As an ombudsman volunteer for the past six plus years, I have witnessed the effects of short staffing and have also heard many of the complaints attributed to it. You probably don't really care what an ombudsman volunteer has to say, but hear me out.
I recently completed my doctoral dissertation and was awarded my PhD (2007)in the applied technology and performance improvement field. The objective of the performance improvement field is to improve the productivity and performance in the workplace through management initiatives/change, technology innovations, outsourcing, or globalization. My study focused on the perceptions of nursing assistants (NAs) working in state-owned veterans long-term care (LTC) facilities regarding factors that could induce them to quit: Basically a staff retention study. The goal of the research was to see what (if anything) could be done to improve the retention rates of these particular NAs.
I selected this topic because of my frustration with the constant loss of NAs in the facility where I was assigned as an ombudsman volunteer. The residents of LTC facilities deserve great care and the NA is the frontline worker. If there is constant turnover, it is hard for the residents to establish a routine and receive the care they want and, at times, the care they need. Harrington and Swan1 noted that high turnover rates lowered staffing levels and that nursing facilities needed to place emphasis on staff retention. Furthermore, by focusing their efforts on retention and staff by addressing factors related to turnover and wages, stability of their workforce may result. Cohen-Mansfield emphasized that “before any attempt is made to reduce high turnover, administration must be aware of areas of concern to nursing staff.”2
I was given permission to study all the state-owned veterans LTC facilities located in a Midwest state. I traveled that state and administered my survey to more than 400 NAs. The results were mixed; some were the same old issues-more pay, better working conditions-but others were interesting and indicated that a small correction in administrative policy might help to reduce turnover. A good example is the policy that allows only monthly pay periods. My study indicated that more than half of the NAs I surveyed were not satisfied (by varying degrees) with the current monthly pay period. With today's technology, people should be able to be paid whenever they want. The greater issue with this policy happened when an employee was hired after the 12
th of the month because they would not see any pay until six weeks later. Clearly, this was one policy that needed to be fixed.
So, what is an employer to do to keep their employees? Do you use exit interviews to try and find out why your employees are leaving? Have you considered that exit interviews might not be a good method, especially if the employees are not leaving voluntarily? Some employees may have an axe to grind. On the other hand, exit interviews that try to determine why good employees are leaving should provide useful information. Instead of trying to determine why employees are leaving, a better approach might be to use a satisfaction survey to find out why your current employees are staying. After analyzing the results, you might be able to tailor a benefit package to keep more of these employees on board.
A great many issues must be considered before you survey staff, such as the frequency of previous staff surveys you may have administered, the number of answer choices for each survey question, and the length of the survey. But probably two of the more important issues to consider are (1) who will be asked to complete the survey and (2) who will administer it. Simply selecting the day shift and asking them to answer the questions results in answers applicable to the day shift only. If you preselect the NAs who will answer the questions, the answers will be applicable to only those individuals. In the research world, this is called a “convenience sample,” which is not optimal.
Who administers the survey is extremely important. If a facility employee administers the survey, how are you ensuring the NAs of confidentiality? Can their answers be traced back to them? Probably a more important issue is whether the aides feel that their answers cannot be traced back to them. During my data collection, the aides only knew that I was conducting a study that could benefit them. I did not work for the organization and they were assured that all their responses would be kept confidential. I even had a form explaining the process. I think they were relieved that I was the only person who would see the actual surveys and that no marks were made that could identify them. I note this because in some of the facilities I traveled to, the staff was surveyed often and yet there were still high turnover rates. I must mention that in these cases the surveys were administered by in-house staff. My question then becomes: Are you frequently surveying the aides and receiving answers that you are a great facility, but the turnover is still out of control? If so, have you considered that maybe the staff is answering questions the way they feel you want them to?