The staffing shortage faced by healthcare facilities — including skilled nursing facilities like those in The Allure Group’s network — continues, raising as many questions as it does problems.
Central among them, of course, is this: How do you find and retain talent? Because it appears not just to be a matter of compensation (though that certainly helps), but also of hiring practices and retention strategies. Of who’s in charge and how they lead. Of employee engagement and opportunity.
There is no question that the cost of the talent shortfall is considerable, in terms of how much it takes to replace a departed staffer, the morale of the already-overburdened staff left behind and most importantly, the care a patient receives.
Neither Medicare nor any other body has determined the ideal nurse-patient ratio for a skilled nursing facility; nursing homes house some 1.4 million Americans. Health inspectors, however, have viewed a 1:8 ratio as being indicative of a shortfall since 2014.
In 2018, CMS changed the way staffing was measured. Where previously it was viewed according to personnel levels in the two weeks prior to a survey, it is now gauged according to payroll records. By the latter method, 70 percent of the 14,000 nursing homes that were examined had lower staffing levels than in the previous study. And decreased levels are inversely proportional to the number of health code violations.
Inadequate pay has been cited as the primary reason SNFs lose people to hospitals or the retail industry, though hospitals have had their issues with retention as well. The turnover rate for the healthcare industry as a whole was 18.2 percent in 2017, its highest in almost a decade, and since 2013 the churn has been such that a typical hospital has turned over 85.2 percent of its personnel.
The average cost of replacing a bedside registered nurse is $49,500, while the overall average is $60,000, with the ancillary costs incalculable.
According to Skilled Nursing News, nursing turnover did slow a bit in 2018 — from 35.69 percent the year before to 33.94 percent among RNs and from 30.77 percent to 28.83 percent among LPNs — as they realized respective pay raises of 3.1 percent and 2.43 percent. But that only begins to address the problem.
One report, according to DailyPay, cites lack of engagement as the primary reason healthcare workers move on to greener pastures, and pointed out that while 58.6 percent of hospitals have new-hire retention strategies, just 21.6 percent of such facilities feature strategies for more-entrenched employees.
Certainly hiring strategies warrant examination. With a new emphasis on coordinated care, Monster.com suggests that soft skills matter more than ever — that, in particular, team players are in demand. Finding such people, that site continues, is a matter of asking the right questions and closely examining a potential recruit’s work history, though in the business world at large there are those who find such an approach inadequate.
Rather, they say, technology is the answer — artificial intelligence in particular. There is AI in development that is capable of discerning some of a person’s major personality traits by examining his or her eye movements, which could one day prove helpful in unearthing the best candidates. More practical at present is AI that sorts through resumes and even determines the worthiness of a potential recruit by examining a video interview. One employer improved the success rate of his hiring by over 30 percent courtesy of such technology.
Yet Josh Bersin, an independent analyst and founder of Bersin by Deloitte, wrote for Forbes that businesses remain rooted in the old review-the-resume/do-the-interview way of doing things, the result being that they get hiring wrong 30 to 40 percent of the time.
So that’s the first thing — bringing in the right people. The second part is keeping them around. It was reported in 2017 that 37 percent of healthcare professionals will look to leave their job within two years, 68.6 percent within five. While everyday pressures were cited as the primary reason for that, another report indicated that 80 percent of the time, employees departed because they viewed their manager as being substandard.
There is, as a result, a trickle-down effect to all this: If a healthcare facility finds quality managers, those managers are more apt to find quality employees. Such hires positively impact the morale of holdover staffers, whose level of engagement — defined as “an individual’s cognitive, emotional, and behavioral connection with an organization’s mission, vision and values” — is raised.
Engagement is viewed as being critical to retention. One way it can be enhanced is by professional development — giving employees the opportunity to expand their skill sets and advance their careers. Another way is by giving employees up-to-date tools that will make their jobs easier.
The Allure Group, for instance, has always strived to be on the cutting edge of technological innovation. We have implemented EarlySense, a contact-free patient monitoring system, and make use of ConstantCare e-vitals (which allows for the sharing of patients’ vital signs to their electronic medical records), various robotics to aid in patient rehabilitation and TeleHealth Solution, a telemedicine platform.
Yes, the staffing crisis is all too real, throughout the healthcare industry. But there are ways to lessen its impact, ways skilled nursing facilities can improve the lives of their employees while ensuring the best possible outcomes for their residents — always the bottom line.
