Evaluating the Hiring and Orientation Process to Improve Nursing Staff Retention in the Skilled Nursing Facility Setting

1. Evaluating the Hiring and Orientation Process to Improve Nursing Staff Retention in the Skilled Nursing Facility Setting Stephanie Sherman University of Kentucky Martin School of Public Policy and Administration Masters Health Administration

2. Nursing Shortage in Long Term Care • Nearly 96,000 full-time nurse and other health care professional positions vacant in nursing homes around the U.S. (AHCA, 2003). • Paraprofessional Healthcare Institute predicts there will be one million nursing assistant positions to fill by 2010 (PHI, 2002). • Contributing Factors: • Baby Boom Generation • Nursing School Enrollments • Retiring Nurses • Turnover

3. Nursing Retention • Average Annual Turnover Rates • 49% for RNs • 71% for SRNAs • Total national costs of turnover for SRNA positions is over $4 billion per year (ACHA, 2003).

4. Importance of Employee Orientation • Failure to orient new SRNAs causes 36% of all employee turnover (Maun et al., 2000). • 75% of all employees who self-terminate made their decision in the first three days.

5. Pine Meadows Health Care • 120 bed skilled nursing and rehabilitation facility. • Located in Lexington, Kentucky • Employees average of 180 employees and over 80% is nursing staff. • Turnover Rates • RNs – 107% • LPNs – 90% • SRNAs – 107%

6. Purpose • The purpose of this study is to evaluate the hiring and orientation process at Pine Meadows. • The findings of this research will inform the design of programs aimed at hiring more effective nursing staff and creating a more knowledgeable and prepared nursing staff.

7. Data Collection • Existing Data from Pine Meadows. • Termination Files • Observation • New Hire Interviews • Facility Orientations • Floor Orientations • Interviews • Staff involved in Hiring and Orientation

8. Data Analysis • Pareto Charts • Voluntary Terminations • Critical Termination Points by position • Top-down Flowcharts • Hiring Process • Orientation Process • Cause and Effect Diagram • Areas of Concern

9. Results

11. 3.0 State Licensure Registry check 4.0 Abuse Registry check 1.0 Application Completed 2.0 Application given to SDC 5.0 Reference check 10.0 Orientation Day One: Facility Orientation 9.0 Orientation Scheduled 8.0 Drug Screen results received 7.0 Interview applicant 6.0 Call applicant for Interview • 0.1 O.R. • 0.2 I.C. • 0.3 E.P. • 0.4 O.R. • 0.5 P&P • 0.6 O.R. • 0.7 P&P • 0.8 E.S. • 0.9 I.C. + P&P Acknowledgement Form • 10.10 R.C. • 10.11 E.S. • 10.12 E.S. + R.C. Acknowledgement Form • 10.13 I.C. • 10.14 E.P. • 10.15 R.C. 7.1 Previous employment questions 7.2 Schedule preferences 7.3 Pay and Benefits 7.4 Dress Code and Staffing policies 7.5 Applicant questionnaire 7.6 Drug screen information 7.7 Copies made of DL and SS card. 11.0 A SRNA Orientation 11.0 B LPN/RN Orientation E.P. – Emergency Preparedness E.S. – Employee Safety I.C. – Infection Control O.R. – Organizational Requirement P&P – Policy and Procedure R.C. – Resident Care

15. Limitations • Single Investigator Bias • Subjective Data • Length of Research Time

16. Recommendation One: Ensure Appropriate Training of all Staff Involved in Hiring and Orientation • Staff Development Department • Practices and principles of HR. • Behavioral Interviewing technique. • Other Staff • Key staff selected for floor orientation. • Effective orientation and training techniques.

17. Recommendation Two: Provide Staff Development with Job Description and Measurable Goals • Up-to-date Job Description given during the interview to ensure accuracy of expectations. • Measurable Goals to Improve Effectiveness • Percent of turnover during orientation process. • Evaluation/Feedback scores from orientees.

18. Recommendation Three: Standardize Facility Orientation and Follow an Agenda • Arrange orientation materials into appropriate categories. • Set an agenda with specific time limits on each category. • Easier to identify material that are too lengthy and/or repetitive. • Allow the addition of important information missing from orientation. • Two day Facility Orientation is possible.

19. Recommendation Four: All Staff Should Know the Importance of First Impressions on Orientees • Train on customer service and teamwork, with emphasis on first impressions with new employees. • Orientee Identification Badges

20. Recommendation Five: Create a Staff Development Location • Private location that no other staff uses. • Professional environment. • Materials and Supplies can be housed in one location and easily accessed when needed.

21. Recommendation Six: Practice Continuous Improvement through Orientation Evaluation and Feedback Forms • Implement a survey given at the end of orientation. • Evaluation of separate parts of orientation to better identify breakdowns. • Anonymous • Mandatory • Recommend the use of structured questions with a Likert Response Scale.

22. Recommendation Seven: Implement a Post-Orientation Mentorship Program • Extra New Hire Support is Needed • High rates of turnover in second, third, and fourth months. • Formal or Informal

23. Thank You! • Dr. Sarah Wackerbarth • Dr. Philip Berger • Dr. Joseph Fink • Joni Gosser, RN • Staff at Pine Meadows Health Care

24. Questions?