Late last year, Massachusetts voters took to the polls and voted against a measure that would have established mandatory nurse-patient staffing ratios in hospitals. They did so by a significant margin with 70% registering a “no” vote, a position endorsed by groups such as the Massachusetts Health and Hospital Association and the American Nurses Association of Massachusetts.
While the hotly contested measure did not pass, several prominent groups that supported passage of the initiative raised compelling concerns about the severe shortage of healthcare talent. The industry is facing growing time-to-fill and turnover rates, resulting in increasing staff vacancy rates. Given the well-established links between nurse staffing levels and quality care, the concern is that mounting staffing gaps are negatively impacting patient outcomes.
While these issues are significant in hospitals, which were the focus of the ballot measure, the challenges are even more daunting in post-acute and senior living facilities, where nurse vacancy rates are running at an all-time high. In post-acute and senior living organizations, annual turnover rates for RNs are at 56%, whereas annual RN turnover in hospitals is at 17%. It’s an interesting dichotomy — most long-term care organizations would love to have the average turnover rates of hospitals whereas hospitals would all but cease to function if the situation were reversed.
In acute care, even the best hospitals with the best recruiters encounter time-to-fill challenges. The average time-to-fill for a bedside RN, for example, is 54 days. Top performing healthcare recruitment teams shave that down to 34 days, while others take up to 91 days and accept that they will have a long-term dependency on overtime and travel workers, along with a negative impact on their bottom-line from increased premium labor costs.
The time-to-fill challenge is not just about hiring, but also about “hiring to keep.” Organizations that hire efficiently but fail to retain their new hires don’t solve for the deeper issue of staff vacancy rates. It’s not enough to hire; organizations need to focus on hiring for fit and retention during the selection process. Failing to do so turns a “not hiring fast enough” problem into a “not keeping long enough” problem, while leaving the real challenge of staffing levels and staff vacancy rate unsolved. And of course over time, persistent low staffing levels lead to burnout and disengagement, which leads to more turnover, which then leads to hiring shortcuts and even more turnover, and so on.
Time-to-fill challenges in senior living and post-acute are often characterized by multiple underlying conditions, including a lack of data or knowledge of benchmarks, challenges around skillsets and organizational structures, work issues related to processes and workflows, and the absence of key technology.
Attracting quality talent has always been a challenge in senior living, but it’s becoming increasingly difficult to fill clinical roles in today’s labor market. In fact, 53% of senior care providers cite “insufficient numbers of quality applicants” as their single top problem. That’s a dramatic statement considering the number of challenges these organizations face. With rapidly growing demand due to aging baby boomers, it can only be expected to grow worse. Senior living facilities exacerbate the problem further by failing to pursue hire-to-keep strategies that focus on retention throughout the hiring process.
Another striking difference in senior living is the role that certified nursing assistant (CNA) turnover plays in both resident care and RN and LPN turnover. High turnover in the CNA role is a key predictor of increased turnover for RNs and LPNs, and the same holds true for tenure — longer retention among CNAs correlates to longer retention among RNs and LPNs. Given this relationship, a key area of focus when investing in hire-to-keep strategies, as well as employee engagement and retention efforts, should be the CNA function.
While CNAs are an obvious target for post-hire engagement strategies, organizations should invest in strategies that support retention across all roles. Fortunately, research shows one approach strategy that works for all role: investing in training and development. Organizations that invest in training and career progression see dramatically lower turnover rates and, as an added benefit, often have an easier time attracting new talent since training and career growth are top drivers of candidates’ perception of employer brand.
While retention is a strong argument for training and development investment, organizations will see other benefits as well. Strong training and development programs allow organizations to grow their new or more junior talent into more seasoned, experienced professionals who can move into hard-to-fill roles. Forward-looking organizations with strong training programs can also take a more holistic view of their employee base to make the best decisions on placement based on behavior fit rather than just job knowledge, secure in knowing that they can train for skills. This kind of “job fit” placement is also a proven way to reduce turnover, as it enables individuals to contribute more fully, resulting in more fulfilling work and higher levels of engagement.
The senior care workforce will need to double in the next 12 years to keep pace with rising demand, and yet many organizations are already struggling to hire and retain sufficient staff to deliver high quality care. This challenge will only grow worse in the coming years. Healthcare leaders need to adopt more strategic talent management approaches today and then build on them over time to mitigate the impacts of the coming talent shortages. This requires rethinking not only recruitment and hiring practices, but also talent management practices across the entire continuum of care.
David Wilkins is the Chief Strategy Officer at HealthcareSource.