The front-line staffers have often been the most difficult employee sector for nursing home administrators to engage. Low payrates, tough schedules and the emotional stress of the caring environment haven’t helped. Statistics show less education is related to both care deficiencies and turnover— about 51 percent of CNAs will leave their jobs within one year.
But eyes are opening to new management models—especially those that promote staff education and personal growth, explained Jay Sackman, president of Georgetown, Conn.-based Jay M. Sackman Consulting, in a session at this week’s LeadingAge annual meeting in Denver.
Nursing facilities have historically tended to ignore the staff sectors that would benefit from corporate nurturing the most, said Sackman, whose lengthy dossier includes service as a nursing home union organizer and as an attorney. Staffers also tend to reflect the environment created by those who supervise them, he said, citing the research of the late Susan Eaton, author of “Beyond Unloving Care.”
Eaton’s years of research had led her to several observations about different work environments and their effects:
Highest turnover: Staff in “custodial” homes had no feedback, little training, no one to help with workloads, high frustration levels.
Middle of the road: Staff in “medical” homes worked more often as a team, had better quality of life, performed better documentation, received better pay than in custodial homes.
Highest retention: Staff in “regenerative/culture change” homes were exposed to more choices, more staff collaboration and staff cross-training and had corporate cultures that promoted staff growth.
Barbara Bowers, associate dean for research at the University of Wisconsin at Madison who also spoke at the session, noted that management styles have shifted as significantly as resident care models have in the past three decades. While administrators once scrutinized staffers to judge which employees might be a ‘quitting risk,’ today’s facilities are realizing that corporate investment in employees’ education is one of the best ways to retain them.
Within the challenging environments of LTC, proper staff orientation is one of the most crucial keys to nurse retention, yet is a step that facilities often undervalue. “You can’t take newly graduated nurses and just throw them in the deep end,” Bowers said. “You’ll drive away bright people who are dedicated to long-term care, and that’s a tragedy.”
The No. 1 job complaint among CNAs is a lack of respect in the workplace, not the low pay rates. “The caring draws them there, but the lack of respect is what drives them away,” Bowers said. For CNAs who stay at their jobs, being shown respect is also the No. 1 reason why they stay, she added.
Nursing supervisors often mistake discipline for leadership, and—interestingly—they often don’t realize how negatively CNAs view their leadership and management, leading to dangerous gaps in communication, research shows.
Staffers appreciate it when supervisors praise them or recognize them with awards, but what they really want is to be asked for their input—and to be heard. Facility administrators have a responsibility to train nursing supervisors in how to listen as well as how to give direction and delegate, both speakers agreed.
“The quality of the staff’s direct supervision is crucial. Upper management needs to identify people’s skills and invest the time & money in training the staff,” Bowers explained. “Turnover is expensive. The money saved on turnover is far more than the money invested here.”
Leadership tip: Try engagement surveys instead of staff satisfaction surveys. Many front-line staffers define “satisfaction” and “engagement” differently. Where engagement generates feelings of empowerment, support and cohesion, satisfaction is often the comparison between expectation and reality, Bowers noted.