Enhancing Employment in Long Term Care:
A Guide to Retention
Good Wages and Working Conditions
Fair and Consistent Attendance Policies
- Assign one person to track attendance.
- Involve your employees in setting attendance parameters.
- Reclassify absences as unscheduled time off.
- Each spell of illness equates to one absence.
- Consider exempting physician excused absences.
- Do not accept physician excuses which simply say "reportedly ill."
- Develop steps of discipline related to inconsistent attendance.
- Implement a policy under which perfect attendance for a specified time frame eliminates previous warnings related to poor attendance.
- Reward good attendance with bonuses, extra days off, hourly incentives for no late arrivals, hourly incentives for no absences, and hourly incentives for not leaving early any time during the week.
- Decrease hours until attendance improves.
- Do not allow an employee to pick up extra hours if his/her attendance is a problem.
- Develop and implement a "no fault" absence policy.
- Develop rewards and discipline based on absences regardless of the reason; however, you do have to accommodate the Family Medical Leave Act.
- Bonus for no absences or tardies -- 4 hours/month for full time; other employees are pro-rated.
- Bonus for 2 or fewer absences during first 90 days.
- No absences for 3 months results in paid day off.
- 10 cents for every hour worked without call-off during each pay period.
- Paid personal day for no absence in 6 months.
- Gift certificate for every pay period for perfect attendance; staff who have not missed work have their name entered in a drawing; for every 4-8 hour shift worked over the FTE status, they receive an additional ticket for the drawing.
- For every 2 consecutive months of perfect attendance, employee receives 8 hours pay.
- Perfect attendance for one year results in one week's pay.
- Perfect attendance for one month has the last disciplinary action concerning attendance removed.
- Incentive program to reward employees for working extra shifts -- you must work your own shift to become eligible. If you work an extra shift, you will be paid $4 more/hour. If time- and-a-half for regular pay rate is greater than pay amount offered, you are paid at the higher rate.
- Continue working to educate the public regarding the role of long term care employees.
- Develop an environment of respect for all disciplines in long term care.
- Mandate zero tolerance for disrespect.
- Encourage employees, family and residents to provide positive feedback related to the performance of individual employees.
- Encourage employees to mingle with other employees during break time.
- Accept and seriously consider employee suggestions for problem solving.
- Develop levels of advancement and growth for all staff positions.
- Encourage all employees to attend staff meetings and other employee gatherings.
- Casual Dress Day -- every other Friday; every pay day.
- Have a theme for casual day, such as hat day, sweatshirt day, Valentine's Day Halloween, Homes for the Aging Week T-shirt day.
- Vary patient mix for staff (this also appears under "permanent assignments).
- Humor in the workplace -- involve management; have bulletin board with cartoons, posters.
- Provide books on humor.
Clear, Measurable Performance Objectives
- Keep your employee job descriptions up-to-date.
- Correlate the performance review with the job description.
- Review the employee's performance after probation and annually thereafter.
- Inform all disciplines of expectations.
- Have your in-house staff conduct competency direct care reviews on an annual basis. This will help your CNAs at survey time.
Consistency in the Work Environment
- Establish written policies and procedures.
- Expect policies and procedures to be followed.
- Develop an appropriate disciplinary system and adhere to it when policies and procedures are not followed.
- Enforce equally for all disciplines and all shifts.
- Do not allow exceptions on holidays, weekends, or times when staffing is down.
- Consider special circumstances with flexibility, and be consistently flexible.
Work Environment Equipped with Adequate, Updated, Working Equipment and Supplies
- Ensure the facility's blood pressure equipment is adequate and working.
- Keep your supply rooms adequately stocked.
- Purchase as possible up-to-date bath equipment with scales.
- Provide electric lifts with adequate nets for transfers and toileting.
- Provide an adequate number and quality of lifting equipment including transfer lifts, toileting lifts, gait belts, slide boards, SLIPP transfer sheet, and bath transfer systems.
- Purchase other ergonomic equipment as needed.
- Provide personal protective equipment.
- Make sure your facility has adequate, clean, working wheelchairs, geri-chairs and tray boards.
- Install motion detectors.
- Maintain an adequate supply of disposable diapers, pads, and wash cloths.
- Ensure your utility areas are clean and well-vented.
- Ensure gloves are available and readily accessible.
- Provide splash-free urinary drainage bags.
- Consider purchasing SLIPP patient-movers.
- Provide separate adequate, working linen carts for clean and soiled linens.
Work-Efficient Work Areas
- Maintain a handy linen supply.
- Make sure transfer equipment is readily available.
- Implement an efficient system to move residents to and from the dining room and activities.
- Maintain spacious resident rooms.
- Implement a simple supply charging system.
Charting Area at the Nursing Station
- Provide a specific area at the nursing station for certified nursing assistant charting. Equip this area with seating, pens, and good lighting.
- Ensure the charting area and system are set up in a private area. If employees are not interrupted while they are charting, they can do a better job.
- Ensure certified nursing assistant access to the call system.
- Promote professional interaction among all employees.
- Create interdisciplinary teams to assess service provided and how to improve it.
- Create employee focus groups.
- Include employees (CNAs) in rehab meetings.
- Ask staff regularly where they think time is wasted and how things could be done better.
- Conduct employee surveys.
- Staff meetings monthly; incentives for suggestions; incentives could be free lunch, buttons, highlight in facility newsletter.
- DON has administrative assistant to handle paperwork, scheduling, payroll, so DON can be on the floor.
- Staffing Coordinator position -- for nursing full time -- handles scheduling, call-ins.
- Quality of Life Coordinator -- is the supervisor of nursing assistants.
- Mentor program -- assign a co-worker to each new employee; training for the mentor would be necessary.
- Dine with new the new employee in the main dining room on his/her first day at no cost to the employee.
Updates on Facility Hiring Efforts
- Post in-house openings in a common area.
- Report hiring progress or lack of progress at monthly meetings.
- Encourage word of mouth positive expressions.
- Encourage all employees -- all shifts and all departments -- to recruit new employees.
- Allow employees from the potential candidate's department to sit in on interviews.
Mandatory, Complete and Accurate Reference Information
- Develop an informal WAHSA network to check references on employees.
- Add a key phrase response to your reference check questions, such as "Would you rehire?"
Specific Screening for Quality Certified Nursing Assistants
- Do not be tempted to accept less quality when the number of your openings rises.
- Provide full details of the job and performance expectations during the interview process.
- Screen candidates for basic moral and work ethic.
- Involve other employees in the screening process.
- Take candidates onto the nursing units to see their response to residents.
- Give assignments with a partner.
- Promote nurse-to-certified nursing assistant interactions.
- Sponsor educational programs and social events to promote team interactions.
Beepers to Communicate with Partners
- Use actual pagers.
- Activate a voice response call light system.
- Consider alternative communication systems such as preplanning at the start of a shift, door markers to indicate assist needed, developing specific work patterns, or working in teams.
- Encourage all certified nursing assistants to wear a panic alarm. If a CNA gets into a crisis when she is alone, the panic alarm enables her to alert the other unit that she is in trouble.
Time with the Supervisor at Regular Intervals During the First Three Months of Employment
- Schedule new employees to eat lunch with their supervisor.
- Schedule weekly brief chats at the end of each shift to discuss how things are going.
- Encourage supervisors to give employees compliments, comments and/or greetings.
- Encourage all employees to call new employees by their names.
- Post a picture of a new employee on the bulletin board.
Pleasant Work Environment and Access to a Lounge
- Ensure the employee lounge is comfortable, pleasant, and easily accessible to the certified nursing assistants and consider making the following available within the lounge: background music, air conditioning, ample comfortable seating, vending machines, free milk, free coffee, refrigerator for lunches, microwave, toaster, bread, butter, peanut butter, and jelly.
- Consider offering a private break area for certified nursing assistants.
- Provide access to a telephone for personal calls.
- Set up a communication bulletin board for personal messages.
- Provide a locker room with a shower area and secured lockers.
- Ensure odor control throughout the facility.
- Provide occasional treats for all staff. Consider having your facility sponsor an occasional treat for all shifts, e.g., pizza, popcorn, cake, cookies, etc.
- Institute a policy that allows a casual day each week -- clearly specify what's appropriate and what's not.
- Allow certified nursing assistants to keep the same shifts when possible.
- Allow certified nursing assistants to work on the same wing when possible. (This scenario can create potential problems such as cliques and less willingness to try other methods.)
- Offer permanent assignments as a longevity bonus if this is desired by the certified nursing assistant.
- Establish permanent float slots.
- Allow CNAs to have input into the team with which they want to work.
- Remember, permanent assignments promote pride and ownership. Residents and families also like the permanent assignments.
- Offer weekend or holiday bonus pay.
- Establish PM/night differential.
- When you need to fill a staffing need, offer a wage bonus for working an extra weekend or a shift other than that for which a certified nursing assistant was hired.
- Pay wage increases as possible.
- Offer merit and longevity increases.
- Annually provide a printout of benefit costs per employee.
Benefits -- Dental Insurance, Life Insurance, Less Expensive Health Insurance and Pension/Profit Sharing
- Provide a vehicle for a staff-sponsored dental program.
- Provide a set dollar amount of preventative care.
- Contract with providers for discounted services.
- Provide a standard dental insurance plan.
- Explore HMOs to find one that has less out-of-pocket expense.
- Consider self-insuring deductibles or a portion of them.
- Consider sponsoring a 401k plan with an employer contribution.
- Assist your employees with individual payroll deduction options.
- Develop a cafeteria plan based on an employee's pre-tax dollars.
- Allow paid sick days for a specific number of sick days.
- Pay for a wellness day off if an employee uses no sick time.
- For an employee who has no absences, pay a lump sum bonus or an hourly increase.
- Provide good lighting to and in parking areas.
- Provide security in and to parking areas during change of shifts.
- Make routine security rounds of parking lots.
Chapter Two: Scheduling Options
Chapter Three: Recognition
Chapter Four: Feeling In on Things
Chapter Five: Fringe Benefits and Other Incentives
Chapter Six: Growth and Opportunities
WAHSA 204 South Hamilton Street Madison, WI 53703
Telephone: (608)255-7060 FAX:(608)255-7064