Nursing turnover is a problem that many nurse managers and Directors of Nursing are aware of, but often struggle to overcome at their home health agencies. Nurses are retiring at a faster rate than new registered nurses (RNs) are entering the workforce, yet the demand for in-home care is at an all-time high as aging baby boomers begin to need more healthcare. Among this fast-growing demographic, 71% want to age in their homes, according to AARP.
Despite this growing need, homecare agencies today are haunted by staffing and retention nightmares. Data published recently by Home Care Pulse indicates that the median overall staff turnover rate for the industry was 61.6% in 2014, with nurse turnover being a component.
This revolving door of talent not only affects patient outcomes, it also impacts the bottom line for healthcare institutions and homecare agencies alike.
Reasons for nursing turnover
In-home caregivers often cite low wages among their reasons for leaving the industry. According to PHI, U.S. homecare workers earn a median hourly wage of $10.49 and, due to inconsistent work hours, typically earn $13,800 annually. On the other hand, nursing assistants working in nursing homes earn slightly higher wages—$12.34 per hour, and $20,000 annually.
Among other reasons caregivers leave their jobs: insufficient training and lack of supervisory support. Many quit within the first few months because the training they received didn’t prepare them sufficiently for their required tasks, according to a St. Catherine University & University of St. Thomas study.
Problems with the software at the point-of-care can also be a huge source of dissatisfaction. If one of the main tools nurses need to do their jobs is inefficient, difficult to navigate and/or forces them to take work home, it’s not only frustrating, it can negatively impact job satisfaction and their ability to interact with patients.
Overall, the costs of this problem are high. According to its “2017 National Health Care Retention & RN Staffing Report,” Nursing Solutions Inc. (NSI) estimates that the average cost to replace a bedside registered nurse ranges from $37,700 to $58,400. For homecare agencies, the average cost of turnover can be roughly $2,500 per employee, according to a 2004 study.
Six strategies to combat nursing turnover
Agencies are working hard to get ahead of the problem and address some of the leading causes of turnover. Here are six key strategies they can use:
1 – Invest in Training
Caregivers report they are interested in receiving continual training, specifically CPR, first-aid and medical training. Because frontline nurses and caregivers are the ones who spend the most one-on-one time with their clients, up-to-date training is crucial. What’s more, training supervisors is integral to this solution. Training at the top can proactively prevent the vicious cycle of turnover.
2 – Streamline Your Hiring Practices
Because in-home care talent is in high demand, agencies should streamline their hiring processes to show their vested interest in a prospective employee. Conduct follow-up interviews, reference checks and background checks immediately and, if possible, make a job offer on the spot.
3 – Consider a Pay Increase
As the push for a $15 minimum hourly wage has swept various industries, organizations like the National Employment Law Project (NELP) have pushed for this outcome. Wage increases are not easy for the employer to shoulder, but they may outweigh the costs of rehiring and retraining new workers when turnover takes place.
4 – Define Your Agency’s Culture
Your agency’s culture establishes the overall appeal of your company. This includes your values, beliefs, attitudes and norms, among other aspects. Developing and maintaining a clearly defined, positive company culture that current and prospective nursing staff can identify with can go a long way toward recruiting and retaining the best talent.
5 – Show Appreciation
Home Care Pulse’s “2017 Home Care Benchmarking Study” found that the majority of agencies—92%—recognize caregivers by giving them perks (like gift cards), while others offer hand-written thank-you cards, pay raises and other bonuses. But showing appreciation doesn’t always have to be material in nature. The study revealed that, above all, caregivers prefer to be praised with verbal recognition by a supervisor—a gesture that comes at zero cost to the employer.
6 – Leverage Technology
According to PwC, the use of EMR and other Web-based tools can decrease paper documentation and improve the continuity of care, but “in order to be of utmost value, technology applications must be fully embraced and integrated.” Part of achieving this is having an EMR solution in place that is easy to use and supports the way nurses work. This includes anytime, anywhere access and capabilities for offline charting when connectivity isn’t available (a common occurrence in the homecare setting), as well as compliance checks that ensure documentation is completed accurately at the point of care—so nurses aren’t forced to take work home.
To learn how Directors of Nursing and other members of your management team can address the nursing shortage at your agency, download our white paper on The Truth About Nursing Turnover.