Browsing "Staff Stability"

Staff Stability – Entry 3

Dear Diary:

We’re using the tracking tools from the Advancing Excellence in America’s Nursing Homes website to track staff turnover. When we started, I was shocked to realize our 60 day staff turnover was running at 47%! We now have an action plan to reduce turnover. Our goal is 20% annual staff turnover.

The new employee orientation program is making progress. A workgroup of staff from all departments, developed a plan to enhance our classroom orientation using resources they found on the Advancing Excellence website. The leadership team really liked their plan!

The three-day orientation will include an overview of our organization from all departments. And there’s a section on Quality Assurance Performance Improvement! I was happy to see that. It will strengthen the introduction of the mission and vision for new employees, as well as stress the importance of ongoing quality improvement being everyone’s job. Developing the QAPI section of the orientation began a discussion of ways to make it easy for staff to bring forward ideas. We’ll highlight our suggestion box and how we include QAPI in the agenda of every staff meeting as examples.

The workgroup also reviewed exit interviews from the past three years. Several staff wrote that they didn’t feel prepared or supported in working with persons who have dementia. So the workgroup recommended expanding the training on dementia. They chose two videos and discussion questions from the “Hand in Hand Toolkit” that CMS produced on dementia care. A great idea came out of the leadership meeting: organize an employee focus group to find out what employees believe new staff should know before caring for residents who have dementia.

The team should finish the orientation enhancements in the next two weeks. We’ll try them out during the next new employee orientation class. The group will meet after the class to make revisions based on feedback from our staff development coordinator, as well as the new staff.

This is just one step, but I really feel like everyone’s on board and we’re making progress. I have several ideas for other things we can do. Resurrect the mentor program and implement regular interviews with new staff are just a couple. What are other nursing homes doing to retain new employees?

Signed, Donna

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Staff Stability – Entry 2

Dear Diary:

I met with Dan, our administrator, and shared concerns I have and have heard from staff about staff turnover. In looking at our data, most of our turnover occurs in the first 60 days of employment. It really was surprising to see that this trend is happening across most positions.  We’re going to share the data at all our staff meetings this month and ask for their input on why this is happening.

Dan and I also reviewed the resources on the Advancing Excellence website. There are some really great tools and ideas there. Dan’s going to work with Human Resources to complete the staff stability tracking tool. I think this will help us figure out whether or not there are any other trends with our turnover. I’m going to dig into the resources on the website. It looks like a big project, but if we can make our staff more stable, I think many other things will run more smoothly.

I’m also going to ask for volunteers to work on our nursing orientation program at our department meeting this week. I think it’s important that staff from all three shifts are involved. There are some excellent orientation resources on the Advancing Excellence website. I’m going to suggest a review of our current orientation program and have them design a mentorship program for nursing assistants and nurses.

At our leadership meeting, we talked about turnover and the housekeeping supervisor and social worker volunteered to help. They’ve both had some issues. It’s great to get input from all departments!

I feel better about this now. At first, it felt like such a big task. Breaking it down and starting someplace I think we can manage really helps. I know that staff stability will depend on more than a new orientation and mentoring program. We can use our next staff satisfaction survey as well as tracking our turnover to measure our results. It’s a journey, but I can handle it with everyone’s help and support. I wonder what other systems I should look at related to staff stability?

Signed, Donna

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Staff Stability – Entry 1

Dear Diary:

Our efforts to implement consistent assignments throughout the facility have run into some problems. Two of the neighborhoods have been experiencing nursing assistant (NA) turnover. Because we have open positions, the NAs are having trouble creating the assignment groups. I was aware that a couple of NAs had quit and I had to terminate one, but I wasn’t too worried because we’ve been able to fill most of our open positions. Working on this area has really shown that we need to reduce our turnover to make consistent assignments successful. Other projects in the past have been stalled when we’ve experienced staff turnover.  I also realize how difficult it is for residents and families when they don’t see familiar faces among our staff—it’s like they are surrounded by strangers.

When I asked the NAs what they thought, I really got an earful! Some think our employee orientation isn’t preparing the NAs for the workload. Others mentioned some employees aren’t very helpful to new staff. When I reviewed out last employee satisfaction survey results, I see we didn’t score too well on staff orientation. This really got me thinking. What should I do next?

Signed, Donna


  • I guess I would get a group of staff members together and go over what happens in orientation. Both the older employees and the new ones.

  • We had similar issues with our prior orientation schedule. We changed it to add an extra day for all CNAs to facilitate more of the “hands on” training as well as the teamwork approach. I think it has made a difference. As I ask CNAs about their feelings regarding the orientation they received, I am getting more positive answers. So we must be heading in the right direction.

  • We have implemented CNA Mentors. We have one on each shift. These people take that new person under their wing for a day or two of full on orientation to the job. The very minor details are discussed (there is a checklist that the Mentors put together so that nothing gets missed) and when they are training with other staff the Mentor checks in with them just to “see how things are going.” The Mentors did a full day of orientation to the program and to what the expectations of this role would be. If someone may need an extra shift or two the Mentors may see this and speak with the DON and the scheduler and it is worked out.

Share your nursing home perspective on this quality improvement issue.