How 3 Nursing Home Operators Strengthened Workforce Pipelines Amid Labor Crisis

Nursing home operators are changing their approach to staffing and recruitment to be more proactive and flexible, helping address severe staffing shortages being felt across the sector.

The pandemic forced Dwyer Workforce Development (DWD) to be more creative about attracting a pipeline of talented folks who might not have been their typical candidates in the past, COO Maria Darby said last week at the Skilled Nursing News Virtual Staffing Summit. Visibility in the community – through job fairs, networking events, and collaboration with non-profit organizations being key.

“How do you partner with nonprofits in a very specific and intentional way … particularly those that are doing work with workforce development?” Darby asked, adding that collaborating with organizations that don’t necessarily have “work” in their name, like Dress for Success, which gives women development tools and professional attire, helped their organization bring in candidates in the past year.

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DWD earlier this year acquired a 50-property skilled nursing portfolio in Texas, managed by Regency Integrated Health Services. The nonprofit offers a program to provide wrap-around support and career pathways for individuals who lack opportunity and aspire to pursue a career in the healthcare industry.

While the recruitment and retention landscape before the pandemic aired on the side of tradition, today’s methods are much more proactive and attentive, said Mission Health Communities VP Customer Experience and Communications Cheri Kauset. Tampa, Florida-based Mission provides skilled nursing and senior living in communities across nine states.

Recruitment and retention practices also are more democratized, with more staff being trained to interview and hire to speed up the process.

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Mission also changed the way it advertises positions to attract a wider pool of talent. In rural communities, one particular strategy that worked was sharing opportunities with high school classes about CNA and CMA education classes for free. In more urban areas, the organization leverages technology to drive traffic from colleges and universities.

“So for instance, one of the things that we do is we have a Resource Nurse position and this is attracting a great variety of registered nurses in leadership positions that are regionally focused to the centers,” Kauset said at the Summit. “They’re coming in and filling in nurse manager openings. They’re helping with survey readiness activities, they’re helping with post survey, corrective activities, all of those things. These nurses will fill in for maybe a wound nurse or an infection preventionist.”

Kauset said her team is also more thoughtful about the way they survey existing nurses; by not inundating her nursing team with an overload of surveys, managers get more thoughtful responses.

“It’s the Uber of nursing – they want to turn it on and turn it off,” she said. “ … We’ve got to adapt as an industry and health care to that. And so we’ve got to ask them for their feedback and the ways they want to be asked.”

The team also created mentorship preceptor programs, with a greater than 85% retention rate among individuals in the program.

“You’ve got to really look at ways at expanding what you’re doing internally. Because if you close the back door, you’re not going to have to source as many in the front door,” she said.

Supporting international nurses and clinical workers

Brickyard Healthcare partnered with an international nurse organization a year ago to hire more healthcare workers from overseas, helping the provider alleviate RN staffing shortages, said Chief Clinical Officer Lisa Chubb. Brickyard provides skilled nursing, long-term care and other services in 23 centers across Indiana.

“It has been so inspirational for me to be able to be a part of the interview process with these nurses,” she said of the 100-plus nurses she has hired for her organization, mostly from the Philippines. “Being able to meet with them one-on-one and getting to know them – although it’s via Zoom – you can feel the passion from these nurses through the computer.”

Demand for foreign nurses has skyrocketed since the pandemic, according to the American Association of International Healthcare Recruitment. Some state governors, like Kathy Hochul of New York, have lobbied to fast-track visa applications and approvals for foreign nursing applicants. Yet in most places, processing for international health care workers can take years.

Chubb said finding the right partner to help hire nurses internationally is paramount, especially considering the backlog.

“The nurses will get through the entire process overseas, when it comes to the exams and the testing and the licensure requirements and all those things,” she said. “And then they kind of sit and wait.”

For providers, understanding the visa process and potential areas of concern for international nurses can help make that transition smoother. Additionally, working their state associations, local government agencies and national government agencies to ensure that when the nurses do arrive there are no extra hurdles to jump through is key.

“We’ve had several senator visits in our buildings, and we talked to them about these initiatives and these projects,” Chubb said. “So as things come across their desk, they’re making the right decisions, and they’ve been educated on a grassroots effort to help us with these initiatives.”

Getting creative with incentives

The approach to financial incentives should be different for each community, state, and region, according to Mission Health’s Kauset.

Her team began utilizing an application that can keep staff up-to-date with communications, resources, opportunities and benefits, and also serve as a platform for members to share positive stories.

Mission also began providing employees with new virtual physical health benefits through Hinge Health, which offers patients physical therapy for neck, back, and joint pain. Those measures, along with a career-planning platform for administrators, have helped level out Mission’s retention numbers, Kauset said. 

On the other hand, sign-on bonuses – often used as a last-resort measure to draw in candidates – did not create a significant increase in retention.

“What we found was a lot of times the person that would apply for one of those roles and be retained in one of those roles was coming into it for the wrong reasons, rather than the right reasons,” she said.

What the team found was that putting more financial resources towards incremental referral incentives for individuals who actually stayed in their positions was a more effective strategy.

“People want to work with other people that are really good at their jobs,” she said. “And so you tend to know those people, right? There’s nobody better telling your story than the person who’s already doing that job and is happy doing it.”

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