A culture of concern keeps staff.

Staff retention is one of the essentials to quality nursing home care. Not only does it reduce the need to train new staff and to find good employees in a dwindling pool of workers, it allows the staff to build a team approach to resident care, helps maintain good relationships with residents and families and, in general, enhances the reputation of the facility.

We have vowed to improve staff retention with a new initiative: our Excellence in Practice program at the Mount St. Joseph Senior Community in Concordia, Kansas, a facility with 100 residents in skilled nursing and residential care. The program enabled us to achieve a staff turnover rate of 30.65% for fiscal year 1997, compared to a state average of 149%. This low percentage even included several employees who "terminated" their employment in one department only to become "employed" in a new department, choosing to embark on a career path in our facility.

How did we do it? We began about three years ago to focus on development of a mission that truly "grabbed the heart." It stresses five attributes: community, competence, human dignity, service and vision. We then created an orientation and training program that fulfilled this mission.

Our mission philosophy is not confined simply to staff orientation. It permeates the facility and gives our staff the chance to make their jobs meaningful through authentic relationships with residents, families and other staff. They can also link their personal lives to their professional lives by expressing the same values throughout both realms, and this allows them to be at peace within themselves and to transfer that peace of mind into their relationships at work and at home.

We begin by striving to select new employees who are attracted to work here, not just for a paycheck, but because it is a place they can leave at the end of the workday knowing: first, that they were able to give excellent care and, second, that they are valued human beings. A formal part of the program acknowledges this by catching people "doing things right" - i.e., performing actions that in some way illustrate our mission values, from serious situations to more lighthearted ones. For instance, we recognized staff who went the extra mile in dealing with families of the dying by paying special attention to their physical, emotional and spiritual needs. And we praised those who contributed to our sense of community with special root beer floats on Father's Day for male residents. These events are noted and described in our weekly employee news sheet.

Our orientation program, which takes four hours, includes an explanation of our mission values, shown in a 20-minute video. It also includes an overview that describes what every department in the facility does. In this way, new hires can see the interconnectedness of their work and understand our team approach. They also are shown that what they do will be valued and that their human dignity can be expressed in their work.

In-services are also key to this approach (paid for out of the same operating budget, but at decreasing costs because of our low turnover). Along with the usual topics presented at any in-service, we have programs that support specific aspects of our mission. For example, we discuss what competence and service mean to the resident. We also celebrate community, and our "connectedness" with our fellow employees and residents, by observing special occasions. We critique ourselves and look for better ways to express human dignity. In addition, we value employee suggestions and insights.

As a facility, we also ensure fair and honest evaluation of employees, recognizing and rewarding excellence, and using coaching and appropriate disciplinary actions when necessary. We give fair market value for services rendered, and we work to develop personnel policies that express our mission.

We have found in both family satisfaction surveys and state surveys that are used to measure our progress that we have improved performance in the two-year period since we started this program, along with improving staff retention.

Janet Chapman is CEO of Mount St. Joseph Senior Community, Concordia, Kansas.