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How to Retain Nursing Home Staff and Improve Organizational Performance

Based on the experiences of more than 400 nursing homes, the Staff Stability Toolkit is designed to serve as an evidence-based resource for nursing homes that are working to reduce staff turnover. The toolkit, developed by Quality Partners' of Rhode Island with Commonwealth Fund support, identifies some of the perverse incentives, such as giving hiring bonuses rather than retention bonuses, and poor management practices, such as ineffective hiring and scheduling, that contribute to high staff turnover in nursing homes. It also offers guidance on ways to sustain employee stability.

The Issue

High staff turnover at all levels, from nurses’ aides to senior management, has plagued nursing homes for decades. Staff turnover wastes resources and compromises the quality of care. Stabilizing staffing is the first step nursing homes must take to use their resources efficiently and effectively to improve performance.

The importance of staff stability for achieving better clinical, regulatory, and financial outcomes was demonstrated through the Improving Nursing Home Culture Pilot project, funded by the Centers for Medicare and Medicaid Services. The project used a framework called The Holistic Approach to Transformational Change (HATCh), which highlights the interconnectedness of workplace practices, clinical practices, and the care environment.

Target Audiences

Nursing home administrators, clinical professionals

The Tool

The Staff Stability Toolkit, which is based on concepts from the HATCh model, provides references, assignments, and worksheets on ways to empower employees by helping them acquire necessary skills, giving them authority commensurate with their jobs, and providing recognition for their efforts. Following these steps will create a working environment that enables employees to do their work efficiently and well, while feeling good about the organization--all of which contributes to staff retention.

The toolkit is divided into five sections.

  • "Section One--Setting the Stage for Success" describes a process for getting started and outlines how to include employees from every department. 
  •  "Section Two--Management Practices that Support Stability" provides tips on recruiting, hiring, and orienting new staff; attendance, scheduling, and consistent assignment; and “A Positive Chain of Leadership."
  • "Section Three--Drilling Down: Gathering and Analyzing Data" introduces a tool for gathering and examining data, such as the composition of the staff, staff length of service, vacancies, and absenteeism, to better understand the organization's current staffing profile. 
  •  "Section Four--Case Study: Achieving Staff Stability" describes how the Burlington, Vermont–based Birchwood Terrace Healthcare applied the recommended tools and practices to achieve staff stability. 
  •  "Section Five—Using Training Strategically" discusses the role of training in supporting staff empowerment and improving organizational performance. It provides information about workforce development and other resources. This section includes tips on writing grants and choosing the right training partner. It also offers information about state-based technical assistance resources for stabilizing staffing.

For More Information

Download the toolkit from the Quality Partner of Rhode Island Web site at Or contact
Marguerite McLaughlin, project manager, Quality Partners of Rhode Island, [email protected]

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