Are your recruitment strategies up to date? The answer is important to continued customer satisfaction with and referral to your facility.

An interesting fact that was documented recently: Nine of the top ten items correlated with residents' likelihood to recommend your facility are related directly to their interactions with frontline staff and management (see "Benchmarks of Resident Loyalty," p. 32). We also know that as the baby boomers come closer to age 85 (beginning in 2031), long-term care becomes a very real possibility for them, but nursing homes may not be adequately staffed to accommodate them. (1) And, finally, we know that job dissatisfaction, while a general term, encompasses more than discontent with money or schedules, but also frustration with the environmental culture of the facility.

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Three interrelated factors are vital to the development of a facility that staff are both drawn to and committed to: a thorough and impressive interview process, accommodating basic needs of the staff, and a work environment in which employees can truly enjoy their jobs.

The Interview Process

Many organizations are so worried about the quantity of their job candidates that they often overlook the good ones sitting at their doorsteps. Even so, being impressed by an individual is of little consequence if that candidate is not impressed with his or her first formal encounter with the facility: the interview. The key to the interview process is to understand that both sides--the candidate and the employer--are "auditioning" one another. That means one must both buy and sell when interviewing a candidate. (2)

Peer interviewing is also vital to the hiring of an employee, as it allows both sides to get a taste of what the other offers. Employees, one-on-one, are more likely to give honest expectations and previews of the working environment, offering invaluable information to the candidate and observing his or her responses. An orientation program is a selling point to many candidates and should be highlighted in the interview. (3) Therefore:

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* Study the applicant's resume before the interview and formulate individualized questions. Familiarize yourself with organizations that the candidate was previously involved with to avoid surface questions and obtain more information.

* Use peer interviewing. Make sure that each employee allows the candidate to ask questions, allowing that employee the chance to note the candidate's concerns and motivations.

* Highlight all orientation programs available for new employees--do not allow candidates to leave the interview feeling as though they will be thrown into a job they are not familiar with. Offer mentor or preceptor programs, and introduce candidates to an employee who is or has served as a preceptor. Bring seminars, workshops, and other orienting events to the candidate's attention to emphasize the importance you place upon the smooth integration of a new employee.

Meeting Basic Needs: Health, Schedule, Pay

Maintaining a manageable schedule between work and home life is of primary concern for those in the nursing profession, as the staff shortage has meant vast amounts of overtime in recent years. Schedules must be developed with employee input, or managers will be at risk of last-minute "no-shows." Flexible scheduling is also vital to staff retention. These concerns have led some organizations to reconsider the standard 8-hour day/40-hour week. Thus:

* Offer nontraditional shifts. Options such as working seven 10-hour days followed by seven days off, (4) working two 12-hour shifts as opposed to three 8-hour shifts, and having nursing staff work two 16-hour weekend shifts and being paid for 40 hours are among alternatives. (5)

* Provide a positive incentive for the staff member and beneficial outcomes for the facility with sign-on, referral, and retention bonuses (some facilities offer a dual sign-on/referral bonus that is split between the referrer and the referee).

* Improve benefits for employees and their families, or offer reduced costs for outside services to assist them with maintaining their lives outside of work. Offer dry-cleaning services, workout facilities, and day care facilities, for example, at a reduced cost; these have been shown to increase satisfaction and decrease turnover rates. (6)

Creating an Environment in Which Employees Want to Work

In some cases, one will find that the happiest employees in the nursing profession are far from the highest paid or best scheduled. Often the reason given for leaving the long-term care industry is not one identifiable complaint but a number of factors that make it difficult for the staffer to enjoy the work.

Talented people are usually not attracted to (and rarely stay with) an organization that offers high monetary compensation but fails to provide a culture of caring. Maintaining open lines of communication with the nursing staff and listening to what challenges them and what their needs are will allow organizations to make individualized accommodations. Invite employee dialogue, and address the following questions: Where is the organization going? How will it get there? What is each employee's role in realizing that vision? And what is in it for each employee? (3) Also, by making continuing education and training a priority, the nursing home acknowledges that continuous learning is important to both the employee and the organization. (6)

Recognizing a job well done and the character traits that allowed for it to happen are essential motivators for employees. The three R's of employee management can drastically change the work atmosphere: respect, recognize, and reward. (7) Implementing a program through which both residents and employees can recognize those who go above and beyond the standard tasks or show a special level of caring will promote that kind of behavior. Thus:

* Offer an education budget that allows nursing staff to take classes and continue with their education for a reduced fee. Consider providing a given amount of paid time off--one or two days a year--for educational seminars and related purposes.

* Show employees the well-deserved gratitude they've earned for their excellent service with plaques, gift certificates, and thank-you letters from the supervisor and president of the facility.

* Use bulletin boards to recognize those employees who have been with the organization for a number of years or to provide information about and pictures of new staff members.

* Host celebrations within the facility for big and small accomplishments alike. Giving residents and staff members a reason to break up their normal routines and enjoy a happy occasion is beneficial to everyone.

* Do not dismiss concerns or suggestions provided by the nursing staff, and ensure that all comments are followed up by an administrator. The more input that the nurses have as to how the facility is run, the more likely they are to truly feel that they are an asset to the organization, thereby creating a sense of loyalty.

Conclusion

It is imperative that healthcare facilities across the country give careful consideration to the recruitment and retention strategies they now have in place. As the baby-boomer generation comes closer to needing long-term care, nursing homes are especially vulnerable to inadequate staffing and, therefore, insufficient care. Nursing home staff often go into the profession for love of the work, but eventually leave because of the demands placed upon them, with little environmental support or monetary compensation. Whether the problem lies in physical demands, scheduling problems, low pay, or the work environment, the nursing shortage presents a wake-up call to healthcare providers. Nurses and nursing assistants are invaluable assets to healthcare facilities; meeting their needs and providing for their wants is no longer an option, it is a necessity.

Danielle Costello and Laura Vercler, MA, CPHQ, are in Knowledge Management for Press Ganey Associates, South Bend, Indiana. For further information, phone [phone] or visit www.pressganey.com. To send your comments to the authors and editors, e-mail [e-mail].

References

1. The Future Supply of Long-Term Care Workers in Relation to the Aging Baby Boom Generation. Report to Congress. May 14, 2003. Available at: http://aspe.hhs.gov/daltcp/reports/ltcwork.htm.

2. Expert techniques for finding, hiring and keeping peak performers. Nurse Recruitment and Retention Newsletter, October 2003;1(3):25-36.

3. Recruitment and retention in uncertain times. Nursing Spectrum, October 6, 2003. Available at: http://community.nursingspectrum.com/magazinearticles/article.cfm?AID=10560.

4. Lafer G, Moss H, Kirtner R, Rees V. Solving the nursing shortage: Best practices for recruitment and retention of nurses. Washington, D.C.: United Nurses of America; American Federation of State, County and Municipal Employees, AFL-CIO; May 2003. Available at: www.afscme.org/una/sns08.htm.

5. Grob G. Emerging Practices in Nursing Homes (OEI-01-04-00070). Washington, D.C.: Office of Inspector General, Department of Health and Human Services; March 2, 2005. Available at: http://oig.hhs.gov/oei/reports/oei-01-04-00070.pdf.

6. Abrams MN. Employee retention strategies: Lessons from the best. Healthcare Executive 2004;19(4):18-22.

7. Klitch BA. Staffing to avoid deficiencies. Nursing Homes/Long Term Care Management 2000;49(10):14,16.

8. Reichheld FF. The one number you need to grow. Harvard Business Review 2003;81:47-54.

by Danielle Costello and Laura Vercler, MA, CPHQ

RELATED ARTICLE: Benchmarks of Resident Loyalty

In a 2003 Harvard Business Review article, Frederick Reichheld asserted that assessing customers' likelihood to recommend is the only way to measure customer loyalty, regardless of the industry. Correlating each individual item below with residents' likelihood to recommend indicates those areas that have the strongest relationship with residents' loyalty to the facility. (8)

Table.

Survey Item                                        Correlation

How receptive management is to your ideas          0.717
Treatment of visitors                              0.692
Likelihood of being treated with dignity (nurses)  0.642
Responsiveness to your own ideas about your care   0.636
Explanation of your care                           0.627
Likelihood of being treated with dignity (CNAs)    0.621
Technical skill of nurses                          0.617
Explanation of your care                           0.617
Responsiveness to your own ideas about your care   0.615
Security of the facility                           0.614

For more information about nursing home resident satisfaction, read the Press Ganey 2005 Health Care Satisfaction Report, available at: www.pressganey.com/products_services/readings_findings/findings/default.php.