With more than an estimated 200,000 jobs to fill (and more to come), nursing home and ALC staff have every opportunity at their disposal to find a new position.
Almost every operator you speak with will tell you recruitment and retention is one of their biggest challenges in today’s labor market, if not the biggest. That's why Skilled Nursing and Senior Housing operators must implement strategies to ensure the right staff is in place to deliver quality patient care.
Covid-19 highlighted the importance of nurses more than ever before. As cases, hospitalizations, and deaths spiked in every city, nursing staff felt the impact. And, as the pandemic wore on through variants and vaccines, nursing staff stress levels continued to rise and burnout became all too frequent, pushing the country’s nursing staff shortage to critical levels.
This trend, however, didn't begin with Covid-19. In 2017, the Health Resources and Services Administration (HRSA) forecasted that America would face a need for 1 million new nurses over the next decade. Among the most significant contributors to the shortage is the aging population of nursing's largest demographic—baby boomers. As they retire and their healthcare needs increase, facilities around the country must get creative to fill their roles.
We don't need comprehensive studies to prove that when health care facilities are adequately staffed, patient care and safety increase. But these nursing staff shortages aren't just limited to RNs. The Bureau of Labor Statistics projects tens of thousands of job openings among LPNs and CNAs.
With the need for skilled nurses at an all-time high, what strategies can long-term care facilities implement to retain current staff, improve work/life balance, and hire new staff to fill needs?
Impact of Nurse Staffing Shortage on the Healthcare Industry
Long-term care facilities were already dealing with several factors leading to shortages in nurse staffing well before the Covid-19 crisis. Cost-cutting, complexity of patient care, and aging populations among patients and staff alike provided plenty of concerns for long-term care facilities navigating staff retention struggles. Covid compounded the pressure an already-stressed healthcare system.
Long-term care facilities were already dealing with several factors leading to shortages in nurse staffing well before the Covid-19 crisis. Cost-cutting, complexity of patient care, and aging populations among patients and staff alike provided plenty of concerns for long-term care facilities navigating staff retention struggles. Covid compounded the pressure an already-stressed healthcare system.
According to an AHCA/NCAL study, 86% of nursing homes and 77% of assisted living communities (ALCs) said their staffing situation worsened between June and August of 2020. Furthermore, almost every nursing home in America (99%), coupled with 96% of ALCs, faced staff shortages at one point. Those shortages only increased worries further.
To combat shortages, nursing homes and ALCs asked remaining staff to work overtime and pick up extra shifts. Those extended hours led to more burnout, which in turn led to more turnover and prolonged shortages. Many facilities turned to nurse staffing agencies to fill the void, but high agency prices hiked operational costs. On account of the mounting crisis, 58% of nursing homes had to limit new admissions. These factors perpetuated fears of shutdowns felt by one-third of nursing homes in America.
Staffing shortages were felt most severely among nursing homes and ALCs. According to AHCA/NCAL data for the end of 2021, nursing home and ALC employment are significantly below pre-pandemic levels. Compared to two years ago, nursing homes are down 220,000 jobs, while ALCs are down 38,000. For reference, home-health staffing has almost (if not entirely) recovered to pre-pandemic levels.
While nurse staffing shortages continue to rise, those remaining on the job saw wage increases between 2020 and 2021. Hourly pay for CNAs rose 7.13%, while non-certified aides gained almost 8% and certified medication techs earned 6.75% more. Directors of Nursing (DON) saw increased average salaries of $105,104 (a 3.09% increase); meanwhile, average assistant DON salaries increased to $80,364 (a 3.36% increase).
Ultimately, nurse staffing shortages are felt the most by the patients who need them. With employment numbers still in decline for nursing homes, ALCs, and similar organizations, facility operators must implement new strategies for staff retention this year.
Steps to Manage Nurse Staffing Issues in 2022
The past few years have exploded the nurse staffing shortage into the public consciousness. As short-staffed facilities have cared for sick and critically ill patients around the clock through the darkest days of the Covid-19 pandemic; burnout, stress, and fatigue led to an ever-increasing turnover. This in turn has increased the burden on those who remain—who frequently find themselves working longer hours in more difficult conditions, caring for an increased number of patients.
With so much uncertainty heading into 2022, how can nursing homes, ALCs, and other skilled nursing facilities better strategize their approach to staffing?
Adopt Flexibility in Nurse Staffing
A recent Skilled Nursing News survey found staggering statistics about nurse staffing forecasts. Among Covid-related challenges, 59% of respondents said maintaining staffing levels would be among their greatest challenges. More critically, 82% said staffing concerns would continue past Covid. To combat those concerns, skilled nursing facilities should turn to a more flexible scheduling model in 2022.
The pandemic taught many American businesses the value of hybrid work, remote teams, and flexible scheduling. Of course, remote work is not as feasible an option in bed-side nursing providing patient care. But nursing homes and ALCs can consider building more agile, flexible schedules to increase retention and attract new staff.
Flexible scheduling lets nurses choose their own hours and shifts, empowering them to maintain their own work/life balance. With modern scheduling software, employees can view which shifts are open and swap shifts with co-workers in-app. Flexible scheduling also relieves some managerial burden, as employees take it upon themselves to fill the required hours.
With the healthcare industry is clamoring for a million new nurses over the next decade, flexible scheduling also serves as a great incentive to attract skilled healthcare workers to your facility. When weighing an opportunity with set hours against one with flexible scheduling, it seems likely that job candidates will prefer the flexible employer in most circumstances.
Similarly, this is a great incentive to retain the nurses you already have and save thousands on turnover costs. According to an NSI Nursing Solutions survey, the turnover cost of a bedside RN averages $40,000 (ranging between $28,000 and $51,000). If more flexible scheduling keep staff from moving to a different facility, it’s well worth the financial investment in the technology to facilitate it!
Due to the nature of the work, total flexibility is never going to be possible. Patients need around-the-clock care. And depending on the facility—and if it is union-operated, for example—rules and contracts may further hinder your ability. But the point is, the more freedom you can allow your nursing staff to choose their own hours (as long as you retain full coverage at the end of the day), the more likely they are to achieve that elusive work-life balance and choose to stay.
Cross-training and reassigning tasks that are not related to direct patient care can also combat nurse staffing shortages while maximizing productivity and profitability. Your facility has staff that can tackle non-direct care tasks, thus easing your nurses' workload. Consider tasks like room dressing, bed making, equipment cleaning, patient transportation, and replenishing personal protective equipment (PPE) and linens, among others. Asking your non-direct care staff for ideas on tasks that could be reassigned can also help those team members understand the need to think differently and make adjustments in their day-to-day activities. With proper training, non-direct care staff can handle tasks indirectly related to overall patient care, freeing up time for an already strained nursing staff to focus on patients.
Create Career Development Programs for Nurses
With shortages expected to continue into the foreseeable future, developing your current staff is crucial to success in 2022 and onward. Nursing homes and ALCs that build pathways to leadership and career advancement are poised to have a happier and healthier staff in the coming years. Furthermore, as most retirees are baby boomers, career advancement is crucial for up-and-coming millennial and Gen Z nurses. Here are a few strategies to create career development programs to meet your nurse staffing needs.
Continued Education
One of the most effective ways to promote career development among staff is to offer learning opportunities and continuing education credits. For example, consider the Nursing Clinical Ladder Program, a career advancement initiative designed to attract and recruit Registered Nurses. The program provided 2,000 New York City nurses opportunities for career advancement while staying in a clinical setting.
Continued education materials, resources, and nursing career development opportunities are fantastic ways to increase staff engagement. You can offer tuition reimbursement, mentorship programs, and leadership training, while also providing free access to medical journals and other informative literature.
Focus on Mental Health
For all the harm the pandemic has caused, the toll taken on mental health cannot be overstated. While we’d all like to think that those in the medical field are cognizant of the bandwidth of their mental health, the reality is that the pressures of the job often force nurses to put their own wellbeing on the back burner.
Take steps to raise awareness about the importance of mental health and wellbeing among your staff. Additionally, keeping open lines of communication between nurses and managers ensures that issues and concerns can be addressed instead of fester. Consider positive ways of showing staff appreciation such as gift certificates for dinner or a spa treatment, upgrading their break room, or implementing a monetary rewards program. While compensation and flexibility are two of the main drivers of nursing staff churn, showing understanding and respect for your staff’s emotional wellbeing can also help.
Conduct Interviews
When your DON or another staff leader regularly sits down with their nurses, they can identify individual needs and facilitate strategies to meet goals. These interviews are a great way to build trust between nurses and leaders and open up career-centered conversations. Through these interviews, you may learn that the development plans you currently have in place for staff don’t address their individual goals or needs. With this knowledge in hand, you can tweak those development strategies to meet the actual needs of your team.
Improve Your Overall Retention Strategies
Data from the RN Work Project has found that among newly-licensed RNs, 17% will change jobs within the first year. Furthermore, 33% will change jobs after the second year. Ultimately, after eight years, 60% of new nurses will have changed jobs at least once. As filling open roles becomes increasingly difficult, improving retention should be one of your top priorities. In order to combat high turnover rates, you must first understand why nurses choose to leave their current jobs. While there are many nuanced contributors, two factors continuously pop up: stress and burnout.
Long hours, inconsistent scheduling, and demanding patients will inevitably take a toll on anybody. While burnout is preventable, it is all too common in nursing.
Some employers fail to spot the obvious signs of burnout, simply factoring turnover costs into the yearly budget. What they fail to see is how this strategy reinforces a high-turnover cycle. Turnover leads to more nurses working longer hours to pick up the slack. Longer hours lead to burnout, burnout leads to turnover, and so on, until your facility operates with a costly rotating door of nurses.
While it's impossible to eliminate all the stress that comes with the job, there are some steps you can take to combat burnout and prevent turnover.
A top-down approach may be necessary to dig up the core problem. Pre-pandemic research (2019) found that 57% of employees quit because of their bosses. Ensure your nursing leaders promote the right kind of culture and support for their nursing staff. Exit interviews are one way to uncover an underlying issue with management, as are anonymous nurse surveys. Should you find that one of your leaders contributes to high turnover rates, remember that they are also under stress. Before you take irreversible action, determine if this is a temporary issue or one that can be resolved by reducing that leader's stress levels.
A strong nursing leader displays empathy towards those under their guidance. They're approachable and have the strong communication skills needed to connect with your staff. When hiring new nursing leaders or promoting from within, look for these characteristics.
When turnover rates are higher than usual, the easy thing to do is schedule your remaining staff for more hours; however, as mentioned, this eventually leads to burnout and yet more turnover. Instead, take advantage of temporary, traveling, and contract nurses to alleviate the stress and fill in the gaps. This buys you valuable time while you search for a full-time replacement nurse.
Set Your Skilled Nursing Facility up for Success Today
With more than 200,000 jobs to fill (and more to come), nursing home and ALC staff have every opportunity at their disposal to find a new position. Don't think they won't jump on a better offer should one come up. That's why healthcare center business owners must implement recruitment and retention strategies to ensure quality patient care. Furthermore, the more staff you have on hand, the more patients you can accommodate. The last thing anybody wants to do is turn away someone in need of care because of nurse staffing shortages.
Of course, implementing such strategies comes with some upfront cost. That's why a reliable financial partner with healthcare industry insight, like Bank of Blue Valley, a division of HTLF Bank, is crucial to helping your business with the investments required to implement new nurse staffing strategies and the potential impact to your bottom line.