A New Approach to CNA Hiring in Skilled Nursing Facilities

In skilled nursing facilities, the elephant in the room is the scarcity of well-trained certified nursing assistants (CNAs) and their high turnover rate. Even if you would like to ignore the problem, it’s not going away.

Staff shortages in long-term care have been a huge pain point for decades, and the challenge is even worse since the coronavirus pandemic swept across the U.S.

To be honest, I’ve never really liked elephant analogies, and yet they conjure an image that’s hard to ignore: A huge animal standing in front of you. Clearly, that’s a problem.

If an elephant really were blocking my way, I’d have many questions.

• How did it get there?
• What do we do about it right now?
• Is anyone in immediate danger?
• Should we just give up and leave?
• How do we move this creature where it should be?
• What do we feed it in the meantime?
• How do we clean up the mess after it’s gone?
• How do we make sure it never gets into the room again?

Unfortunately, the CNA staffing crunch is likely to get worse before it gets better. The U.S. Bureau of Labor Statistics says the job sector that includes nursing assistants and orderlies is projected to grow 8 percent from 2019 to 2029, much faster than the average for all occupations.

In some areas, the turnover rate of CNAs is at crisis proportions, as many of you in long-term care already recognize. For example, Texas skilled nursing facilities reported a 97% CNA turnover rate in a 2018 report by the Texas Nursing Home Workforce.

Staffing Amid COVID-19

Add to the mix the off-the-charts unusual challenges stemming from the coronavirus pandemic, and hiring managers need help fast. Yes, COVID-19 has added some gargantuan weight to the turnover problem in skilled nursing facilities.

For some nurse aides, COVID-19 has sparked child care and at-home school supervision challenges that weighed in their decision to stay home instead of work. Further, extra funds to supplement unemployment checks are available in some states under the CARES Act. With this financial assistance, some healthcare aides have found they can make more money on unemployment than they did while working.

Now more than ever, the pressure is on to find experienced staff to help you navigate government regulatory changes, auditors, and a world of new expectations for skilled nursing facilities amid COVID-19 repercussions.

If your previous challenge was finding warm bodies to keep your facility adequately staffed, your even greater challenge now is to keep your staff healthy and working amid concerns about infection control and a disease that strikes hard at vulnerable elderly residents with comorbidities.

The more experienced your team is, the better you can ensure that you’re taking the necessary precautions to prevent the spread of COVID-19 and keep staff and residents alike safe.

Break Down the Challenge

Clearly, a new approach is warranted to resolve this behemoth of an issue. Or maybe several new approaches are needed. Think about that other ugly analogy of eating an elephant a bite at a time. Sometimes the best way to solve a huge problem is to tackle many smaller pieces of the problem one at a time.

To break down the CNA staffing challenge, consider new ways to manage these elements:

• Getting help recruiting candidates who are a good fit.
• Providing benefits that will attract quality candidates.
• Onboarding and training your recruits.
• Supporting staff wellness.

Recruiting Candidates

If your current recruiting process is not yielding staff that stay with your organization more than a year, you might want to shake that up. Consider hiring experienced external recruiters to help you with the process.

You might also want to rethink your entire recruiting process. Are you optimizing your online human resources systems to build a pipeline of candidates, track your best sources for candidates, and refer inexperienced candidates to CNA training?

It also makes sense to track the characteristics of new hires that stay with your organization longer. To further explore what makes staff stay in their jobs, ask them. Keep notes on the reasons they stay or go, and make sure supervisors know what they find attractive about working in your organization.

Boosting Benefits

To draw in the best candidates during the recruitment process, you will want to emphasize the culture and benefits you offer. You’ll want to note in your job ads the ways your organization’s benefits align with what applicants are seeking in their next role.

Consider how you can differentiate your facility from others competing for recruits. You may stand out in some of the following ways:

• Signing bonuses.
• Paid time off.
• Coaching and mentoring.
• Support for fitness and wellness.
• Professional development.
• Contributions to the local community or society.

Onboarding and Training

Once you have attracted promising candidates, you will need to make sure they have onboarding that instills the company culture and confidence in their ability to carry out their duties. Your training and staff development program is key here. To ensure that you have nurse aides on staff who are competent in their ability to provide appropriate care, they will need to be well educated in what it means to provide high-quality care.

Then you will need to continually focus on fostering employee engagement to reduce turnover. Leadership plays a big role by building good relationships from the start.

Supporting Staff Wellness

To support your staff and reduce absences amid the pandemic, make sure nurse leaders continually communicate with CNAs about the importance of precautions being taken related to infection prevention and control and about strategies for reducing stress and maximizing self-care in this environment.

Appreciation is priceless. The dedicated staff members who show up each day and care for your residents need to know their sacrifices are recognized and valued.

Encourage family and community involvement in showing appreciation to your team as well, whether that takes the form of thank-you notes or gift cards for local restaurants. This type of recognition can strengthen existing bonds with the community, encouraging locals to work in your facility and families to place their loved ones in your care.

Consider other ways to support your staff as well, such as offering yoga classes, catering free meals, and offering COVID-19 child care stipends.

In these tough times, managers should not forget how welcome their staff members will find an open door, a listening ear, and overt praise for their dedication.

To keep your level of care high, you need to retain your well-qualified staff. And to do that, leaders need to show — with actions, not just words — that they care for their caregivers.