What is the biggest challenge for nursing home recruitment today?
It’s hard to answer this question in one sentence. There are definitely a lot of combined factors that have recently come together to create the perfect storm, so to speak. I would say general burnout and job dissatisfaction, specifically in the long-term care industry, is a leading cause, along with residual unemployment challenges and competition from local agencies. Interestingly, all 3 of those reasons overlap and get to the core of the issue, which is a discussion that probably can’t be covered properly here.
How did we get here? How can we make sure we don’t end up back here?
We all like to blame COVID-19 and subsequent unemployment benefits on the fact that we are here, however if we’re honest with ourselves, we can recognize that most of the challenges the industry has faced have been right here all along and COVID-19 only exacerbated the signs. To truly ensure that we don’t end up back here I believe will require massive reform at a societal, legislative, and economic level however we can still do our best to address these challenges in a more limited capacity using the tools that we do have locally.
To get there, I believe employers must take an honest look at the reasons why clinical care providers are leaving the industry or choosing to work elsewhere and do their utmost to minimize those factors within their own organizations. There is often a certain level of complacency on the part of operators to accept the lack of quality care providers and turn to agencies or other short-term solutions without getting to the core of the issue which is a shame, because there is a lot that can be done within each organization. Additionally, if operators would truly band together to support each other in addressing the root of the issue, I believe there is a power here that has the potential to generate real, everlasting change.
Where do you see the industry evolving to address these issues?
The industry has already evolved to address some of these issues, however most of the solutions have been “band-aid” solutions that I’m concerned will not have lasting changes. Already we are seeing that many of the waivers put in place during COVID-19 have been removed, yet the staffing challenges they were designed to address are still here. As I mentioned, I believe changes must be made on a national, legislative and societal level and they must happen simultaneously. Interestingly, throughout the 20th century, there have been multiple periods in time when nursing shortages were rampant and various solutions were implemented to address some of those challenges.
However, most of those changes were implemented at a single-system level. For example, at one point during WWII, the US Government stepped in to create incentives to draw nurses into the workforce. Several decades later, the Department of Labor stepped in to help address job dissatisfaction in the industry. At no one point, however, did all the various agencies ever come together to address real lasting changes and, while I believe that even a single-system solution is better than nothing, the end goal needs to be that we create nation-wide awareness to address this issue at a multi-system level.
Can you give us 2-3 strategies nursing homes can implement today to manage the crisis?
Some of these strategies may seem oversimplified but I cannot stress enough the importance of company culture. Everyone talks about rates, and that is certainly high up there, however we need to have an honest look at the reasons why a qualified nurse in 2022 is choosing to work for the agency or facility down the block, and I don’t believe that it’s just about the rates. Survey results often indicate that positive company culture is more important than rates.
What is being done to provide true, compassionate support to our nurses and CNAs? How are we empowering our care providers, noticing their struggles, and validating their fears? Nursing care hours are long and draining. While so many other industries have the luxury of introducing some level of hybrid work model, there is no substitute in our industry for direct patient care.
Employers can also use out-of-the-box solutions to address both culture and staffing shortages simultaneously by improving other organizations within the facility, indirectly providing some measure of relief to the clinical team. For example, improving the Activities Department can indirectly improve company culture while simultaneously taking some of the pressure off of CNAs and nurses. It’s a lot more enjoyable for the average CNA to sit with residents through an hour-long Pound class, than running from bed to bed taking vitals. That Pound instructor also costs a lot less than weekly CNA overtime or bonuses. Investing in the Environmental Services department can improve company culture by creating an aesthetically pleasing environment as well as the working conditions within the facility, making it easier for the clinical team to do their jobs well.
Secondly, if you read employee reviews on agency websites and career sites, there is an overwhelming voice of nurses who are choosing job flexibility over job stability. That tells us that short-term commitments, daily pay, and scheduling options may be more attractive to today’s nurse or CNA than a generous sign-on bonus that kicks in after 90 or 120 days.
Lastly, rates and compensation cannot be ignored. Of course, increasing rates is always easier said than done but if there is a way to implement even one very small increase, even the smallest change can have an impact. For example, it may be worth analyzing the existing wage grid and identifying where potential staff is most likely to fall into. If the targeted nurse candidate has 2-3 years of experience, consider increasing rates minimally just for that level of experience and then “tapering” off the rest of the grid.
How can we tap into other markets to find and hire employees?
This is a good question. Unfortunately, with the TNA program coming to an end throughout the country, this is going to be a lot more challenging than it once was. It was disappointing to find that despite all of the talks of creating a proper career path for TNAs, there was a lot less support provided for transitioning TNAs to CNAs for the long-term. I believe that true education reform needs to happen to draw more nurses into the industry. I also wonder if the traditional 8 and 12 hour shifts may eventually be replaced with shorter shifts, in an effort to improve working conditions for care providers.
It was extremely heartening to see so many skilled nursing facilities throughout the country step in to create wonderful CNA programs and I’m glad that so many CNAs have been introduced to the industry through their efforts. That being said, I don’t believe that there is enough of a push to introduce LPNS and RNs to the industry and I also think there needs to be a better career path and facility-wide incentives to encourage CNAs to take the next step of their career to becoming a nurse.
Why are nursing homes companies unable to manage staffing in-house?
This is usually just a simple matter of either not having the right staff or not having the right system organizationally to be proactive about hiring. A lot of facilities have wonderful employees who are being pulled in multiple directions and aren’t prioritizing recruitment.
There is also not enough education at a facility level which can often result in potential candidates being inadvertently turned away by a well-meaning receptionist or HR personnel. Lastly, some facilities are still stuck in the old-school mindset that it is a privilege to have a job and therefore we are not going to pursue candidates who don’t seem serious. They don’t realize that this is no longer an employer’s market and quality care providers have unlimited options.
We need to pull all the stops to pursue those candidates and convince them to choose us over the prospect across town and that means getting very aggressive with our potential candidates and it also means being a lot more open minded than we used to be about what the ideal candidate looks like.
How do you think this will be resolved?
Ultimately, as mentioned earlier, I believe the ball is in the court of nursing home operators to band together at a national level and petition for system-wide changes – legislatively, culturally, economically and socially. At a legislative level, we need representation to create awareness at the highest level about the issues at hand. There are wonderful people in the industry who are trying to accomplish change, but they don’t seem to have the support they need to get as far as they need to. The enforcement of the vaccine mandate for healthcare employees proved this. We need to push for educational reform within our nursing schools and programs, economic incentives designed to encourage our wonderful nurses to both pursue healthcare degrees and continue their education, and we need labor changes to support the working conditions of nurses, specifically in the long-term care space, and help improve employment satisfaction.
As far as the industry itself goes, we need public support and awareness about the importance of the long-term care industry and the population it attempts to better the lives of. There is a lot of misinformation out there about nursing home operators pocketing too much profit while scrimping on care and I think the public doesn’t realize that their margins are that much smaller than in other healthcare industries. I don’t claim to have all of the answers but I do know that the industry possesses some of the best, the brightest and the most determined. I have faith in them to come together and push until change happens and I truly welcome the day when healthcare recruitment is no longer a viable industry 😊