Models for Practice
During the First 90 Days of Employment
Published by
Wisconsin Association of Homes
and Services for the Aging
204 South Hamilton Street
Madison, WI 53703
Preface
A few years back, WAHSA's
Health Issues Committee developed the Task Force on Long Term Care Employment. The purpose of this task force was to
examine current concerns, consider future trends, and recommend positive strategies to issues such as labor
shortages, recruitment and retention, work ethic, attendance concerns, and general labor trends.
The first project of the task force was the booklet Enhancing
Employment in Long Term Care, which originally was published two years
ago. The book was adopted and enhanced by WAHSA's sister association, the Indiana Association of Homes and Services
for the Aging (IAHSA). Earlier this year WAHSA incorporated many of the additions incorporated by IAHSA, and
republished this book of ideas to enhance job satisfaction and retention in long term care.
WAHSA's quest to enhance recruitment and retention in long term care has continued to spark new ideas and new
products. Most recently, IAHSA surveyed long term care facilities for ideas for a new publication,
Models for Practice During the First Ninety Days of Employment
. The Indiana association has graciously shared this publication with WAHSA as we
continue to work together to nurture a more positive environment for people to live and work in this arena we call
long term care.
Like IAHSA, WAHSA believes the first ninety days of employment is a critical time for retention. As such, we hope you
find these low cost ideas easy to implement and helpful to utilize.
WAHSA wishes to acknowledge and commend
the efforts of the long term care employees in Indiana, and the staff of IAHSA for sharing these ideas with us.
Sincerely,
John Sauer, Executive Director
Attracting Employees
What do you do to attract applicants?
First impression of facility is important; friendliness of receptionist is very important
Professional advertisement in local newspaper
Ads in church bulletins, laundromats, colleges, high schools
Word of mouth
Good benefits that are fully explained; medical insurance a plus
Flex hours; advertise that moms can leave after the school bus and be home when it arrives
Tuition reimbursement
Offer competitive pay rates, especially for positions with greatest turnover
Offer attractive benefit package to those scheduled to work 20 hours or more per week
Assign a "preceptor" to new employees for the first 90 days
Child care in facility
Post available jobs in house
Participate in career days in the area high schools
Good community public relations; attend job fairs, health fairs
Appearance of facility
Discuss fact we are accredited
Employee referrals; bonus paid to current employee
Quick response by department heads for interviews and follow-ups
Use response post cards on receipt of application to let candidate know when they will be contacted
Open house for interviewing; on the spot interviews
Sign-on bonuses
Recruitment bonus for current employees who refer new employees
Serve as a clinical site for nursing students
In ads, stress mission, benefit program and shift flexibility
Offer and provide orientation with above average co-worker
Shift differentials
Free uniform after one year of employment
Medical doctor in building also sees employees
Cross training of different departments
Encourage "pool" employees to become permanent; present a 30-minute orientation to first time personnel; help them have a pleasant experience
Offer tour of facility at time of application
High school/work programs; high school seniors attend class five days per week for two hours per day; program explores different health occupations while getting CNA license
Job shadowing through technical programs
Nurses work every third weekend instead of every two
Benefits offered to employees working 20 hours or more per week
Successful Techniques for Screening Applicants
Give clear, concise job description
Require resume to pre-screen for interview
On-site application and interview
Complete drug screen and criminal check
Check references
Second interview
Work with local agency "Welfare to Work"; they do the screening
Look for job stability
Ask a series of questions (same questions) to all candidates to learn about individuals likes and dislikes.
Make applicant feel important and comfortable
Make eye contact with the applicant
Have applicant observe area where she will be working
Have other staff members interview applicant to get feedback
Screening committees
Two step interview process; first Human Resource Department, then Department head
Interview by department heads including many open-ended questions to determine suitability
Conduct joint interview by management team
Department heads screen applicants as a group for other department head positions; trying to implement this with other front line departments
Facility tour and introduction to staff and residents to observe comfort level and interaction
Make sure transportation to work is not an issue
Ask what kind of residents she has cared for in the past, how she responds to aggressive residents, co-worker issues
Questions: what do you like best about the job? What is the worst part of the job? What can I expect to hear from past employers? How did you solve problems at your past job?
Orientation Process
Common Orientation Components
Review policy and procedure manuals thoroughly
Review safety policies and procedures
Review job descriptions and expectations on a weekly basis, then bi-weekly, then monthly as necessary as evidenced by satisfactory performance
Provide constructive feedback
Three hours of orientation to facility and policies and at least one week working with another employee
One time weekly for four hours -- Review resident rights, HIV/Aids, OSHA, needs of the elderly, paperwork, employee handbook
One day to review policy book, insurance, safety; at least two days on each unit that they will be working on
40 hours of orientation
Three hours of policy and procedure history and mission of organization presented by the CEO
CNA Training Assistants act like a mentor for new employees
Review mission of organization
Review two weeks after person begins to determine their favorite part of job, least favorite aspect of the job
Sample Orientation Programs
Before employee begins, an appointment is made for her to meet with human resources for completion of new hire paperwork and review of employee handbook; she then goes with the department head for orientation and training in areas such as general safety, evacuation, fire/electrical safety security, blood-borne pathogens, MDS; there is ongoing department orientation for the first 90 days related to job duties.
Orientation program addresses needs of aged, organizational chart, personnel policies, appearance and grooming, first aid, fire prevention and evacuation, tornado, resident rights, ethical considerations and confidentiality universal precautions and a specific review of residents the employee will be caring for
Orientation day lasts eight hours and includes policies, procedures, videos, tours; there also is training with someone for 4-5 days on the specific job
Physical exam and then a general orientation to facility by Human Resources for the morning; lunch is provided and then the new employee receives a specific orientation to the job; she then spends three days with a peer
Total orientation time is five days and includes tour and introductions to all department heads plus completion of mandatory inservice requirements
Two hour orientation with Human Resources before reporting to the respective department for work; included here is a tour, time clock procedures, payroll paperwork, required films; one month after hire a four-hour orientation is given in order to meet all department heads and have an extensive review of the handbook
A welcome sign is posted and refreshments are served on arrival; we plan our day together, we review paperwork and create a schedule together; we do not use many videos. Administrator has lunch with the new employee
Four-hour classroom orientation session that covers personnel policies, dress code, customer service, benefits and facility tour; after one week we visit with new employee to see how things are going
Day one is four hours; staff development coordinator goes over all policies, tours the building; introduces to co-workers; day 2-10 -- work with another employee who holds the same position; Staff Development Coordinator observes performance and assists where needed
Two orientations for each employee -- facility orientation which covers basics of OSHA, resident rights, employee manual, safety, time clock, blood borne pathogens; and department orientation which covers actual training for the position. Each department has its own process for orientation which ranges from 3-14 days.
Part I -- 1/2 day corporate orientation covering mission, values, history, human resource policies, benefits interviewing residents and staff, experiential learning. Part II -- facility specific information such as parking, resident rights, lockers, safety. Part III -- position/department specific orientation
After completing general orientation, new employees are guests for lunch in the Main Dining Room and a member of the management team will dine with them
Try to keep new employee on same schedule with a buddy
Nursing department orientation on the first day -- logistics, OSHA, OBRA guidelines plus specific nursing policies and procedures; used a scavenger hunt game to acquaint staff to the facility
Hospital Based Units
RN/LPN orientation is a six-week minimum; assign 1-2 preceptors, give overview the first week, one day shadow, 1st week assign 1-2 residents, 2nd week assign 2-3 residents, 3rd week assign 3-4 residents and one admit and one discharge, 4th week with unit secretary, MDS coordinator, admissions coordinator as well as 3-5 residents care, nurse manager meets with new nurse weekly; CNA orientation -- meet with them initially to establish their needs, strengths and weaknesses, two weeks full-time orientation with 1-2 preceptors rotate all three shifts
One full day of hospital orientation is given by Human Resources department that covers hospital policies and includes all mandatory in-services. Then they orient with department for 3-5 days
Full day orientation includes personnel manual, guest relations, lunch with CEO, tour; then at least three days of orientation on the unit and shift
Hospital orientation begins during application/interviewing/recruiting/even advertising process. Orienting people to our culture requires that Human Resources provide golden rule treatment of candidates. Hospital orientation is scheduled once a month from 9-4. It may or may not be the employee's first day. It is designed to be warm, welcoming and informative; includes music, balloons, slides
After a general orientation, the new employee is paired with a preceptor for up to six weeks of orientation
First three days are with Human Resources to discuss benefits, tax forms, required in-services; the rest of the first week is spent with supervisor doing a departmental orientation; second week the new employee shadows someone with same job class and becomes aware of facility policies and procedures
All new hires attend a four-hour hospital orientation before beginning on the unit. Orientation on the unit is with an experienced employee, usually on at least two shifts
All licensed personnel have five days with clinical educator; unlicensed personnel have two days with the clinical educator. Each person then has a clinical orientation on the unit generally 10-14 days for LPN, three weeks for RN and 5-8 days for CNA
A needs list is given to all new associates so they can identify areas in which they need assistance; resources are then provided to help them; all new associates receive a packet of competencies which they must complete within 90 days
Day 1 -- orientation to department including how and where to find supplies, policies and procedures; documentation using our computer system, goals and expectations of new staff member; Day 2 -- work with assigned staff member, gradually increasing responsibility for care, no assigned patient; Day 3 -- 1-2 patients, during this time progress toward goals is reviewed.
Human Resources provides a two-day orientation of non-nursing issues, including blood-borne pathogens, TB, safety, resident rights
Training Period
What do you do to encourage employees to remain?
Assignments
Assigned to another CNA for three days
Assign someone to work with new employee until she reaches her comfort zone
Department heads have employee working with them until they are sure of their position
Do not reassign to different units within the first six months, if possible
Employees are assigned a trainer for 3-5 day training period
Have 3-5 orientation days on the same unit, so new employees can get into a routine
Send employee to another unit to broaden her knowledge base
Assign a preceptor
Buddy system -- one good experienced person to work with new person
Provide resources such as reading material, videos
Gradual case load for nurse aides; place on unit which best suits their level of competency
Communication
Informal three and nine month evaluation by supervisor; keep in touch on a regular basis
Welcome forms distributed to all departments heads introducing new employees so they can welcome them also
Give new employee a notebook to carry around so they can jot down questions or concerns
Follow-up with department director at least once a week for the first month
Have been discussing a 21, 30 or 90 days touch-base orientation group
Keep detailed achievement list
One-to-one sessions with supervisor
Two week evaluation; 90 day evaluation with pay increase; insurance after two months
Mission follow-up; are we doing what we say in our mission?
Post welcome signs with a little bio about new employees
Reinforce the orientation by asking questions and encouraging employees
HR director checks in with employee during first week
Provide a lot of contact with their immediate supervisor and department director; remind current staff to be supportive and friendly
Ask their opinions as to how unit functions; make effort daily to greet employees and ask if they have questions or concerns
Thank employee for going a good job
Post new employees' picture in the break room, welcoming them to the facility
Follow-up with new employees, listen to concerns
Friendly, patience, praise new employees' work, use diplomacy when correcting errors
Periodically review training to date and praise employees' progress
Executive Director meets with new employees to see how they are adjusting
Staff development director follow-up with new employee
Meals
Have new employees pitch in during lunch
Free meal ticket for three days of training
Provide a five-day meal ticket to welcome them to the facility
Lunch/break with co-worker
Provide a free meal ticket during the first week of employment
Employees are assigned to a trainer for 3-5 days, employees and trainer receive free meal ticket during training
Miscellaneous
Award company logo polo shirts at the end of the 90-day training period
Provide information about committees that they can participate in that include family members, staff and residents -- for example, social committee, quality of life committee
Mentoring Programs
For new nurses, a 12-week program with one main mentor who is designated as a resource buddy for the first year of employment. Perks such as stethoscope, drug book; bonus for three years of maintaining same FTE status and additional bonus for five years
Develop a CNA trainer program -- long time CNAs are asked to work as mentors to new CNA students. Hopefully, the long term commitment will rub off.
Implement a "senior aide" program
Assign new employees to work with a well-seasoned employee. New employees must complete a skills check sheet as duties are preformed. Preceptor also initials this check sheet.
Each new employee is assigned a mentor/preceptor for the orientation period (3-5 days) and follow-up into the first three months or employment. No more than three employees are assigned to one preceptor. Preceptors must meet certain qualifications
Experienced CNAs work with new employees for a two week period; selected CNAs are paid an additional $.50 per hour. There are certain requirements to become a preceptor, not just longevity
Recognition of Employees
Food Events
Monthly employee appreciation receptions -- 45 minute staff party; grab bag, entertainment, songs, awards
Banana split days
Bring in food -- pizza, sandwiches, etc.
Each month have an employee appreciation day -- ice cream social, caramel apples, donuts
Recognition dinner; annual banquet, entertainment, prizes and gift for each employee
Staff that work extra hours get free meals, DQ treats or coupons
Recognition party each quarter for employees
Special meal after completion of good survey
Catered all-employee dinner
Award Programs
90-day pins, employee of the month
Pins for certain years
Attendance Recognition
Perfect attendance sheet
Perfect attendance receives day off with pay; employee of the month receives $50 gift certificate, plaque and parking spot; employee of the year gets $150 gift certificate
Attendance gift certificate
Bonus days for perfect attendance
Perfect attendance for two consecutive months receives $25 cash or $25 savings bond
Established Recognition Programs
Would like to start a staff recognition box and have family, staff, residents input information about good employees
"Good Samaritan" program
"Pat on the Back" program for special efforts
If your team does not have any accidents for a three-month period, each team member gets a $25 bonus
"Service Star" program -- resident, co-worker, family, can write a letter (star); when you receive so many stars the employee earns a paid day off
Employee of the month -- certificate, picture in newsletter, savings bond, eligible for employee of the year; employee of the year -- plaque, pin, reserved parking fore a year, cash, trip
Applause sheets -- fellow co-workers and residents voluntarily fill out sheets to recognize other employees; the information is then published in facility newsletter and posted
Weekly "Caught Caring Award"
"Ambassador Program" -- nominated by peers, residents, families if they go above and beyond job duties; if selected, we have a breakfast in their honor, picture and name on display in local newspaper, plaque and jacket
"Angel Program" -- angel cards submitted for above and beyond; each employee who receives a card also receives an angel button; angel of the month gets angel pin, picture taken. Angel of the Year receives a rhinestone pin and a gift certificate
"Associate of the Month" receives a gold star on badge
"Catch in the Act" Program -- manager gives a certificate and candy bar
Birthday Gifts -- For employees with at least one year of service, they can pick a gift with a $25 value from a catalog; those with less than one year receive an umbrella or water bottle
Printed Forms of Recognition
Bi-weekly newsletter features "Roses to…"; Attitude slips that go to HR file
Frequent thank you notes to the department
Publish thank you notes from families
Care grams or cards
Thank you board -- employees are recognized by other employees for small and large efforts
All family and resident thank you letters are posted
Appreciation certificates
Use talent cards, bravo pads that display an "I Can" attitude
Letters of appreciation when we see acts of kindness
Anniversary cards every year on anniversary of employment
Other Forms of Recognition
Tokens given that can be used for purchases at our general store
Birthday cards
Verbal recognition
Promote from within for example restorative care, unit carrier CNA
Be flexible (schedule) when they have special needs
In July, hold a free car wash where department managers and supervisors wash employees' cards
Send to state association conventions and educational training seminars
After 20 years of service, receive a savings bond
Ongoing appreciation on a daily basis by Executive Director and department heads
Recognize privately and publicly
Flexible scheduling
Preferred parking space for employee of the month
Special dress down days with refreshments; turkeys and hams given on Thanksgiving to every employee
Involve in problem solving process of department
Offer training and staff development opportunities
Monthly service excellent award recipient
Incentive Programs
Describe the Incentive Programs that Encourage and Reward Employees
Other than Monetary Incentives
Free immunizations and screenings, sick child care at discount price
Flexible scheduling
Tuition assistance
Staff chooses uniforms
Staff and family picnics, pot lucks and back sales
Fridays are dress down days
Education seminars outside the facility
Project Pride -- staff turns in ideas that cost $250 or less; if the project is selected, the staff member helps plan the project and purchase any materials; winner receives a prize
Publish thank you notes from residents and families
Free meal ticket for working extra shift
"Catch'm in the Act" Program -- when an employee goes above and beyond regular duties, any manager can give a certificate to the employee which can be redeemed for candy, soda or other treats
Paid days off to use for vacation if they are not used for sick days
Bonus days for attendance and for recruiting new employees
Holiday and sick pay accrual after 30 days
Individual's birthday is considered a holiday
All nursing personnel may attend workshop of their choice yearly; hospital has goal sharing program -- for an 18-month period the following has to be met:
Hospital financial goals
Unit goals as directed by administration
Personal individual goals, i.e., current CPR
After 18 months if goals are met, each individual receives a check for 1-3% of annual salary
based on goal accomplishments
Encourager Group -- Anyone can belong and we charge $1.00 per month. If someone is ill or has a hardship, we give cards, money. Once a month we have an "encouraging event" pitch in etc.
Flowers sent by facility to sick employees or if there is a death in the family
Safety-fund money is paid out for no work injuries
Paid Incentives
Six months perfect attendance receives $100
Perfect attendance for two months, the employee receives $25 cash or $25 savings bond
Perfect attendance savings bond
Upon successful completion of six months employees receive a 2% increase in pay
90 day review with merit increase
Nursing assistants receive $.60 increase once they pass the state test; other departments receive 10-20 cent raise after six months of service
Retention bonus of $200
Nurse attendance get 4.5% increase after completing training program and state exam
$.25 increase for non-nursing staff after 60 days
Monetary bonus given to employees that work 510 hours; then 1020 hours, then 1530 hours
90 days and annual increase based on performance
Referral bonus -- if new employee stays 120 days, current employee receives $250
Begin earning time off benefits immediately, but they are not paid until employed for at least 90 days
WAHSA 204 South Hamilton Street Madison, WI 53703
Telephone: (608)255-7060 FAX:(608)255-7064