Staffing shortages in nursing homes are worse now than ever before. In 2019, 588,000 certified nursing assistant (CNA) positions in nursing homes needed to be filled. Since the start of the pandemic, 238,000 CNAs have left the industry.
Turnover is at an all-time high, staff continues to make wages that are not livable or are disparate when compared to other settings, and the workload is unsurmountable. Something needs to change.
A powerful session on Reframing Aging and Long-Term Care at the 2022 Gerontological Society of America Annual Meeting asked attendees to reflect on headlines related to nursing homes they would want to see in the next five to 10 years. An attendee responded, “Nursing Homes: The Best Place to Work.”
This response exposes the change needed. Successful recruitment and retention of workers to nursing homes is paramount to ensure the delivery of quality care to residents. Therefore, creating an environment that is sure to attract and retain workers is an important first step.
Exactly what this environment looks like and how to get there had been elusive until that session. To solve issues regarding the recruitment and retention of nursing home workers, we need to focus on making nursing homes places where people want to work, or even the best places to work.
The idea of creating the “best place to work” is not new. We can look to the many examples of the current best places to work on the United States’ top 10 list. Currently, organizations such as Google, Lululemon and Boston Consulting Group are among the best places to work. As we aim to transform nursing homes and reframe long-term care work, we should consider what draws the public to jobs in these organizations.
It’s clear that Google — a highly revered and well-known organization — encourages creativity and the expression of ideas, which yields greater productivity. This calls into question whether and where input from all nursing home staff is consistently and intentionally solicited. Google maintains an open communication and open-door policy, where employees are encouraged to share their thoughts and ideas. Oftentimes, power differentials are at play in the nursing home setting, thus restricting the voices of particular staff, such as CNAs. How do we change that? Resident and family councils exist in nursing homes. What about employee councils?
Google also makes decisions built on data, not impulse. Where are the opportunities to collect, analyze and act on data (e.g., resident, family and staff satisfaction surveys and metrics on resident care and outcomes)? If a nursing home is not equipped to work with data in these ways, can it partner with academic institutions and researchers to improve decision-making?
Google prioritizes diversity and inclusion. Is there representation across positions in nursing homes, are staff invited to spaces where their presence is necessary (e.g., huddles or resident care discussions), and are these critical staff a part of decision-making and made to feel welcome?
Google also pays attention to employees’ quality of life. One example: offering flexible work schedules. While more structure is required in the nursing home setting to ensure adequate coverage for residents, might staff be able to create their schedules given specified parameters?
And Google famously provides free food and coffee; while costly, would it be possible to provide nursing home staff with free coffee daily and food, at least weekly or monthly, to start? Google fosters a fun work environment. Where are the opportunities to put the fun into nursing home work? For example, might nursing homes put in areas for staff to take naps, work out and engage creatively?
Google also provides ample opportunities for career advancement, parenthood vacations and advanced education opportunities with a focus on keeping morale high by ensuring that workers feel as though they are contributing to the organization. How are staff in nursing homes being supported regarding their needs and goals? For example, childcare and transportation have been cited as significant needs among nursing home staff, so providing perks that support staff in these specific areas could pave the way for future retention.
To be sure, there are significant challenges for nursing homes to create the best place to work relative to Google — challenges rooted in strict regulations, low reimbursement, stigma and decreased resources, to name a few. However, like Google, the long-term care space is ripe for innovation and recommendations specific to addressing these challenges from the recently released National Imperative to Improve Nursing Home Quality report and new efforts from the White House are promising.
Creating a highly sought-out place of work requires a significant amount of investment. However, the output will well exceed the input. In the short term, the best place to begin in creating the best place to work is to develop better relationships among nursing home staff and understand their needs and goals.
Long term, nursing homes have to establish a clear mission with strong, transparent senior leadership, and a focus on compensation, culture, work-life balance, opportunities for career advancement and clear communication.
Jasmine L. Travers, Ph.D., MHS, RN, is an assistant professor at NYU Rory Meyers College of Nursing and affiliated faculty of the Hartford Institute for Geriatric Nursing.
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.