Unmet Needs Lead To Staff Turnover

Nell Griffin

Nell Griffin, EdM, CHC, CPHQ is a Healthcare Quality Improvement Facilitator

A two-year study of three nursing homes in Sweden offers valuable data for all nursing home leaders. The study, Unmet Expectations: Why Nursing Home Staff Leave Care Work, was published in the International Journal of Older People Nursing, an online peer-reviewed quarterly journal in 2008. The results of this study are particularly relevant to our industry today as the long-term care industry struggles with staff turnover and related negative effects to cost and quality of care.

In the study, the unmet needs identified by caregivers resulted in experiences that lacked encouragement and trust and professional development. Because their work experiences lacked these essential elements, the staff had feelings of insecurity, differing opinions about the care delivered, being disregarded and feeling betrayed. This resulted in employees’ decisions to leave and pursue other opportunities.

Training Boosts Retention and Trust

Setting aside the fact that the topics in 483.95 Training requirements are required (see the IASC article, QAPI Can Engage Staff and Improve Your Facility), providing these trainings can be included in the strategy to address staff unmet needs identified in the Sweden study. A purposeful training curriculum can support leadership efforts to encourage staff, promote professional socialization and increase mutual trust.

Nursing home leaders are aware of the regulations and the roles of the Centers for Medicare and Medicaid Services (CMS) and the surveying agency for their state.

When a nursing home becomes certified to participate in the Medicare and Medicaid program, that nursing home agrees to meet certain requirements. CMS’s responsibility to beneficiaries is to use Medicare and Medicaid dollars to pay only for services that meet these requirements. It’s the role of the surveying agency to confirm the regulations are being met in the facilities that are receiving payments through the Medicare and Medicaid program.

The reformed regulations require nursing homes to assess and update all of their care policies, practices and resources while at the same time providing for residents’ daily needs safely and effectively.

QAPI Programs and Resources

Quality Assurance and Performance Improvement (QAPI) is a structured process that is included in the required list of mandatory trainings. Although using them is not mandatory, CMS has provided free tools and resources to help with the implementation and sustainment of quality improvement practices. The Process Tool Framework tool aligns the tools and resources with each of the 5 QAPI elements.

Completing the trainings and implementing the reformed requirements requires nursing home leadership to plan and provide resources that include time for staff training and participation in improvement activities.

Two websites have free, ready-to-use programs and resources, The Centers for Medicare and Medicaid Services (CMS) and Agency for Healthcare Research and Quality (AHRQ). Nursing homes can assign team members to review these websites, select the tools and programs to be used, create a training program, and complete peer-to-peer training.

Long term care professional organizations are a resource for trainings, tools, and guidelines. After joining, nursing homes have access to trainings available only to members.

State QIOs Can Be a Valuable Resource

The Quality Improvement Organization (QIO) in each state is another training resource that is free for CMS certified healthcare providers. Nursing homes can contact the QIO in their state for assistance with quality improvement activities and to determine the available trainings.

The QIO Programs website or the CMS QIO webpage can help with locating the QIO program for each state. QIOs can help nursing homes locate the professional organizations in their state. CMS, AHRQ, professional organizations, and QIOs are resources that can help nursing homes implement and sustain the Medicare and Medicaid Programs; Reform of Requirements for Long- Term Care Facilities, all of which are effective on November 28, 2019.

Because the reformed requirements require staff inclusion, once implemented they can decrease staff unmet needs and help increase retention.


Topics: Administration , Executive Leadership , Regulatory Compliance/CMS , Staffing , Training