The right culture change can improve staff retention

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Many skilled nursing facility (SNF) managers suspect that their staff turnover is due to employees finding better pay and benefits elsewhere. But a 20-year program studying SNF retention indicates that monetary perks rank third or fourth on lists of reasons why people leave their jobs.

“Staff want the nontangibles—respect, meaningful work, input in decisions and a voice in the organization, open communication, and to know what to do in their job and why they are doing it,” said Susan Gilster, PhD, NHA, a fellow of the Alois Alzheimer Center in Cincinnati.

That’s not to say money doesn’t fit into the equation.

The program that Gilster worked on with Jennifer Dalessandro, BS, NHA, at the Alois Alzheimer Center found that the facilities they studied spent $350,000–$600,000 per year on turnover. If you could cut back on these costs, your facility would be able to offer more competitive wages.

During the April American College of Health Care Administrators (ACHCA) conference in Charlotte, NC, Gilster and Dalessandro discussed the following techniques that SNFs can use to improve their retention.

Revisit your vision and mission

Most organizations develop a vision, mission, or credo to live by. But how often do you review yours?

“Use your vision constantly,” Gilster said. “Ask, ‘Why are we here, what does our work mean, and what difference do we make?’ ”

Additionally, ask those questions not just of yourself and others on the management team. Involve your entire organization.

For example, if you don’t already conduct exit interviews, start doing so. “Ask staff why they are leaving, and do something with the information,” Gilster said. If employees say they are leaving because their manager didn’t respect them, ask them for examples. Consider hosting leadership training for all of your supervisors to reeducate them in their roles.

Survey your staff members’ satisfaction during their employment as well.

Give employees ownership of their SNF’s processes. For example, at one facility in the study, too many employees were calling in sick during the weekends. The administration gathered staff members together and asked them whether they thought this behavior was consistent with the facility’s vision. The staff members said no, so the administration asked them what they could do to bring the actions back in line with the vision.

The staff members decided that if an employee called in sick on a weekend, that person would have to work the next weekend shift. Allowing the employees to find a solution to the problem instilled pride and accountability in their work as a team, Gilster said.

Stimulate and motivate

Understand that work is only a part of your staff members’ lives. Make efforts to connect with them on a more holistic level. Foster an environment that focuses on staff members’ successes in their jobs, as well as the other im—portant areas of their lives, Dalessandro said. Try some of these efforts to keep work life exciting:

  • Celebrate accomplishments. Make a big deal out of it when a staff member finishes a school program or job-related training.
  • Make success personal. If an employee goes above and beyond at work, send a note to his or her home praising the person for it.
  • Go national. Nominate staff members for nation-al awards. Many people think that they can’t compete with an entire country of contenders, but the truth is that many of the awards take time to apply to, so the candidate pools tend to be small, increasing your chances, Dalessandro said.
  • Honor your differences. A member of the ACHCA conference audience said her facility hosted an ethnic appreciation day for staff members. “At the time, our staff represented 23 countries. Instead of being part of a minority, every one of them was a star of the show,” the participant said.
  • Help out in an emergency. Open an employee emergency fund to help staff members if they get in a jam. “If someone’s car breaks down, and he or she has no other way to work and no way to pay for the repairs, the initial reaction might be to quit,” Dalessandro said. If you have a fund to help a staff member out in a time of need, you may save an employee.

    However, make sure that people aren’t taking advantage of your good will. Set up a plan to have the employee make small contributions back to the fund once he or she gets back on track.

  • Seize every opportunity to educate. Offering continuing education seems obvious, but what does continuing really mean? At another facility Gilster and Dalessandro studied, continuing meant constant. For example, the facility accepted a resident from a nearby hospital. The new resident was only slightly ill when she was admitted, but her illness quickly worsened.

    Shortly thereafter, the facility received a phone call from the hospital alerting the SNF that the hospital had a Norovirus outbreak. Administrators used this timely and vital case as a chance to stop everything and teach staff members about Norovirus, hand hygiene, etc.

  • Survey staff members about topics they’re interested in. In addition to ongoing education relevant to their jobs, staff members might also enjoy and benefit from workshops about how to change a tire, financial planning, or health and wellness.

    Start off on the right foot

    Make sure that you keep your employees around long enough to engage in all of the great ideas mentioned above by adequately orienting your staff members to their new jobs.

    Gilster provided the following tips for excellent orienta-tion practices:

  • Don’t skimp on the pay. Pay the orientation attendee a full day’s salary, not a “training rate.”
  • Don’t shortchange new employees. Orient-a-tions should be at least two weeks long in most cases. In Gilster and Dalessandro’s study, 80% of facilities gave new hires only three days to learn the ropes.
  • Take buddy programs to the next level. Having a senior employee mentor a new employee is a huge help for the fresh face. However, the mentors may find the task daunting with all of the other work that they have to do.

    Incentivize your mentor programs. Pay your peer leaders extra per hour for helping out. Also, give your mentors adequate and frequent training and objectives that they should strive to meet with the people they are teaching. This will help them to feel like they are achieving goals and making a difference.

    One-stop shop for all of your 2008 coding manuals

    Don’t miss the 2008 code changes—including major updates in lymphoma and hearing-loss codes. You will now be able to code your residents’ conditions more specifically. You don’t want to use old, out-of-date codes. The codes are final and will take effect October 1 without a grace period.

    You can now preorder your 2008 coding books through HCPro, either in a package or individually:

  • 2008 ICD-9-CM Manual, Volumes 1 and 2
  • 2008 HCPCS Level II Manual

    For more information, go to You can also call Managing Editor Andrea Dickey at 781/639-1872 or e-mail her at

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