In an ongoing effort to seek ways to reduce turnover among direct-care workers, Better Jobs Better Care (BJBC) was a $15.5 million research and demonstration program funded by the Robert Wood Johnson Foundation and Atlantic Philanthropies from 2003-2008. BJBC was designed to bring about changes in long-term care policy and practice that help reduce high vacancy and turnover rates among direct-care staff across the spectrum of long-term care settings and improve workforce quality. Cornell University, led by Karl Pillemer, PhD and Rhoda Meador, PhD, designed the retention specialist program to address the causes of nursing home turnover.
The retention specialist program is a staff development model designed to improve the certified nursing assistants’ (CNA) retention in nursing homes. The program trains a staff member as a retention specialist who is responsible for evaluating, implementing and sustaining a retention program for CNAs. The retention specialist position led to a significant decline in turnover rates and had positive effects on CNAs’ assessment of the overall quality of the nursing home in which they worked and the quality of retention efforts. After the program, one retention specialist said, “Prior to the training, it had never dawned on me that part of my role as a HR director was to help new staff feel at home, or that an employer should try to make them feel accepted. I was more concerned with finding people who could do the job. This knowledge has also been factored into what we now expect our mentors to do. This has made a big difference.”
One staff member in a nursing home was designated as the retention specialist and received 3 days of training on effective retention programs. The staff member had the expertise and received tools and ongoing support to systematically address problems of low job satisfaction and resulting turnover. The retention specialist evaluated needs and resources and customized a CNA retention strategy for the nursing home as well as evaluated the programs’ success and modified them as needed. The position required about 20% of the time on the program. Below are the components of the program used by nursing homes in the study.
Training should present intervention strategies that are based on evidence such as:
- Respect and recognition for staff
- Good supervisory and coaching practices
- Career ladder programs
- Peer mentor programs
- Good communications, conflict management, and partnerships
- Promoting work/family balance
Communities will need to decide on their own which programs would be most helpful—essentially, a needs assessment, which is a systematic approach to determining the strategies they will use.
Set up an information kiosk for direct-care workers on personal issues that may affect their ability to do their jobs, such as:
- Financial well-being
- Healthy lifestyles
- Child care
Start with a couple of best practices and add to them over time:
- Nursing homes in the study tended to start with 1-5 retention practices that are shown to work
- All nursing homes set up an information kiosk with information provided by local communities
- Most nursing homes started a peer mentor program or upgraded a current one
- Most nursing homes already had a career ladder or upgraded a current one
- Several communities started informal programs around employee respect and recognition and communication training
Factors for Success:
- Understand that there is not a one-size-fits-all program—you will be most successful if you tailor it to your community
- Select a retention specialist who will be a champion for the program within your community – or better yet, train an entire team (e.g., an administrator and a direct-care worker)
- Make sure your leadership is supportive of the program
- The success of the retention specialist is a continuous, integrated approach to the ongoing operation of the organization.
- Average turnover of CNAs dropped by 10%
- CNAs reported that the “community attempts to keep good employees”
- CNAs rated the quality of their community as higher
- The effects of the retention specialist were strongest in communities that had several retention programs—demonstrating that this program may be more successful for larger communities who have more resources
Need more information?
Contact Karl Pillemer.