The high rate of staff turnover in nursing homes is not a recent phenomenon, according to the National Institutes of Health (NIH). As far back as the mid 1970s, studies have documented average turnover rates for registered nurses, licensed vocational nurses and others ranging between 55 percent and 75 percent, according to studies cited on the NIH website. According to one 2016 research paper, this continues to be the trend, with some facilities currently experiencing between 55 percent and 100 percent in vacancy and turnover rates annually.
Turnover is not only costly, but also can negatively impact the quality of care provided to long-term care residents. In addition to the direct replacement costs associated with turnover, facilities incur indirect costs for increased overtime and new-hire training. Turnover increases the workload and stress levels of existing staff, and can negatively impact residents who bond with employees and often mourn their separation.
Seeking ways to mitigate this troubling phenomenon, some facilities and management companies have been encouraged to implement employee satisfaction surveys. The goal is to identify employee issues and concerns early on so they can be addressed, hopefully reducing turnover. Unfortunately, such surveys also can raise numerous red flags with employment law defense attorneys.
The values of employee satisfaction surveys
Many employers are initially drawn to employee satisfaction surveys to allow employees to feel heard, to identify areas that need improvement and to improve communication. This is particularly important when interacting with a workforce that has a strong complement of Millennials, a generation that values having their voice heard. Millennials are also comfortable with technology in the workplace, which means the use of digital surveys and alternate means of obtaining employee feedback are on the rise.
A 2016 report by international consulting firm AON notes that providing opportunities and feedback that enables talent to grow and develop is a key part of engaging employees. Experts have pointed out that employee engagement can boost morale, which ultimately leads to motivation, loyalty and retention, as well as improved attendance, performance and productivity.
Survey results can also help management by providing a snapshot of employee attitudes at a specific moment, enabling employers to measure, in an objective manner, how well their efforts at improving employee morale and other issues are working. A formal survey may not be the only method of establishing a benchmark of this type, but the information collected can provide a useful guidepost through which data like turnover, the volume of grievances and the types of complaints filed by employees may be considered and used to highlight areas needing improvement.
The risks of survey design and process
While surveys can be the centerpiece of a program aimed at improving employee retention and facility performance, surveys that are not managed correctly also can lead to expensive investigations and lawsuits. For example, the questions posed on a survey may sometimes give rise to claims on the part of employees; and the employer’s response to the information gathered, or lack thereof, can be just as fraught with legal consequences.
The pitfalls of such studies were demonstrated dramatically when a longtime Modesto, California municipal division manager, Jocelyn Reed, pointed to an allegedly flawed employee survey when asserting that City Hall was biased against female workers.
The city had claimed its survey results indicated that Reed was playing favorites among employees. But Reed said that the questionnaire—which revealed “dissatisfaction with management bosses”—did not clearly indicate if the unease was aimed at Reed or if it actually pointed to other managers and supervisors in her division. Either way, in November 2016, the city agreed to pay about $236,000 to settle the allegations made by Reed, according to news reports.
What can a facility do to minimize its legal exposure when conducting surveys? To begin with, every step of the feedback process should be considered before engaging with employees. Although the guiding principle behind a survey is the ability to gain insight into certain aspects of the employment environment, significant thought must be given to the specific individuals actually providing the feedback. Will it be the entire workforce, a particular department or just management? Who will review the feedback? Also, how do you, the employer, plan to use the information? Will you investigate the reasons for low performance in a particular department, region or the entire workforce; or are you simply wishing to gain a general understanding of employee goals?
The answers to these questions will drive the design and rollout of a survey. If you seek to understand why a particular department’s performance has fallen off during a certain period, the department head probably isn’t the most appropriate person to review the survey answers.
What if an employee says performance has decreased because the department leader favors “a certain type of female” employee? This is a concern because in some states, such as California, a response like this may be considered as grounds for putting the department head on notice of a potential claim for discrimination or sexual harassment, which may give rise to an employer’s duty to investigate. An employer who ignores the response runs the real risk of being in an unfavorable position if a discrimination or harassment claim is ever filed.