Kristin Baird, RN, BSN, MHA

A few years ago, when managing a big project for a long term care company, I was struck by their high turnover among nurses and nursing assistants. When I brought up my concerns to the chief HR officer, he shrugged and said, “That’s normal. People will leave for ten cents more.”

At the time, we were looking at 44% turnover, which I’ve come to see is not uncommon. My question then was the same as it is today: Are we too accepting of high turnover as the norm in long-term care? Are we like the HR executive who shrugs it off? If so, this fatalistic view could be keeping you from striving for a culture your employees don’t want to leave.

I worked as a nursing assistant in a skilled nursing facility during college. I loved my residents and my co-workers but felt de-valued by my nurse leader. To her, I was a warm body covering a shift. I couldn’t wait until I could find something better.

Contrast this to my daughters’ experiences working as CNAs for a long-term care organization. Both were engaged in the work and continued part-time long after college graduation, not wanting to leave “their” residents. In fact, one of my daughters met her husband while working in that skilled nursing facility. On their wedding day, the two left the church and headed to the nursing home so their residents could celebrate with them.

The major difference between my CNA experience and my daughters’ was that they worked in a very mission-driven organization and it showed. They felt a strong connection that never wavered, and I’m certain, 10 cents would not have lured them away.

Since my negative experience as a nursing assistant, I’ve spent decades examining culture and what causes staff to engage or disengage. The bottom line is culture. Does the organization have compelling mission, vision and values statements? Are the mission, vision and values evident in how decisions are made? Are they part of daily operations or just on a plaque in the administrator’s office?

Organizations with enviable retention make culture a priority. The leaders have passion for their work, make a conscious effort to attract and retain the best talent, and foster a strong connection to purpose.

Rather than assume that high turnover is inevitable, embrace the belief that enhancing culture can, and will, make a difference. Start by developing these leadership skills in your managers, including:

  1. Hire for fit. Rather than hiring the next warm body, make sure managers know how to ask behavior-based interview questions to identify candidates who have the personal qualities needed to contribute to the desired culture.
  2. Master the stay interview. Most managers know how to conduct interviews for hiring and even exit interviews, but few are proficient in conducting stay interviews designed to re-recruit and retain the best staff.
  3. Stay connected, aware and involved in daily operations. This doesn’t mean micro-managing. It does mean making rounds on employees, observing and coaching on a regular basis.

It is possible to improve retention by designing a desirable, mission-driven culture.

Kristin Baird, RN, BSN, MHA is the founder of Baird Group, a consulting firm dedicated to improving the healthcare experience for patients, residents and the people who serve them. A nurse, consultant and author, Baird specializes in improving culture through transformational leadership development, coaching, training and research.  She is a highly sought-after speaker for national and state conferences and leadership institutes.