Today, skilled nursing facilities (SNFs) of all sizes in all corners of the country are finding it harder and harder to attract qualified full-time employees, and retain them over time. From large multi-facility chains to small facilities and everything in between, human resources (HR) professionals at skilled nursing facilities face similar hiring and retention challenges. Good people are hard to find these days, and it can be even harder to keep them over time—especially in light of the ongoing coronavirus (COVID-19) pandemic.

While there’s plenty of research and anecdotal information freely available to help guide your hiring practices, we at Richter recommend two strategies in particular that, based on our experience, position SNFs for success:

• Implement processes and guidelines that help identify winning candidates up front. Don’t just have someone fill out an application and then base your hiring decisions on that. Instead, develop a process that includes multiple face-to-face interviews (at least 2-3) for every candidate. Ideally, specific personnel from the candidate’s discipline (e.g., clinical, financial/accounting, administration) should participate in interviews. The goal: Get an honest feel for the candidate—who they are, what drives them, why they seek this opportunity and much more. No doubt, this requires an investment of time for everyone involved; but proper vetting up front helps you weed out bad hires early on, before they end up on the floor serving residents.
• Establish aspirational criteria that apply to all candidates. You should hire a candidate for the right reasons – not just to fill an immediate need – and hire to your SNF’s unique culture (yes, you have one). Particularly with clinical staff, it’s essential that candidates are qualified, compassionate and want the job for the right reasons. Working in skilled nursing is tough, and easier alternatives do exist. In fact, toward the bottom end of the spectrum (where shortages are acute and turnover is high), average compensation for a nurse’s assistant is on par with unskilled jobs in areas like retail and food service. Candidates could earn comparable wages in less demanding environments, so make every effort to hire the ones who demonstrate genuine interest in the field.

Once you hire an employee, it’s crucial to onboard him/her properly. In fact, research by Glassdoor found that organizations with a strong onboarding process improve new hire retention by 82 percent and productivity by over 70 percent. Yet, according to Gallup research, only 12 percent of employees strongly agree their organization does a great job of onboarding new employees.

Given severe labor shortages in SNFs across the country – particularly in clinical areas – it’s tempting to fast-track orientation—or skip it altogether. Consequently, a new hire could arrive on the floor with inadequate training and/or mentoring. In most cases, frustration ensues, resident outcomes are impacted and, too often, the new hire quits prematurely. Full-time employees are in short supply these days, so this scenario is the last thing your facility needs. Avoid it by establishing a structured orientation program – if necessary, down to the minute – then build processes and timelines into it and assign roles and responsibilities to stakeholders.

It’s also important to establish and nurture peer mentoring initiatives so that new hires can turn to an experienced ally and advocate in their department—someone they can look to for help, advice, answers to questions and other guidance. We’ve seen peer mentoring programs in action in SNFs across the country, and without a doubt, they play a key role in helping employees do their jobs better and stay with the organization over time.

Finally, there’s engagement. You can find volumes of information online regarding employee engagement initiatives and strategies, and we encourage you to embrace those that best fit the needs of your staff across the organization. Broadly speaking, engagement efforts in a demanding setting like an SNF should emphasize:

• Appreciation. Employees want to feel appreciated, and they want their employer to tangibly demonstrate it. Sometimes, it’s as simple as telling someone they’re appreciated—just letting them know how much management cares about them.
• Ongoing training. It’s no surprise that the highest performing organizations across industries also have the most highly trained workforces. You should aspire to similar heights.
• Goal setting. Employees should work with their supervisor to set goals early on. Those goals should align with the facility’s goals and work toward supporting the overall mission, vision and values. Knowing what success looks like from day one helps employees work toward success—and they will be happier and more engaged in the process.
• Continuous feedback. Feedback mechanisms should be well-integrated into your operations so employees understand what they are doing well, and what areas could stand improvement.
• Real opportunities for advancement. Employees should feel empowered to reach their fullest potential— and your facility should encourage that by structuring opportunities for professional development, and ultimately, advancement.