Fighting the Perception of SNFs as ‘Minor Leagues’ of Nursing

Skilled nursing operators know the cold facts: Finding and retaining quality employees has gotten a lot harder as the improving economy created a job-seeker’s market, especially among more specialized practitioners such as nurses.

And that’s before considering SNFs’ reputation as a “farm system” where nurses go to pick up a year or two of experience before moving on to settings that are considered more prestigious or exciting — such as hospitals or private practice.

A prestige problem


“We have seen and heard that people will leave for the hospital because of the higher pay and the prestige,” says Natasha Bryant, managing director and senior research associate at LeadingAge.

“I think the perception of working with older patients is that you’re not going to have to do as much —even though that’s not actually the case,” Bryant continued.

Bryant, who leads the LeadingAge Long-Term Services and Support (LTSS) Center at the University of Massachusetts Boston, said nurses — especially licensed practical nurses (LPNs) — can actually end up having more responsibility at a SNF than in the supposedly more glamorous world of hospitals.


“Often, they can be charge nurses and supervising some of the direct-care staff,” Bryant said of LPNs in skilled settings.

The problem starts with nursing training programs, which Bryant says place an undue focus on hospitals as clinical settings for aspiring nurses. Were they introduced to it at an earlier point in their nursing careers, Bryant says, LPNs and registered nurses might find the work at SNFs to be as challenging as working in acute care — if not more so.

“The responsibilities — specifically for the LPNs — can be pretty extensive, and more so than in the hospital setting,” Bryant says.

Susan Hildebrandt, who runs LeadingAge’s new Center for Workforce Solutions, echoed Bryant’s sentiment.

“We have a lot of sub-acute areas that are very, for lack of a better word, exciting, but you definitely have people moving to hospitals because the like that environment better than long-term care,” Hildebrandt said.

She pointed to a recent LeadingAge study in which 30.6% of surveyed long-term care (LTC) providers identified registered nurses as the most difficult position to fill, with 22.2% naming LPNs and licensed vocational nurses (LVNs). That’s going to pose a significant problem for providers going forward: The same study estimated that LTC operators will need 73% more registered nurses and 70% more LPNs to accommodate demand by 2030. By that same year, LeadingAge estimates that care providers will have to boost total staff by 2.5 million people.

Of course, money plays a key role in a provider’s ability to retain quality staffers, and SNF operators find themselves at a disadvantage relative to other workplaces.

“There can be higher pay in a hospital setting than in LTSS, and that’s harder to overcome, because some of it is driven by reimbursements from Medicare and Medicaid in nursing home settings,” Bryant said.

Building partnerships

Recognizing the workforce challenge, the team at Ecumen — a non-profit senior housing and care company based in Shoreview, Minn. — decided to forge partnerships with local colleges, including the University of Minnesota and St. Catherine University in St. Paul. Nursing students from St. Catherine, for instance, work in a variety of care settings at Ecumen’s facilities, which range from independent living to assisted living to skilled nursing.

“There are plenty of people who want to go into gerontology, and sometimes it takes a little convincing and exposure for others,” Shelley Matthes, the company’s senior director of quality improvement and resource utilization, told Skilled Nursing News.

Ecumen also received a grant to encourage student nurses to consider a career at rural facilities, which Matthes said account for most of Ecumen’s footprint. Under that program, called Ecumen Scholars, students gain hands-on experience and learn about the potential advantages of working with seniors.

For Matthes, the connection is personal: When she first graduated from nursing school, she had her heart set on a job as a labor and delivery nurse, but high demand for those positions eventually led to her finding a position in elder care. Like many in the field, she initially thought she’d spend a year before moving on to other settings, but soon fell in love with the work.

“There’s so much value in it,” Matthes said. “It’s not just a short-term fix. You develop relationships.”

Written by Alex Spanko

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