Preventing Nursing Staff Turnover:

3 Principles You Can Use Right Now to Increase

Retention in Your Facility

Joni Mauritz

Objectives

• Discuss nursing homes and nursing staff roles

• Discuss nursing staff turnover

• Discuss retention strategy

Introduction• The Department of Health and Human Services (DHHS)

estimates that people over the age of 65 will have a 40 percent change of entering a nursing home (Long-term Care 2007)

• The American Health Care Association reports that in 2005 there were 15,989 nursing homes in the United States that employed over 1 million people. In West Virginia there were 132 nursing homes that employed 11,843 individuals (American Health Care Association, 2006).

Nursing Staff

We could walk into any nursing home today and ask the administrator, “What is the most important staff role in your facility?”

Any reputable administrator would respond that their nursing staff is integral to running the nursing home.

Common Nursing Roles in Long-term Care

• Certified Nursing Assistants (CNAs)—spend every shift dressing, bathing, feeding, toileting, lifting, moving, taking vital signs, and providing post mortem care for patients (Nursing Assistant Central 2007)

• The US Department of Labor Bureau for Labor Statistics reports that the mean hourly wage for a CNA in West Virginia is $8.99 per hour which comes out to $18, 690 per year

Common Nursing Roles in Long-term Care

• Registered Nurses (RNs)—perform the majority of patient assessments, monitoring, complicated procedures such as feeding tube maintenance, wound care, and intravenous catheter placement, participate in care planning, supervise CNAs, serve as directors, educate families while being the patient and family liaison

Common Nursing Roles in Long-term Care

• RNs are always in demand in long term care especially as supervisors.

• The current mean salary in West Virginia for a registered nurse is $23.78 per hour (US Department of Labor 2006).

Nursing Staff Turnover

Why care?

1. West Virginia dictates how much staffing is needed in a facility per patient.

• The WV code for nursing home licensing states that, “Staffing shall not, other than during short unforeseeable emergencies, be less than an average of two and twenty five one hundredths (2.25) hours of nursing personnel time per resident per day.”

Nursing Staff Turnover

Why Care?

2. Turnover compromises patient care.

• When a member of your nursing staff resigns there is a break in the care due to a new staff member coming in who is not familiar with the patient.

Nursing Staff Turnover

Why Care?

3. Turnover is expensive.

• Turnover requires additional spending in human resources to recruit, hire, and train new staff members.

What Causes Turnover?

• Lack of job satisfaction

– A 2005 study used looked at 25 indicators of job satisfaction and found that work pressure, organizational quality environment, and perception of “being in a facility that cares” were all strongly associated with commitment.

– CNAs were the least satisfied staff members

(Karsh, Booske, & Saifort 2005)

What Else Causes Turnover?• Management turnover influences nursing staff

turnover.

– Castle (2005) reported that, “A 10 percent increase in top management turnover is associated with a 21% increase in the odds that a facility will have a high turnover rate of nurse aides.”

– “A 10 percent increase in top management turnover is associated wit a 30% increase in the odds that a facility will have a high turnover rate for registered and licensed practical nurses.”

Let’s Be Real!

• How can we expect our best nursing staff members to stay with our facility if our actions stemming for our attitudes do not promote a work environment where our employees can receive not only extrinsic but intrinsic benefits?

Lets Be Real!

What changes could we make right now, not within our buildings, but within ourselves to invoke a sense of well being and calm in our facilities?

Innate Health• An inside-out concept

• Realize that difficult situations happen to EVERYONE in our buildings—not just management

• Every individual working in our buildings has the inner wisdom, to choose to their way of thinking, and to think with a clear calm mind, and ultimately make the best decisions.

Innate Health

• Everyone has the natural capacity to handle the mental challenges that come our way.

• We utilize resiliency like our residents immune systems use antibiotics to fight off UTIs—just in a mental way…

3 Principles

• Mind—the energy that creates our lives as we know it

• Thought—the continuation and expression of the minds energy

• Consciousness—the expression and perception of our thoughts

(Pransky 2003)

How Does This Relate to Turnover?

• If you the administrator is in a calm state of mind, you are going to think positively, and in turn your resiliency will shine though and your nursing staff will see this.

• You will come to appreciate what they contribute to your organization and treat them that way.

Why These Principles Work

• Your employees will experience less pressure.

• Because they see that you care, they will feel that they are an integral part an organization that cares.

• Your nursing staff will experience a greater sense of job satisfaction which we all know know is key!

Thank you!

References

American Health Care Association. 2006. The State Long-Term Health Care Sector 2005: Characteristics, Utilization, and Government Funding.

Castle N. 2005. Turnover begets turnover. The Gerontologist, 45(2), 186-195.

Decker F., Dollard J., & Kratidor K. 2001. Staffing of nursing services in nursing homes: present issues and prospects in the future. Seniors Housing and Care Journal, 9(1), 1-24.

Karsh B., Booske C., & Saifort F. 2005. Job and organizational determinants of nursing home employee commitment, job satisfaction and intent to turnover. Ergonomics, 48(10), 1260-1281.

Medicare. 2007. Long-term care. Retreived 7/4/2007 from

http://www.medicare.gov/LongTermCare/Static/Home.asp.

National Bureau for Labor Statistics 2006. Occupational Employement Statistics. Retreived 7/4 2007 from http://www.bls.gov/soc/home.htm.

Nursing Assistant Central. 2007. What is a CNA? Retreived 7/4/2007 from http://nursingassistantcentral.homestead.com/index.html.

Pransky, J. (2003). Prevention from the Inside-Out. Cabot, Vermont: 1st Books.

West Virginia. Title 64, Legeslative Rules, Series 13. Nursing Home Licensure