Bring long-term care staffing back to safe levels


As suppliers compete for the same limited number of staff, they need to get creative, according to an industry expert.

With demand for bedside nurses outstripping supply, long-term care facilities need to look for viable and efficient ways to attract and retain nurses to provide the care their residents need, expert says of Industry Reginal Hislop III.

Hislop, a widely recognized healthcare executive, consultant, author and thought leader in healthcare, specialty healthcare, post-acute care and healthcare policy, spoke with Health Leaders on how long-term care staffing can be brought back to safe levels.

This transcript has been lightly edited for length and clarity.

HealthLeaders: Overall, what is the overall state of nursing staffing and long-term care facilities right now?

Reg Hislop III: If I were to use a scale of 1 to 10 with 1 being as bad as it gets and 10 being excellent, we were around 6 before COVID so they were probably 5 or 4 and maybe in some cases 3. When we think about When it comes to staffing, we talk about it in terms of nationalized trends, but the reality is that each market sector or region experiences things differently – positively or negatively – compared to national trends. The national trend is poor, but if you go to certain environments in certain places – rural, for example, or downtown – it’s much worse than the national trend.

So we have a long way to go and part of that is fighting an uphill battle in terms of reputational issues in the industry, but also fighting some trends that have been blights on the whole industry health care, particularly with regard to the clinical bedside staff, that is, people are burnt out and have retired.

The average age of RNs and LPNs wasn’t very young before COVID, so you can imagine how many people just said, “I don’t need to keep doing this anymore” or “I can keep doing this, but I’m going to do it differently. I will take a step back, reduce my hours, only work premium shifts, maybe join a staffing agency that allows me to work in the same environment I was in, but do it at a rate of much higher salary. So we have a lot of moving parts going on right now.

HL: So how do they fill the staffing gaps?

Hislop: Some just aren’t, and that’s the reality. Some of our clients who operate in rural areas literally cannot find staff for particular shifts, so they are operating at a bare minimum and in some cases have had to focus on reducing organic enumeration or reducing occupancy levels to meet where staffing levels are achieved or can be achieved.

The main dependency vendors use today is one of the three arrows in the quiver, none of which are so large. One is simply the salary. Pay more. Do whatever is necessary. Offer as many financial incentives as possible, whether it’s signing bonuses, improved base pay, incentives for taking shifts, higher shift spreads for shifts difficult to fill and to use any kind of financial leverage possible to fill shifts. The other is to rely on outside organizations. It’s precarious in some markets because some agencies don’t have enough staff and can’t attract additional staff to fill extra shifts.

The in-between is having people work overtime, adding extra shifts, using incentives to create environments where people can be flexible to pick up – instead of full shifts – part shifts, doing things with teams of two or three people to creatively solve some of the key openings on certain shifts, but not filling the full eight, 10 or 12 hours. But these are all tape-type solutions; they are not permanent.

HL: As they strive to bring the workforce up to safe levels, what should they be doing to recruit nurses?

Hislop: Unfortunately, it will be difficult to do much in the short term. We have a supply and demand problem. The demand for bedside nursing care exceeds the supply of available people. Some markets are better, other markets are not, so as long as that imbalance exists…vendors are competing for the same limited supply of staff.

What suppliers can do is be creative. It seems rudimentary, but keep all your staff and try to increase the time they are ready to work. See if you can bring your part-timers to two-thirds time or two-thirds full-time and do it in a way that gets maximum coverage and productivity from your existing workforce.

The next thing you need to do is look at how you provide different elements that are part of the staffing equation. Remuneration is only one element. The other elements include job satisfaction, support, giving people the opportunity to set a team schedule, self-planning, finding creative ways to address some of the fundamental elements that take people away from care nurses at the bedside and say, “Is there a way to Are there ways to improve the work-life balance, the internal quality of life in the organization? »

Partner with various agencies to see if there are ways to work with some of the nursing programs and schools in your market to provide people with the opportunity to complete their education and work for the provider…while supporting some of the tuition, if feasible. Explore a variety of creative perks options, which can be as simple as eating meals at work or partnering with daycares. Many of our nurses are women and they have children who need childcare options. The real challenge is, in the short term, to be sensitive to remuneration, but also to quality of life.

HL: What about retention? What should they do to retain their current nurses?

Hislop: Retention is the #1 thing, so providers need to value their staff in a way that shows them, beyond the dollars, the importance of the work they do. There is a lot of recognition to be offered to the people who do the work. This includes a number of different things.

One is identifying the work they do and rewarding and acknowledging them for it. It doesn’t have to be huge to hand out movie tickets or gift cards. Doing appreciation events is a great thing. Speak directly to staff and have open lines of communication, and ensure floor-level and building-level management are open and communicative in how they deal with any work-life challenges staff may have currently facing Burnout.

Make sure you use your staff wisely and are sensitive to some of the issues that exist and don’t overburden them. Stay away from some bad stuff like mandatory overtime. Some will react and say, “But if we don’t, we won’t have staff”, and the answer is yes.

But the word mandate is different. If you say, “We’re not going to require… overtime. [But we] will ask, and we will work with you to help you take your shifts. This sets the tone of mutual respect.

The reasons I hear from nurses why they no longer work in certain places or why they don’t feel obligated to stay in bedside nursing are three-fold. The first is that they are overworked. Second, they are not treated with respect. Third, they are essentially put in a position where they feel like they have no say in the trade-off that might be made when it comes to the quality of patient care. This last one is a big one.

We need to have open dialogue and communication about what is safe and how we can help them and shift some non-nursing duties so we can all focus on patient safety.

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


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