Compassionate Care Series

Turnover, especially of front-line direct care staff, is a costly, disruptive issue for many health care providers. When there’s little staff continuity, care suffers. This can spiral into further issues that affect operations, including dissatisfied residents, families and other staff, regulatory citations that can sometimes result in fines and breakdowns of systems that can cause unnecessary hospital readmissions.

Many providers attempt to combat this problem by treating the symptoms. They throw good money after bad, spending thousands a month on staffing agencies to plug holes in the schedule, or pay overtime to a small number of staff who repeatedly volunteer to cover shifts. While paying overtime in the short term is better than overusing agencies, this strategy can still backfire because it creates a new “norm” of income for the staff working overtime. When the vacancies are filled and overtime goes away, these staff will often quit because their income is “cut” after having been artificially inflated for a short time. They then move on to other opportunities where they can try to make up that difference.

Another strategy providers use is to pay bonuses for new employees to come on board and/or referral bonuses to existing employees. While this can be mildly effective, improper management and tracking also can cause problems similar to the overtime scenario.

The final and probably most common approach desperate providers take is to get into a wage war with other providers in their market, in essence driving up costs for the whole market.

The total cost burden for one front-line caregiver position turning over can be quite expensive—as much as $7,000 to $10,000, depending on the location. This includes the direct costs that most providers account for, such as advertising, but also the indirect costs, such as lost productivity. The problem of turnover can rapidly deplete operational funds if not addressed—download our Turnover Cost Calculator to see how your organization is doing.


So, what can providers do to combat this problem? As mentioned above, the answer lies not in treating the problem’s symptoms, but in investing the time to identify the potential root causes. One common root cause for turnover is the front-line supervisor, who is placed into a role that requires oversight of other staff’s performance while also performing one’s own job duties. Without proper education and training, these supervisors might fail to do this part of their job, allowing staff to do their own thing, which creates problems that get kicked up to the director of nursing or administrator. Alternatively, the supervisor might try to supervise but use a punitive approach that ends up driving staff away.

There’s a better way, and it’s found by equipping supervisors with coaching skills. When supervisors are properly trained, they have more confidence in daily staff oversight and likely have more time to succeed at their own job. These coaching skills include active listening, self-awareness, self-management and understanding how to properly present a performance problem to an employee. When front-line staff feel like they’re being listened to, and can participate in getting problems solved with their immediate supervisor, they have greater loyalty to the organization and higher job satisfaction. This is a great equation for improved retention, which sets the stage for improved outcomes in care, greater satisfaction of residents and families and improved regulatory performance. Operational costs also can decrease because money that was being spent on agency, overtime, etc., can be redirected to other areas that benefit residents and staff.

Coaching is the first line of defense for retaining quality staff. The key is proper education—contact Bob or your trusted BKD advisor for more information on this program.

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