”Growing” your nursing assistants is talked about all the time. Every operator either wants a Nurse Aide Training Program (NATP) or a way to expand and develop Nursing Assistants for retention. If your center embraces the philosophy as a slow and steady process with daily improvement goals, the process is simple. If you and your team have an “abundance” philosophy and believe in improvement, positive feedback, and that people quit their bosses BEFORE they quit a job, you have the mindset for a nursing assistant career ladder or professional development program.
Begin by identifying your goals. Recently at a conference, a speaker reported the “average” turnover for Nursing Assistants (NA) was 6-months, and that should be a “goal” - her message was to deliver the minimum to the newly onboarding recruits…My head was spinning - WHO wants to be the “minimum” in ANYTHING? Have you ever started your professional day by saying, “I’d like to be mediocre because it gives me the minimum I need”?
Goals: Increase the AVERAGE tenure for new NAs to one year.
HOW: Recruit higher caliber people for Nursing Assistant positions to care for residents.
Analyze:
Calculate the average tenure for NAPT and external NAs.
Align by characteristics/traits based on length of tenure, exit interview, and training.
Review the onboarding/orientation process (BE HONEST - is it boring?)
Time allotted for “onboarding” and competency review - are you flexible?
Wage and labor studies - are you paying prevailing wages?
Benefit study - not only health, vision, dental, PTO but things like meals, flexible schedules, career ladder, tuition reimbursement
Leadership feeling proud after holding 10-week Core Dementia Care Program for Nursing Assistants and others!
Action plan: Based on findings, develop an INTENTIONAL action plan to improve what you do.
Case Studies:
The Sue Smith Senior Living Center studied their analytics. During COVID, they’d hired and PAID students to attend the NATP. They found these employees left twice as fast as those who’d taken the class without pay. The team rescaled the program and promoted it as an opportunity to earn a scholarship for the program. At the end of one year of working for the center, the employees would make a (taxable) $1000 bonus. They successfully moved the onboarding cost to the future after the student/employee demonstrates competency, proficiency, and good work habits. The center also signed up as a Regional Certified Nursing Assistant Test Site. They successfully “grew” their own NAs and recruited people who came to test.
Another center uses group interviews with NAs assisting. This process gives everyone “skin in the game” and makes hiring the team goal-oriented. The NAs hired using this process were initially intimidated but acclimated better during onboarding and reported they “feel like I had friends” when starting work. This same center has begun a Mentor Specialist program for the NAs.
Leader NAs are trained in Mentorship and engage in Mentoring Circles with a supervisor and each other. They are assigned new and returning employees, and the relationship is friendly, helpful, supportive, and to consider the Mentor someone they can confide in if they need work-related help. In addition, the Leadership NAs are given “Black Belt Training” and receive black gait belts in this center. There is also a group of Leader NAs called PIPists (Performance Improvement Specialists) who help investigate falls and skin concerns and engage in other QAPI projects.
Most centers with lower than average turnover share specific characteristics. First, they have authentic “open door” practices - meaning - that if the door is open, staff members should feel free to come in. Second, the communication is good, and disagreements are friendly with more solution focus emphasis. Third, the employees in successful centers are HAPPY. They are empowered to share ideas and concerns, problem solve and discuss information bluntly with leaders.
WHAT WORKS: Being open-minded leaders. Admitting mistakes or that you may not know as much as your staff, asking the team what THEY think works—drawing upon THEIR expertise.
WHAT WE KNOW IS SHORT-SIGHTED: The old-school belief, “The staff will go down the street for a quarter more…” or “They never stay, no one does.” Reframe the perspective, consider the Servant Leader approach, and we often create the dynamics we want to avoid.
