in caregivers leaving for agency or traveling positions. In several different recent surveys, while the money was a factor, nurses reported that they left because they became disenfranchised with their leaders. They reported that they felt they did not care, nor support them.

Leaders themselves are struggling with new regulations/rules, daily crisis management, staffing — and the list goes on and on. They are unable to step out of the vortex they are in and think about what it is going to take to change the trajectory. Many leaders do not believe that they can change the trajectory. You can always change the course of where you are going with your organization. You set the tone and, in many ways, the response of your employees. 

Think of the new hire. Ask yourself, “When I think of a new employee, do I think about them through the lens of a checklist and things that need to be done to mark the checklist complete?” In contrast, what would the actions be if you thought about them through the lens of, “And so, it begins…”

Seeing the beginning of a marketing campaign to prove to the employee that this is the only place that they want to be employed by. Doing everything that can be done to assure that their experiences begin in a way that the employee tells their family after their shift, “My day was fantastic, I made the right decision!” 

Look ahead to the future, ask yourself the question, “And so, it continues…” what can be done to make that new beginning sustainable and consistent. 

I recently had the opportunity of talking with a healthcare facility that had both low turnover and vacancy, with a stellar reputation. The secret sauce to this facility? They had answered the question of beginning and continuing and lived it through their leaders. They had changed the narrative of a revolving door to a narrative of engagement. Leadership engagement with their employees. 

They had personal development plans for each employee. They facilitated onsite classes to be taken to advance employees’ certification or degree completion. They sat down with their employees weekly and had three questions they asked:

1. What is going well this week for you? (Answers were many times personal as well as professional.) 

2. What can I do to support you this week? (In the beginning, they reported it was overwhelming, now they get, just keep doing what you are doing most of the time.) 

3. Any barriers or issues that you were unable to resolve that you want me to know about? (Employees have taken ownership and most of the time now are able to solve their own issues.)

You have a choice: Stay in the vortex, or change the narrative and step out of it. It is all in how you think and say, “And so, it begins and continues…”

Martie L. Moore, MAOM, RN, CPHQ, has been an executive healthcare leader for more than 20 years. She has served on advisory boards for the National Pressure Ulcer Advisory Panel and the American Nurses Association, and she currently serves on the Dean’s Advisory Board at the University of Central Florida College of Nursing and Sigma. She was honored by Saint Martin’s University with an honorary doctorate degree for her service and accomplishments in advancing healthcare.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.