Case Study for Long Term Care

Hope is a long term healthcare facility that is currently accommodates 100 residents. Our mission is to provide high quality long term care; therefore it’s important to deal with the issues that won’t allow us to achieve our mission. As a human resource manager I would like to elaborate a few critical problems we are facing. It has been a while that hiring and retaining qualified staff remained an ongoing challenge. Our annual turnover rate is 40 percent. In addition we are dealing with aging workforce in our facility. Those with five or more years experience are 55 age and older are complaining about the high workload that is beyond their abilities.
Recently the state Department of Health and the federal authorities for Medicare/Medicaid visited our facility. They have assessed that our residents are in danger of inadequate nursing staff-to resident ratios and lack of a qualified nutritional dietician. The facility has been given 90 days to increase staffing by eleven licensed nurse aides, three registered nurses and a registered clinical dietician. The survey team will return in 80 days, unannounced and if these deficiencies are not resolved, they will have no choice but to close the facility. The other challenge is competing with two hospitals in the community that are continually seeking the same types of health professionals. We should consider the fact that they have greater resources to attract and retain staff. Since we have only 80 day to recruit new staffs we need to come up with a short term plan that attract nurses to our facility and also a long term plan to retain staff. Our facility has been part of the community for nearly fifty years and has the advantage of an excellent reputation and community support. It is important to make an extra effort during these 90 days to keep our facility reputation. The human resources department has been assessing the issues and would like to propose some solutions to deal with the problems. We would like to assure that facility remains open and residents are well cared. The figure one will demonstrate our issue and proposed solutions.

Inadequate nursing staff-to resident ratios

Quality of nursing home care is an important issue in a public policy. We are responsible to maintain the mental, physical and psychosocial well-being of each resident. The inadequate nurse staffing is an important factor that causes the reduction in the quality of care. To avoid this problem a minimum staffing standards law have been implemented. However, the funding to the nursing home did not increase as a result of this law, therefore we have to manage the budget in a way that meets the minimum staff requirement and take care of other expenses. To meet the patient care we need a mix of nursing personnel to provide care 24 hour period. To recruit nursing staff we need to assess the nurse workload and nurse staffing pressce. Nurse workload means the quantity of nursing services per patient and nurse staffing is the process of assigning appropriate number and type of nursing personnel to satisfy nurse workload.
We are required to hire three registered nurses (RN), eleven CNAs and a dietitian. RNs provide complex nursing care and their wage is higher compare to other positions. Hiring three RN in such a short term is very challenging and costly; therefore we suggest hiring one RN and two Licensed practical nurses (LPNs). LPNs do provide routine nursing cares which include taking patient vital signs and giving them medicines. Since we are considered a low acute facility a combination of RNs and LPNs would provide an excellent care to our resident. If our plan won’t satisfy the community we can then hire more RNs in future.
We need a good plan to recruit eleven CNAs in a short period of time. Recruitment, retention, and turnover are clearly interrelated. Therefore the strategic we use to solve one of these issues can help to solve the rest as well. Recruitment and retention of adequate number of nurses is a major concern and it’s mostly related to the salary. In addition we would like to start a pay for performance method in our facility. By adding a bonus of 2 percent we can encourage a higher quality work and innovation. This helps both in our recruitment and retention plan. Another way to attract nurses and decrease the high turnover in our nursing home is providing health insurance and job security to them. Lack of health insurance is also a main obstacle to increase the number of frontline nurses in long-term care facility. Since their pay is minimum they live below the poverty level therefore, having a health insurance is critical for them. Moreover, to assure that we will have eleven CNAs we suggest that our facility contact the state health department and request for a license that would allow us to train CNAs ourselves. This way we won’t have to deal with the recruitment issue in future. To make the process faster we can also use various sources to advertise for job positions, such as employee referral, former employees that left under good condition and external recruitment such as community colleges, universities, clinics and hospitals. In our selection process we will assure the each person fits to our job, value and culture of our organization to avoid future turnover issues.

The main reason to implement these interventions is to help our facility remains open. Although we are spending more money from the budget for recruitment, retention, and turnover but in a long term it is cost beneficial. If we succeed to keep our employee and increase the satisfaction of nurses we won’t need to spend more money in recruitment and we can avoid the cost of turnover.