Recruitment and retention tips direct from frontline workers

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Emily Mongan
Emily Mongan

When I was in college, I took a job as reporter at our student newspaper toward the end of my freshman year. I hadn't taken any journalism classes yet, except for an incredibly basic introduction to mass communication class where we learned what year the printing press was invented and how radios worked.

I thought this would put me at a disadvantage — I hadn't done any journalism class assignments yet, so how would I learn how to report? I took the job anyway and had a bit of a revelation a year later when I entered my university's journalism school and began taking classes: The best education wasn't the one I had sitting in a classroom — it was the hands-on experience I got talking to editors and sources through my reporting job.

I think the same philosophy can be applied to a lot of the education sessions providers attend at local and national conferences. It's not that the information presented there isn't valuable; it's just a different type of education than learning the concepts through hands-on experiences, or by talking with employees or residents directly.

Attendees at the Pioneer Network Conference held this week in Rosemont, IL, got a chance to experience that latter type of education on one of the most pressing topics in the long-term care industry: employee recruitment and retention.

Sue Misiorski, national director of coaching and consulting for PHI, the group dedicated to improving conditions for direct-care workers such as nurse aides, moderated a panel of four CNA care partners from senior care and living organizations in the Chicago and Boston areas. The idea of the panel, which was called “In Their Own Voice: A Conversation with Care Partners about Recruitment and Retention,” was to identify “what's hard” about recruitment and retention and figuring out what, “if we made a couple of tweaks, doesn't have to be so hard,” Misiorski explained.

The issue is especially pressing since the number of adults over the age of 65 is expected to increase 128% by 2050. The number of working women in the age demographic most likely to take frontline care jobs is projected to grow by only 20%, Misiorski said.

“We need to understand what we can do as employers to make a workplace as person-centered for [workers] as it is for the elders,” she added.

When asked what drew the employees to their job, the panelists gave a variety of responses ranging from flexibility to set their own schedule and opportunities for advancement and managerial roles to word of mouth from other employees or the community that a facility was a welcoming, home-like place to work. That last bit is critical, Misiorski emphasized.

“What is your brand as an employer? I don't think we often think of that in our field. We think of our brand of caring.”

Misiorski also asked what keeps them around when other employees may leave. The number one response was the residents, followed closely by the relationships they have forged with their supervisors and co-workers.

“It's a family there,” one panel member said. “We don't consider it a job. We consider it daily living. I find joy in that.”

The panel also explained that self-scheduling and schedule flexibility, opportunities for education such as vocational and nursing programs, and control over their day-to-day responsibilities have also kept them anchored to the same organization year in and year out.

But some employees do eventually leave, with many — as many as 75% of workers — quitting due to issues with their supervisors, Misiorski said.

The panel responded that communication is key to creating a good employee-supervisor relationship, from being open to what's going on on the nursing floor to their overall vision for the organization. Approachability also emerged as a common theme, with the CNAs finding they worked best with leaders whom they felt they could come to with issues without having to worry about being reprimanded.

Treating every level of employee with the same level of respect, being accountable and relatable, and taking a “hands-off” approach to empowering workers rounded out the reasons why the panel has stuck with their supervisors for as long as they have.

Panelists explained that while their organizations have impressively low turnover rates due to their leadership teams and structure, the same structure that drew them in could drive other workers away. One of the Boston-area CNAs gave the example of the resident-centered structure at her facility; residents can choose when they get up, eat, shower and generally go about their days. While that focus on the resident as a person keeps her engaged at work, it was a turnoff for some workers who would have preferred to get residents up and ready by 9 a.m. each day.

Employees who leave because they aren't a good fit for the facility's structure “are the people you wouldn't really want there in the first place,” Misiorski noted.

The panel concluded with each CNA offering up something that would make their workplaces even better. The responses ranged from holding more staff meetings to granting employees more say in budgeting and menu planning. They also recommended teaching new employees the importance of not just sticking with their daily work assignments, and offering a hand to others when needed.

Panelists also said that attending conferences has brought value not only to them but also to their organizations. One CNA, for example, came back from a conference with information from a session on reducing alarms; she taught her co-workers, and the facility eventually eliminated alarms entirely.

So take the panel's advice, and listen to the voices of your frontline staff. From improving communication and schedule flexibility, to investing in continuing education and conference trips, understanding what motivates your staff may just drive them to stick around.

Follow Staff Writer Emily Mongan @emmongan. Email her at


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.