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.