Dr. Eleanor Barbera

During the Q&A section of my McKnight’s Fall Expo webinar “Letting them go with style,” the conversation turned toward why staff members are leaving their long-term care positions.

As I pointed out then, workers often give plausible but incomplete reasons for leaving their positions because they plan to work elsewhere in the industry and don’t want to burn any bridges. Others exit without giving notice. Without knowing the real reasons why employees leave, it’s difficult to make adjustments that will lessen turnover.

Challenging assumptions

Organizations sometimes disparage the departing employee rather than look at what might have contributed to their resignation. Psychologically speaking, this lessens the “narcissistic injury” of someone leaving. A narcissistic injury is one that hurts our sense of self. Rather than feel the pain of being rejected, we reject them.

A typical assumption is that there was something wrong with the resigning worker. For example, they weren’t dedicated enough, they didn’t appreciate the benefits of the organization, or they weren’t very good anyway (the “sour grapes” effect). This leads to the sweeping conclusion that you just can’t find good people these days.

Rejecting someone who has left us may help us get over failed romantic relationships, but it’s a missed opportunity in business, especially if our workers keep marching out the door in droves as they have a tendency to do in LTC.

Factors associated with turnover

As I pointed out in a previous post here, “The keys to reducing turnover in long-term care,” turnover is associated with a variety of factors. A few of them may be addressed in the selection process (older, more experienced workers are more likely to stay on the job) and some of them require corporate decisions (better pay, better benefits and higher staffing levels are associated with staff retention).

Many other aspects can be altered through changes in training and culture. Poor working conditions, work schedules not meeting needs or expectations, lack of role clarity, and a lack of appreciation are associated with turnover. Workers are more likely to stay on the job when given opportunities for professional growth, sufficient orientation, permanent assignments, and supervisory training. Employees remain when they feel like valued team members and have positive relationships with coworkers.

How can we find out which of these elements are contributing to turnover in our particular facility so that we can devote our resources to addressing them?

Ways to investigate

I. Enhance your exit interview strategies:

o   Interview everyone who leaves, including consultants. (In almost 20 years, I’ve never once had an exit interview! Consultants see things too.)

o   Use interviewers who are not direct supervisors, in order to allow the opportunity to discuss the supervisory relationship, a frequent source of job dissatisfaction.

o   Ask questions in a way that allows departing employees to be helpful rather than critical. For instance, rather than question what they didn’t like about the job, ask them what they’d change to improve the job or organization.

o   For more strategies, a Google search can be quite illuminating.

II. Survey your current employees:

o   Don’t wait for people to leave before you ask them how to make your organization better. Chances are they know why their coworkers are leaving but won’t say anything unless they’re asked directly.

o   The following article (found via a Google search) highlights not only the reasons departing employees are loathe to criticize their employers but also offers helpful techniques to enhance communication with your team: The truth about exit interviews.

o   The “factors associated with turnover” section above in this post can be a good starting point for items to include in a formal survey of employees.

III. Take on the role of employee (I know, a radical idea!):

o   I knew a member of the clergy who worked as a certified nurses aide before beginning his religious role within the organization. He wanted to understand what life was really like for residents and aides. He said it was very illuminating. Among other things, he got more respect from his coworkers in his religious role.

o   I heard a story of an administrator who took a turn as resident to see what it was like to live in his nursing home. This resulted in changes such as altering the times of medication delivery so as not to interfere with residents’ sleep.

o   If you want to know why your aides won’t stay, becoming an aide for a while will offer insights gleaned in no other way. (It will also give you major street cred.)

IV. Use a secret shopper (or covert coworker):

o   If chain stores can hire people to purchase goods and report back to the company about the shopping experience, why can’t we do the same? A sensible, competent aide or nurse from one site could be temporarily moved to another to observe and report on the environment. Their information could be used to inform decisions about where to start to reduce turnover.

Some of the reasons employees are leaving are beyond our control — workers move, have health problems or are lured by higher paying, less stressful positions — but there are enough factors within our control to make a considerable reduction in turnover. The first step is figuring out where to begin.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident’s Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.