Finding RNs to work in the long-term care, skilled nursing and assisted living environments was difficult before the onset of COVID-19, and that challenge continues now in many areas of the U.S.

The long-term care industry has faced critical staff shortages for years, said Mandy Smith, HSE, LNHA, CEAL, CEHCH, RAC-CT, RAC-CTA, LPTA, LMT, WCC, regulatory director with the Ohio Health Care Association (OHCA).

“The industry has struggled with hiring nurses, both RN and LPN, and nurses’ aides,” she said. “However, the industry is resourceful and has to be, as it’s overregulated and under-reimbursed.”

Identifying good candidates for long-term care

Regardless of the role, the industry looks for candidates with a serving heart and values that align with an organization, said Sue Coppola, BS, RN, CHC, chief clinical officer at Sunrise Senior Living, which has 17 communities in northern Illinois.

“We’ve found that in-house recruiters, who are living and breathing our principles of service each day, are better equipped to identify nurses who will be an excellent fit to serve our residents and work alongside our team members,” she said.

Once hired, the first few months of orientation are pivotal, according to Coppola.

“We’ve analyzed our onboarding experience and found that our nurses’ ability to complete the onboarding process in its entirety, before they’re fully immersed in their role, is crucial,” she said.

Deborah Dunn, MSN, EdD, GNP-BC, ACNS-BC, GS-C, president of the Gerontological Advanced Practice Nurses Association (GAPNA), said, “Having a great orientation is critical for RN retention. Most nurses who leave their jobs do so in the first year of employment. That tells us they weren’t satisfied and perhaps not a good match.”

Providing a structured, phased orientation helps new employees understand the organization, from learning work processes to performance expectations, according to  Dunn.

Acute care perks can help

Some companies have adopted recruiting strategies used in acute care, such as offering sign-on bonuses, flexible shifts and self-scheduling, according to Smith.

“Others offer a choice of weekly or daily pay,” she said. “Even with these perks, there still aren’t enough nurses to fill the need.”

Coppola added, “We offer sign-on and referral bonuses, tuition reimbursement and ongoing education opportunities, including CEUs.”

These perks do have an impact, according to Dunn.

“When LTC facilities provide market value pay, generous sick time and vacation benefits, they retain staff much better than those that do not,” she said. “In addition to offering the traditional benefits seen in acute care, organizations will want to also consider (other) key points.”

According to Dunn, it is important to know facilities that employ more RNs tend to attract more RNs to work there, and having supportive managers and administrators is essential.

COVID-19 contributing to shortages

The presence of COVID-19 has exacerbated the challenges with nurse recruitment and retention for long-term care, skilled nursing and assisted living providers.

“Staffing challenges have worsened with COVID-19 because, like the general population, some nurses are in a high-risk category and decided it’s too risky to continue to work in the direct care environment,” Dunn said. “This may also cause staffing shortages in the future.”

While some staff have concerns about working in a high-risk facility, others have logistical challenges in reporting to work.

“Some are dealing with day care closures, being quarantined or ill, or (having) a sick family member,” Smith said. “These all lead to additional staffing burdens on providers.”

Facilities that converted entirely to serving COVID-19 patients or those who developed a dedicated isolation wing for these patients had staffing challenges, according to Dunn.

“In these instances, selected staff who met certain criteria and volunteered to work in these units often worked extra days and long hours,” she said.

Essential retention strategies

Retention has been a consistent problem, according to Smith.

“Many new graduates come through our facilities to learn, then move on to acute care hospitals,” she said.

Coppola noted there are four key aspects of the job that make the difference between a nurse staying with or leaving an organization:

  • Compensation
  • Work/life balance
  • Meaningful work
  • Recognition

Dunn recommends providing employee recognition events throughout the year. “Recognize and celebrate satisfaction scores, patient and family thank you notes and cards,” she said. “Let staff know you appreciate them every day.”

How to build loyalty

Finding ways to get employee buy-in to your company is important for retention, according to Smith.

“We’ve seen success with flexible scheduling, paying more frequently and accommodating personal requests, such as starting a shift 15 minutes later to drop kids off to school,” she said.

Dunn added that helpful factors related to scheduling include providing a stable and predictable schedule.

“You often find nurses who left a job because they couldn’t take their scheduled days off or had to frequently work mandatory overtime,” she said.

Even though nursing is a rewarding career, it is a stressful job.

“Having adequate time off to recharge is important to be fully present at work,” Dunn said.

LTC career development, education assistance

Another way to retain dedicated, talented nurses is by providing a clinical ladder.

“The ladder connects professional growth, length of service and the added responsibility to pay rate and benefits,” Dunn said.

For additional retention strategies, Dunn suggested offering continuing education onsite as well as CNE dollars for attending conferences each year. “Pay for membership in a professional organization, and encourage your nurses to join,” she said.

The OHCA provides scholarships to member employees that apply and are selected, according to Smith.

“The amounts vary and can go toward college or professional certifications,” she said. “The Educational Foundation of OHCA has awarded over $2.1 million in scholarships to more than 1,000 individuals since 1989. That has helped individuals further their careers.”

Coppola encourages nurses looking to make a career change to examine senior living jobs such as long-term care.

“There’s a misconception that assisted living and memory care is where you go to slow down,” she said. “I’ve worked in both the ER and ICU, and I can tell you that this work is both incredibly challenging and enormously fulfilling.”