There’s often a wide gap between what managers think today’s healthcare workers want and what’s truly in demand, differences that can lead to dissatisfaction and hinder recruitment efforts.

In a recent, as-yet unpublished survey of 715 healthcare workers, professional services firm Huron asked nurses, clinicians, other staff and leaders about what they value in their workplaces and their satisfaction with those factors. The variations indicate building leaders and others in middle management roles play an outsize role in keeping nurses satisfied.

Work-life balance, feeling valued, receiving formal recognition and job flexibility were among the areas where leaders and workers showed the biggest disconnect, said Huron Managing Director and healthcare expert Craig Deao. 

“If you look at those, consistent with what Gallup and others have found, probably 70% of what people want out of their workplace are things that are actually influenced by their local leadership,” Deao told McKnight’s Long-Term Care News.

“A lot of middle managers say, ‘If it were up to me, I’d pay them all a million dollars a year, but it’s not up to me: It’s up to the board, the CEO and HR and our budgets.’ But only about 30% of the stuff that really matters to folks requires capital investment, or senior executive or HR policy, things like benefits and pay,” Huron added. “Things like feeling valued and recognized and having good communication and an empathetic leader, those are definitely under the control of management.”

Echoing a presentation he made at AHCA’s Fall Conference for CEOs and senior executive leaders in November, Deao said it’s critical for skilled nursing operators to continue investing in leadership training for mid-level managers even amid staffing and financial challenges.

The national turnover rate for all nursing home employees was an eye-popping 48.5% in 2022, up significantly from 39% in 2021. That’s a jump of more than 25%. At least one other major study put turnover of certified nurse aides at over 100%.

It’s important local managers know how to build a supportive environment and provide the less-tangible, workplace factors that today’s workers essentially demand from their employers. Many middle managers were not trained for the jobs they’ve fallen into, and may need more ongoing training and resources than in years past. But given the right tools, those managers might make a significant difference in workplace satisfaction.

“Our belief is that the heart of culture and performance is all about the skills of middle management,” Deao said. “It’s where the frontline of the leadership teams meets the staff. It’s the key role. Usually, the strategic plans are good. Up at the top, they’re trying to emulate and do those right things. But there’s a huge signal loss as those things get executed out on the frontlines of management.”

Recruitment table stakes 

The survey examined worker and leader views on 24 different job factors considered in previous worker retention studies, including child care; financial incentives; competitive salary; diversity, equity and inclusion efforts; feeling valued; workload and role alignment.

Workers said they were most satisfied with health insurance, transportation and retirement benefits; they were least satisfied with workload, scheduling flexibility, competitive salary and formal recognition, according to a preview supplied by Huron.

Deao said the results reveal opportunities that providers can seize on, particularly around increasing feedback and recognition. He recommended multi-site providers use robust employee engagement surveys so they can begin to understand the influence of softer skills and management decisions on retention.

“If your leader is having formal, touch-base conversations with you on a monthly or so basis, then you’re far more likely to feel engaged than if it’s less than quarterly,” he noted.

Calling it “table stakes” to get potential workers interested in open positions, Deao added that providers must be willing to innovate and respond to worker desires. Turnover rate has been problematic for skilled nursing anyway; new pressures make it harder to refill empty slots.

Creating an experience for workers

“The demographic game just really isn’t in our favor for the workforce. If you believe that, then you start getting much more creative in thinking about how jobs should be designed,” Deao said. “This is the time when we really have to fundamentally experiment with work redesign, changing the job from how it’s always been done, because it wasn’t always good before COVID.”

One of Deao’s health system clients was down 400 nurses and asked its other employees how they could pick up tasks to lessen burden. Housekeeping volunteered to clean rolling medication carts and linens, and transporters turned on location tracking tools that could make moving patients to in-building scheduled activities more efficient. Another client offered four-day on-site schedules for nurses; on the fifth day they now work from home and complete medication reconciliation or quality improvement work.

Surprisingly, endlessly increasing compensation doesn’t necessarily get workers to stay in a job, Deao has observed.

“We’re seeing this with the boomerangs that may have chased a higher bonus or a wage, and then realize that they’re miserable … and are coming back [because] the day-to-day experience is better,” he said.

That’s a way you can really differentiate. Create an experience where people want to spend their days, where they’re making meaningful progress on things they care about, that they’re doing the things they were trained to do, that they’re not just putting out fires all day long doing stuff that’s below their competency.”