Frontline staffing has gotten a bit easier for nursing home providers, with a stronger influx of job candidates. But competition in the sector is so strong that a new hire might leave for a better opportunity before long.

With this as the backdrop, onboarding has become a particularly crucial time for operators to implement retention practices and introduce employees to company culture, including opportunities for professional development and career advancement.

Indiana-based Majestic Care has a 77% conversion rate from candidate interview to hire, but these hires are sometimes leaving for another opportunity as early as two weeks into the job, Laurel Lingle said during a panel at the recent Skilled Nursing News Virtual Staffing Summit. At the time of the summit, Lingle was vice president of talent acquisition at Majestic. Lingle now serves in the same role at Journey Skilled Nursing.

“I think that’s one of the greatest areas that we’re going to focus on now,” Lingle said of onboarding and the early stages of a hire. “Getting the candidate in the door has become easier in these past 12 months, but it’s making sure they stay and that it’s not just another position, that it’s truly a career and that they’re committed.”

Amber Kirwin, senior vice president of talent acquisition at Signature HealthCARE, agreed that hiring has picked up in 2024 compared to pandemic years: “The playing field is starting to level out,” she said. A lot of this success is chalked up to less competition with travel nurses and agencies, as well as hospitals that were offering sign-on bonuses in the $25,000 to $30,000 range during the height of the pandemic. Louisville, Kentucky-based Signature offers skilled nursing and other services across 10 states.

The importance of onboarding

Signature is focused on ensuring 24-hour coverage at its facilities and has made changes to its compensation structures and retention efforts to help achieve that goal. With regard to onboarding specifically, the operator made an upgrade to its applicant tracking system and added Signature branding from the beginning, with video job descriptions and welcome videos, Kirwin said.

Candidates now can see more clearly what’s going on behind the scenes once they’ve accepted their offer. There has in the past been a “black hole” for candidates between the job offer and waiting on background checks and screening processes to be complete.

Now, redundancies in the onboarding process have been reduced, Kirwin said, noting there were questions asked multiple times throughout the process, from pre-screening to the application, with the same information requested in multiple areas.

Signature has also adopted provisional hiring. This means that if an individual has licensure verification and meets certain qualifications, and the state allows it, they can get started in their new role faster.

“Because of those enhancements, we do see an increase in candidate flow, which is leading to our highest number of hires over the course of the last four to five months,” said Kirwin. Hires will likely decline with the holiday season, but Kirwin expects a positive trajectory in 2025.

Majestic has also been growing its internal staffing pool, helping to reduce agency use. The internal pool also is a recruiting tool in itself, for those looking for more long-term employment.

Workers in the pool have the chance to go into buildings to fill a full-time slot, which enables them to see which particular locations they might prefer, what units they like and “where their passion lies,” Lingle said.

And, onboarding is now so much more involved in the effort to retain hires, with a focus on giving all needed information about benefits and perks, but also everything Majestic can offer in terms of a career path.

The promise of internal growth

Career paths are brought up early on at Signature as well, with the operator’s internal training structure offering upward mobility for administrators, nurses and other staff members. Internal growth, plus outward partnerships with educational institutions and community organizations, have helped grow frontline staff overall, Kirwin said.

Several of Signature’s nurses just went through wound care certification, which will allow facilities to address some increased patient acuity coming in. And Signature nurses also are pursuing in-depth training in the Minimum Data Set (MDS).

MDS training in particular was hand-picked by Signature as a career track, given high turnover for these roles, Kirwin said.

“MDS is a huge one. I think MDS is becoming such a critical role and harder to find,” added Lingle. Majestic offers its own internal administrator-in-training (AIT) program along with wound care certification and MDS training.

Majestic as of April enhanced its tuition assistance program as well for frontline workers, with the program available to staff with all levels of certification and training, said Lingle.

Overall, the combination of stronger onboarding and more defined career pathways is crucial in building stronger and more stable teams, and that involves getting to know each hire.

“Having that constant contact once an offer is made, really understanding that particular person coming in is crucial, and understanding what their long term goal is, and how we get them there,” said Lingle. “Partnering with [staff] and helping them proceed forward is huge. I think they feel more committed to the organization if we can have that lined out for them versus just taking on a position.”