Wei Deng

The long-term care industry faces a talent crisis. As McKnight’s recently reported, new surveys from the National Center for Assisted Living (NCAL) and American Health Care Association (AHCA) paint a bleak picture. 

Of the 4,000 assisted living facilities surveyed, 63% are experiencing talent shortages. Almost all of them (98%) have asked staff to work overtime or take extra shifts due to such shortages. And 87% say they have struggled to hire staff, with two-thirds citing “a lack of interested and qualified candidates” as the biggest obstacle. 

Meanwhile, 87% of nursing homes say they face “moderate to high staffing shortages.” Although over 90% of them have increased wages or offered bonuses to attract and retain staff, those measures are not working.

While the NCAL and AHCA petition the federal government for support, what can facility administrators and scheduling coordinators do now? The first step is to rethink scheduling norms in long-term care.

Amidst a shortage, nurses and nursing assistants tend to have more say in how, when and where they work. Indeed, many have turned to travel nursing agencies and talent marketplaces to optimize not just their income but also their freedom and well-being. 

Facilities may underestimate how much damage a rigid schedule can do when attempting to hire healthcare professionals to fill shifts. My team recently interviewed nurses about this issue. 

They flagged several scheduling practices as problematic:

  1. Switching caregivers between daytime and NOC shifts frequently and unpredictably. The stress, sleep disturbance and inability to plan for personal and family responsibilities make switching between days and nights unsustainable for most nurses. While many nurses can manage night shifts for three weeks at a time, few can handle the instability of switching every three days. Nurses who raise this issue but feel unheard are likely to seek work elsewhere.
  1. Eight-hour rather than longer shifts. Most nurses are willing and able to work a 10-hour to 12-hour shift, but they can’t do two eight-hour shifts in a day. Thus, when facilities only offer eight-hour shifts, nurses potentially sacrifice hours of wages per day, or they struggle to find and afford caretakers for their children for an extra day every week. Plus, longer shifts may enable them to avoid rush hour on the roads and commute less frequently.
  1. Demanding “on-call” hours tacked onto already long shifts. Many nurses feel overworked, no matter how many hours in their shift. This leaves them physically and mentally drained. Adding to that load with on-call hours increases the risk of short-term mistakes and long-term burnout — both of which impact patient care. Nurses who don’t feel like they have time to rest and recover will seek out employers who protect everyone from the mistakes that result from fatigue.

The theme here is letting healthcare professionals choose when they want to work. They will not all pick the same schedule. Some nurses have childcare responsibilities and therefore prefer to work overnight when their partner or a family member can watch the children. Some work a second job or attend school. Others want to schedule their shifts to be alongside colleagues who make the job more rewarding and supportive.   

Just offering scheduling flexibility sends a message that nurses rarely hear: “Your needs matter to our facility. We value the skills you offer and the lives you lead outside work hours. We want employment here, whether full time, part time or contingent, to align with your personal goals.”

To be clear, even if every facility adopted this mentality, structural challenges would remain. Nurses are retiring, nursing schools cannot meet the demand for talent, and the cost structure of healthcare has undermined financial models that once worked in long-term care.

Nevertheless, I believe the healthcare facilities whom we serve with our marketplace need to send a powerful message to nurses who have lived through post-COVID healthcare and would-be nurses who have heard the stories. 

Nurses need to believe their workplace experience will improve. Otherwise, many will continue to leave the industry for lower-skilled work that pays better or at least offers much-needed flexibility. To address this talent crisis, let’s solve scheduling first and build from there. 

Wei Deng is the founder and CEO of Clipboard Health. Clipboard Health matches healthcare facilities with nurses nearby, and operates in dozens of U.S. cities. It is backed by Sequoia Capital and Y Combinator. 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.