I once rode down a crowded afternoon elevator with the CEO of a managed care company. “It must be 5:01,” he commented wryly. I heard a measure of scorn for his employees’ lack of dedication to the job. What I saw was a group of people fleeing from utterly uninspiring and unappreciated work.
Similarly, in long-term care facilities with high staff turnover, some may see an absence of commitment on the part of workers, while others recognize that there’s something wrong with the job and the way employees are being treated. If workers are fleeing for the private sector, it’s not because they have an intense desire to work at Burger King.
Managers are no doubt familiar with many ramifications of turnover, such as the time and expense of finding and training new hires, the overtime costs for filling in shifts and the need to engage expensive agency workers. It’s also recognized that staff become demoralized in a high-turnover environment and that the quality of care can suffer — two points worth considering in more depth.
When key employees depart — such as nursing supervisors, department heads and nurses — direct care staff may be hesitant to bring problems to new workers just settling in to their jobs. Without the ease that develops between team members over time, important information may not be relayed, glitches in the system aren’t identified and resolved, and problems can fester and multiply.
When staff retention is low, workers become burned out on meeting new team members. They don’t want to put in energy toward welcoming newbies because they know the likelihood is that the individual isn’t going to stick around. This exacerbates the problem because a new worker who doesn’t feel welcomed is less likely to remain with the job.
The impact on residents is profound. Residents are in a vulnerable position, reliant on others for their most personal needs. It’s difficult for them to adjust to being assisted with toileting and bathing by a familiar person, but an unpredictable rotation of strangers who are new to the work adds another level of stress to their lives. For residents with dementia, expect an increase in distress — and the kinds of behaviors that make new hires less likely to remain on the job.
Turnover begets more turnover.
That’s why I was heartened to read Editor Jim Berklan’s July 18th column about a provider making staff retention a centerpiece of their business model and later that week, Editorial Director John O’Connor’s piece on the push for vocational training that could improve the onboarding and retention of new employees.
Companies can hire retention specialists, as described on this LeadingAge page, engage in an onboarding intervention such as the hospital-based program described here, or develop their own plan of action specific to the needs of their facility.
The success of initiatives in improving staff retention shows that turnover isn’t due to shortcomings in the employees who leave, and it’s not an unchangeable reality of the field. Addressing staff retention is crucial to the health of an organization and to the residents within it.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an 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 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.
