The Retentionist role may be the newest effort to bolster the workforce at nursing homes, which have long struggled with labor instability and shortages.

With state funding backing the effort, Monarch Health Management – an operator of 45 skilled nursing facilities (SNFs) as well as over 20 long-term care communities across Minnesota – has seen great success with the introduction of this role in the last year or so of its existence.

Monarch’s Retentionist is solely focused on improving employee retention by gathering insights from new hires across various departments. Sounds simple, but it requires a lot of employee interaction aside from data analysis and gathering.

Through early feedback surveys and in-person follow-ups at 30, 60, and 90 days, the Retentionist identifies common breakdowns in onboarding and facility-level communication.

Initially, Monarch was retaining only 1 in 5 new leaders. After implementing the survey and follow-up system through the Retentionist, retention improved to 4 out of 5, according to Dan Strittmater, VP of innovation and bench strength at Monarch,

“One big aha moment was with these nurse leaders,” Strittmater told Skilled Nursing News. “[The Retentionist] went and connected with them and met with them in person as well … We didn’t get any better at onboarding, but we went from retaining one out of five to retaining four out of five.”

For new hires in rural facilities, who have often expressed difficulty with virtual onboarding, the data collected by the Retentionist prompted changes in how orientation was supported at the facility level.

At the end of the day, Strittmater said the success of the program lies in the importance of creating a consistent, welcoming culture across Monarch’s facilities, which is challenging given the company’s size and rapid hiring growth – in the last year or so Monarch has increased hiring from 230 new employees monthly to over 400.

And so, the Retentionist’s help in developing welcoming committees and events to strengthen community bonds at each site, went a long way.

“Every interaction is important and every hire is unique,” Strittmater said. “Those are 400 different experiences that people need to have, and they need to be connected to somebody,” Strittmater said.

In the midst of the changeover to hiring almost double the number of employees, Monarch centralized its Human Resources (HR), which while efficient yielded its own issues.

“[It’s] a good strategy, but they would go, ‘Oh, we’re retaining 25% of these new hires,’” he said.

And that’s where the Retentionist’s presence especially came in handy, he said.

Operationally, Monarch made some dramatic improvements, with external agency use being reduced significantly, saving the company approximately $1 million per month, Strittmater said. The number of consultant – or temporary – nurse leaders dropped from 26 to just 3 nurses. Internal support roles, like float directors of nursing, were expanded to fill gaps more cost-effectively.

Having a Retentionist on hand also yielded other useful insights such as that only some of the new hires were suited for managerial positions, and without proper preparation there would be high turnover, Strittmater noted.

Developing leaders may take six to 12 months and Monarch was committed to learning from mistakes and continuously improving its retention and onboarding strategies, he said.

Bridge between recruitment and retention

Monarch’s Retentionist, Beth Spreigl has the official title of talent retention director. She stepped into her newly created role last February following a state grant designed to strengthen recruitment and retention efforts. While Spriegl has been with Monarch for several years in various roles – most recently leading the float social services team – the new position allowed her to focus entirely on the employee experience, from onboarding through long-term engagement.

Spriegl views her role as a bridge between recruitment and retention. She developed a five-point framework to identify opportunities and gaps: recruitment, hiring, orientation, facility welcome, and onboarding. Any weak point in that sequence can lead to early turnover, and that all departments share responsibility in ensuring a smooth experience for new hires, Spriegl told SNN.

One of Spriegl’s first priorities was to implement and analyze 30-, 60-, and 90-day new hire surveys, alongside “stay surveys” for long-term employees. These tools helped her identify trends and communication breakdowns that were leading to disengagement or departures.

When she sees red flags – such as at a negative 30-day review – she digs deeper by distributing broader surveys and conducting in-person site visits to understand the root issues, she said.

These visits are designed to be flexible and supportive, and the conversations are off the record to put employees at ease for honest feedback. Spriegl also offers multiple ways for staff to share anonymous feedback, whether it’s through Teams, phone calls, surveys, or face-to-face conversations.

Once all the data is collected, Spreigl compiles a summary report highlighting what’s working, and what’s not. She then meets with the facility administrator and regional director of operations to present the findings and discuss potential improvements.

‘One voice matters’

Spriegl’s mantra is that “one voice matters.” She recounted an example from a facility in St. Paul where a single negative 30-day survey and Glassdoor review inspired big change.

After validating the concerns through on-site observation and staff discussions, she compiled the results and worked with the team to form an Employee Engagement Committee. Originally intended for just four team members to participate, the invitation was opened up to everyone – and 15 staff members ended up joining.

The committee eventually launched all-staff, all-shift appreciation events and created a structured new hire welcome program, complete with guided tours, welcome boards, and peer introductions to ensure consistency and warmth in the onboarding experience. Leadership rounding also became a focus, with department heads encouraged to regularly connect with staff, even if just for a few minutes, by asking simple but meaningful questions, such as, “Where are you at? What do you need? How can I help?”

Beyond all this, Spriegl also handles responses to every Indeed and Glassdoor review herself, reinforcing her belief that all feedback, and her personalized responses often lead to deeper conversations with current or former staff and give her insight into recurring pain points or wins across Monarch’s more than 50 facilities.

“One person’s voice is an opportunity for change, for positive change. And I’ve seen one person make incredible positive differences. And, I’ve seen one person, unfortunately, causing destruction,” Spriegl said.