By Kristin Carroll

Building a strong and stable workforce continues to rank among the most daunting challenges across the skilled nursing sector, but providers are notching wins in recruitment and retention.

Monarch Healthcare Management, Journey and Senior Management Inc. Care & Rehab have succeeded in drastically reducing use of agency staff; have created new roles, committees and educational programs that are driving workforce stability; and are attracting new workers through partnerships with schools.

“We have seen a change. Our pipeline for candidates has increased about 33% over the last few quarters,” Laurel Lingle, vice president of talent acquisition for Journey, said at the recent Skilled Nursing News RETHINK Conference in Chicago. “One thing that we still see is turnover, but we are no longer dependent on agency. We have been completely agency free since February, which is a huge feat for us.”

Journey operates 22 facilities across Georgia, Indiana, Kentucky, Maryland, Ohio and West Virginia.

High school students, people looking for a second job and new retirees are filling in the gaps at Senior Management Inc. Care & Rehab, said Vice President Andrea Thayer. As a result, the organization sees a runway for growing its workforce.

“They’re saying they’re seeing that we can pay more, so they’re coming to us,” Thayer said. “There’s very little agency in all of our buildings.”

Senior Management Inc. Care & Rehab operates five facilities in Wisconsin and Minnesota.

Monarch, which operates 50 facilities in Minnesota, has reduced its reliance on agency staffing by $1 million per month, said VP of Innovation and Bench Strength Dan Strittmater. Monarch has also partnered with local education institutions to draw more people into the long-term care space.

“Getting them hooked on long-term care is about long-term relationships at an early age and getting them to come up in lots of different careers,” he said.

Staff support at heart of retention

Employees often leave jobs for “greener pastures,” seeking more pay or better benefits, but often, simple measures can drive retention.

For Care & Rehab, that means treating their employees with dignity and respect, getting to know them on a personal level, Thayer said.

“We walk the halls,” she said. “People know us. We know them.

Thayer herself is accessible to employees via social media such as Facebook Messenger, and emphasized the importance of considering the company’s workforce as family. Thayer said her dog also joins her at the facilities, further building rapport with staff. The company also rolled out an initiative through which employees eat for free during their work shifts. Thayer and her husband noticed they were eating for free when making site visits and wanted to extend the same consideration to their staff.

Lingle also said that “making them feel like they’re part of our family” underpins many of Journey’s worker programs. The company introduced a new set of benefits, the Journey Advantage, which offers a $5/hour attendance bonus and free cellphones for employees.

“What can we do to better their experience with us, inside and outside of work? I think that’s key for us in the retention,” she said.

Monarch offers additional educational support for new nurses, Strittmater said. Monarch discovered new nurse managers may have been stellar employees but didn’t feel prepared to take on a leadership role.

“In the last five years, you get a lot of nurses who come out with minimal training, or maybe they had really rough virtual reality clinicals,” he said. “So, give them extra education support.”

New roles focused on retention

Following the acquisition of several facilities, Monarch created the role of retentionist to help improve the employee experience, Strittmater said.

“One of the key things that she’s done is just draw data, whether it’s through conversations one on one, meetings, surveys … just pulling back the curtain and going, let me tell you what your end-user experience is like for new employees,” he said.

The retentionist also acts as a sounding board for new nurse managers, building relationships so the company can better understand where the onboarding and training process failed.

“It just gave them a connection and more patience and tolerance for some of the things that we weren’t doing well,” he said. “It also gave us some really good data and information.”

Journey has created a culture committee to drive retention efforts and build a solid culture “from the CEO down,” Lingle said.

“[We made sure] the team selected represents all states, all walks of life with us,” she said. “They have goals, measurable items, and make sure that we’re celebrating wins. We want everyone to feel appreciated, whether it be in the workplace or outside; you graduated, you got a new degree, you had a new grandchild, making that personal connection.”

The culture committee also steps in to make sure celebrations are consistent across Journey’s many locations, Lingle said.

“Social media now is brutal,” she said. “One building is doing something, another building sees it, and they’re asking their ED, ‘We didn’t get that. Why didn’t that happen?’ So this culture committee is helping us make sure that Journey’s culture is consistent across the board and everybody feels that same culture in their buildings.”

Reaching the next generation

Just as high school students are filling in gaps in staffing at Care & Rehab, Journey and Monarch have also reached out to local districts to build a career pipeline for students.

Care & Rehab’s outreach to younger employees resulted in the creation of a certified CNA school.

“That’s held at one of our locations, and we pay for free housing during that,” Thayer said. “Anyone who comes in the door when I’m walking the halls, I’ll ask them, ‘Would you like to go to nursing school?’ We pay for 100% of their nursing degree.”

Monarch partnered with Cristo Rey High School in Minneapolis, Strittmater said. Students from the school complete internships at all levels of the organization and receive a stipend for their tuition. Monarch has used funds from Minnesota’s New Americans in the Long-Term Care Workforce grant program to help grow this initiative, funding 20 internships in 2025.

Another high school in western Minnesota works with Monarch to train new nurses. The school nurse held the clinicals, both online and in person. Students received school credit and had their training costs covered. Strittmater said the biggest success from this effort was that students stuck with the program.

“There were four people that finished, and three of them failed the test two times; they had to pass it the third time, and they passed,” he said. “But the school counselor said, ‘Well, these are people who would have quit normally if they failed a test the first time.’ They weren’t college bound students. They were really stoked about that.”

Monarch grants $1 million per year in scholarships for nursing training in Minnesota.

Journey also works with high school students, Lingle said. Across the company’s facilities, high school students come in for clinicals. She said it’s rewarding to have students come through and learn the work first hand. Having a current employee speak with students can also make a difference.

“When you’re presenting, take somebody that’s in the role, that’s with you, that can really talk about the day to day, what the life of a nurse is, what the life of a CNA is,” she said. “Those students don’t know what it really entails … It is rewarding work, but it’s hard. So letting them know firsthand what they’re getting into, I think, is ideal to make sure that it is a retained position when they come into the building.”