The Revolving Door Staff Problems in Nursing Homes.

Crucial to operating a successful Nursing Home is having stable and adequately trained staff.This is especially true in the CNA category. From one shift to the other one is never sure if there will be adequate staff to provide a quality care. The LTC industry keeps engaging in the same futile exercise at a very high cost without effectively dealing with this problem. Many start a CNA class with the hope to train and retain staff. Unfortunately, by the time the class is completed you may not retain 20% of the graduates if lucky. Often the retention over a six month period will even be less than that. The liabilities associated with inadequate staff are huge. Negative survey outcomes, unhappy families and license refferrals with the potential of malpractice litigation are just to name a few.I think the reason for this lies in the fact that such positions carry little incenstives, rewards and prestige.Cost benefit analysis most likely will show that current methods are ineffective.The industry must use a new approach to this dilemma.If you are a Nursing Home Administrator chances are that you know an administrator or a director whose license has been refferred.

At my facility we do a number of things to retain CNAs. The first thing you have to understand is your CNAs are what people think of your facility. They are your direct care staff. It is not likely that if they are uncompassionate, angry, unhappy, or crabby that families, residents, and surveyors will think highly of your facility. With that in mind here is what I do:

1. I am positive. I never complain radiate a negative attitude. If you as an administrator or owner are crabby, guess what you are telling your staff? They will emulate you! I have stayed at hard jobs, that pay less for longer times because my boss was kind. So be nice and friendly.Enerytime I talk to a CNA I say thank you. I say it like they are taking care of my own mother.
2. Institute some employee appreciation just for CNAs. We have a Parking spot for employee of the month. They also get a $25 gift certificate, their name on a plaque, and picture above the plaque.
3. Talk to the CNAs. If you don't your a jackass. They know the residents better than anyone. Get all the information you can from them daily. It is your job to assess the frailities and strengths of the facility and the best way to do that is talking to the people that know the residents the best.
These are relatively inexpensive ways to make your staff happy. Happy staff give good care. It really is that simple.

Hi Phil and Tambi Pharayra,

I worked at a facility in IL, and I agree that having a stable and an adequately trained staff is a must, starting from CNA to the Dept. heads.
The owners want you to hire the cheapest employees. I have seen job descriptions of Dept. heads with education requirements such as high school or middle school...you've got to be kidding me. But, you get what you pay for. LTC industry has to change as a whole and hire qualified employees. The other thing is location. If a Nursing home is on the 98th street in Chicago, the employees you will get are going to be from that area, and guess who is going to be blamed for the nursing home failure? Most of the nursing homes do not offer decent benefits.
I have worked in a nursing home under similar circumstances.
Amjad Hussain

Hello Phil and Tambi,
Moreover, CNAs should have paper and computer skills,inter alia and they should be given the right salary reward in order to give them incentive to keep going.With a low glassic ceiling the substitution rate will be so high! CNAs need to be given an incentive, financial and educational wise.
So, I think Tambi's idea is a good one, and can be a synergic profitable enterprise!
Good luck guys,
Adam (MBA)

I've had to pay out of my pocket to provide descent parties to celebrate nurse week and cna week. This is from a company that makes over 200k a month profit! I am paid well so I just bite the bullet. Some of the things I've learned is to have various managers pick up decoration etc. from various stores I or the activities/HR person has scouted that will match our vision for the theme. Then we take good care of the things, leave the tags on and have everyone take them back for a refund! This means no one person pays for everything, 5 to 10 people return things so the local stores don't get suspicous, and we all have a great time. We feel really smart that we've pulled off the great party all of the employees are talking about. Another thing is residents, family and employees alike love to watch us have fun. By us I mean employees, managers, residents all together. We sing, we dance, we act silly. They love this! Have fun!

I believe that the administrators of the facilty, particularly at wesley acres in des moines iowa have no clue what they are doing as well as who they really want to hire as well. I have worked in the nursing industry for five years and the women i work with have not completed high school, they act like they are in middle school creating gossip and drama, management discourages any further education for the cna's to attempt to hold them back, and keep them as ther cna slaves working to many shifts and getting burnout so they can hire someone with less money and no experience-this is why ther is a revolving door. Why would you stay at a facility whjere you dont feel like you are anything? another things the employees and the managers will gang up on a staff member and treat them so horribly that they have no choice but to stay and have a nervous break down or quit the job in the unit and nothing ever gets done about these problems, why is that? these choices are both ridiculous and ther should be more regulation from the corporate office on office abuse. Its nonsense and makes entirely no sense. The residents are number one and it is their home. The staff should leave their stresses at home and come to work for them and for them alone nothing else should matter. The elderly adults are our grandmothers and grandfathers-not biologically but they are always first.

You make an excellent point. Obviously the underlining mechanism is greed and keeping wages down to the extent that the employees resign themselves to the false sense of security and dependent on starvation wages.The regulations must set a minimum of resident to staff ratio that is realistic and also the state must make it mandatory that employers provide full health insurance to all employees and their families at no cost to employee.Additionally, LTC companies must be open for purchase of their stock by employees at a discount.When you think about it CNA's and nurses should organize themselves and start their own facilities.