The staffing crisis is an ongoing dilemma for home care. To combat its effects, nurse leaders in home health agencies may be asked to find creative solutions. These professionals often focus on the lack of potential candidates and the difficulties related to hiring. But staff turnover is a large part of the crisis as well, especially in communities where employers compete fiercely for workers. This article discusses the contributing factors and the impact of staff turnover, along with strategies to improve staff retention.
Causes of Turnover
According to a Home Health Care News article,the current turnover rate for the industry is 79%, an increase of 12% since 2022 (Famakinwa, 2024). High turnover and staffing issues often mean that home care providers cannot accept new patients.
People who voluntarily leave their positions share several concerns. The decision to leave is usually not driven by the wage the employee is earning. Instead, these are some of the frequently cited reasons for resigning:
- Limited or poor relationship with immediate supervisor
- Lack of autonomy and flexibility
- Feeling tired of the status quo and stifled when attempting to contribute to improvements
- Feeling overlooked or undervalued for individual talents and contributions
- Exhaustion, coupled with long hours and overtime
- Demands of the work exceeding compensation
- Prospective new job offers a promotion or opportunity for new challenges
Once any single reason, or a combination of those just listed, causes feelings of dissatisfaction, employees progressively become less engaged over time. Then something prompts the final decision to quit.
The Costs of Turnover
High turnover rates affect an agency in many ways, from finances to quality of care.
Finances: Significant research shows the high cost of turnover in post-acute care. The estimated direct cost to replace a certified nursing assistant ranges from $3,000 to $6,000; a nurse costs between $6,000 and $9,000 to replace. Direct costs include some or all of the following:
- Recruitment expenses
- Time invested in hiring
- Cost of coverage of the vacant position
- Drug screening
- Employee health screening/testing for new employee
- Orientation
Staffing: When employees resign, it creates open positions that can challenge the agency’s ability to fill shifts, especially when vacations, illness, or other reasons constrain the schedule. If the agency does not have adequate staff to cover these gaps, it may need to cut back on patient visits and turn new patients away, impacting patient care, community relationships, and the budget. This situation can also affect the agency’s fiscal stability.
Agency culture: Turnover, especially when high, affects employee morale of those who remain. When a smaller number of employees must complete the same amount of work, the risk of staff burnout increases. Seeing frequent resignations can also undermine individuals’ belief in the team’s competence, affecting the overall culture of the agency.
Quality of care: When employees leave, the agency loses their knowledge and experience. New hires need time to get up to speed on agency policies and procedures, as well as the needs of each patient, that can ultimately impact care delivery. Lower quality care can also affect patient satisfaction, possibly resulting in loss of business. All of these factors put a strain on agency finances. Restricted budgets can then further hinder the care and services that an agency can provide, creating a vicious cycle.
Combating Turnover for Existing Staff
Check in and address individualized staff needs
It is important to be aware of how staff are doing every day, especially now with a shortage of candidates. The nurse leader should check in and see how staff are coping and if they are feeling appreciated.
Staff may show signs when they aren’t valued. These employees may be struggling with either personal or work issues. These are some indications to look for:
- Decreased work productivity
- Negative change in attitude
- Voicing more dissatisfaction
- Increased absence or tardiness
- Social withdrawal
- Negative work environment
(Harvard Business Review, 2019)
The nurse leader should be alert for these signs and offer employees some extra appreciation, assistance, or attention. By helping employees feel more respected, the nurse leader may retain an employee who otherwise might resign.
Another way to take the temperature, so to speak, of staff is to conduct a “stay interview.” It can be much more effective for retention than an exit interview because it takes place before the employee has decided to leave. Stay interviews may help retain staff considering quitting because they create an opportunity to address concerns before they become catalysts for exit.
Change agency culture to put employees first
An employee-first culture is based on the concept that employees are the best asset of the organization, so they need and deserve encouragement. A positive culture not only motivates employees to stay but also helps them improve and possibly recruit new employees who may fit into and enhance the present culture. Nurse leaders can show employees that the agency prioritizes them in several ways.
Positive communication: Staff must feel comfortable coming to leadership with any of their concerns, ideas, and questions. The nurse leader needs to promote timely and constructive communication among all staff. Transparency during communication is especially vital. It is natural for staff to have fears, questions, and concerns, but those only fester if they feel leaders are not forthright with them. The nurse leader should also communicate when employees have done something well and voice appreciation for all that staff members do.
Invest in staff development: Employees need to feel confident about their skills and often want to grow in their careers. To do this, they need opportunities to gain more expertise. The nurse leader should prioritize investment in the staff’s professional development.
Consistent appreciation: Everyone likes to be appreciated and it can take many forms, from giving a small and unexpected gift, such as a drink or a snack, to exchanging a high five when an employee has completed a task. Don’t forget to give employees small doses of appreciation on a daily basis. It goes a long way to cultivating a positive culture.
Flexible schedules: A healthy work-to-life balance is critical to job satisfaction. One way to promote this goal is by utilizing a flexible schedule module. Allow staff to self-schedule according to what works for them. Some may prefer 8-hour shifts; others prefer 12-hour shifts. This concept may be intimidating at first, and nurse leaders need to set usage criteria for this to work, but many leaders find that when they allow staff to self-schedule, the number of call-offs declines.
Combating Turnover of New Staff
It’s not just existing staff members who turn over. Approximately 20% of new hires resign within their first 45 days of employment. Reasons that new hires may depart early include discovering that the job isn’t what they expected, they don’t like their manager, or poor training. The nurse leader can prevent some of these issues by hiring the right person for the right job and being very transparent.
During an interview with a potential candidate, be open about the job’s duties so new hires are fully aware of expectations. Use a behavioral-based interview during the process. By revealing the behaviors where candidates default, the nurse leader can predict more accurately how the candidate will perform in the future and can also gain insight into the candidate’s character and talents.
Once the agency hires candidates, they should go through a comprehensive onboarding and orientation process. Each of these serves an important purpose. Onboarding should foster a feeling of belonging to the organization, and orientation should offer new employees the direction and information they need to fulfill their job duties. The two work in harmony and can either empower new employees to do their best or just do the opposite: motivate them to leave the organization. One without the other is insufficient to promote employee retention.
Summary
Home health agencies can survive the staffing crisis. To do that, they need both to seek external solutions and also review the current state of their agency’s internal culture. Meet staff where they are with individualized solutions. Although no single fix can decrease turnover, if nurse leaders utilize these tips, they will be well on their way to stabilizing their staff.
Sources
Famakinwa, J. (2024, July 3). Home care’s industry-wide turnover rate reaches nearly 80%. Home Health Care News. https://homehealthcarenews.com/2024/07/home-cares-industry-wide-turnover-rate-reaches-nearly-80/
Gaivin, K. S. (2022, August 1). Nursing home staff turnover up 25 percent from last year: survey. McKnight’s Senior Living. https://www.mcknightsseniorliving.com/home/news/business-daily-news/nursing-home-staff-turnover-up-25-percent-from-last-year-survey
Harvard Business Review. (2019).
Pavlou, C. (n.d.). How to reduce new hire turnover. Workable Technology Limited. https://resources.workable.com/tutorial/new-hire-turnover-rate
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