Excellent SNF - Need advice for competing with acute care and clinic recruiting

[Nurse Beth, MSN]

Dear Nurse Beth,

We are an excellent skilled nursing facility, but are having difficulty recruiting LPNs and RNs. We can not compete with acute care on wages. Do you have any advice on how we can compete with acute and clinic nurses?

Thank you.

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Dear how to get nurses to work in your excellent SNF,

That's a great question because it is a dilemma. But you can do it!

For many nurses, it's an employer's market when it comes to new grads. Hospitals in many areas can afford to be choosy and turn away applicants. The fall back position for the nurses is then sub-acute nursing.

In your area, it sounds like the other way around. You are competing with acute care and clinic facilities for the same nurses. Are you targeting new grads or experienced nurses? You would have better luck with new grads who would appreciate a job and the experience with procedures and nursing skills that you offer.

You have to be creative, and willing to spend some money upfront in order to save money and improve patient care in the long run. You must be able to look past this month's budget and to try different long-term strategies. This is where many acute care facilities fail. Often the finance people are short sighted and end up costing the facility hundreds of thousands of dollars in recruitment and retention over the years, not to mention the indirect costs of low morale (errors, patient satisfaction, poor attendance). This is something every nurse who has ever worked in a hospital knows.

Focus on your employees. Do they know how much you value them, and are they treated with respect? Is poor performance not allowed and is evidence- based practice supported? Top performers want their managers to deal with coworkers who perform below the bar. Employers who permit low performers to continue to perform poorly lose their top performers because the high performers have to pick up the slack and perceive their low performing coworkers to be rewarded while they are punished.

Reputation and Recruiting

Explore non-monetary ways to compete. How can you make your great facility a desired place to work? You know it is excellent, but you want the community and nurses to know as well. Make it a goal to become known as the premier skilled nursing facility in your area. Have you won any awards? Been featured in local magazines? Call the editors and have them do a feature article.

What are you currently doing for recruitment? Do you have a booth at career fairs, speak at local colleges with nursing programs?

What can you offer nurses that would be a perk?

Self-scheduling? The hospitals in your area may already be doing self-scheduling, but if not, it would be a great recruiting tool.

How about the Baylor plan? Is there any way you could offer a Baylor Plan of staffing? Baylor is where nurses either work weekdays or weekends, but not both.

The nurses who work weekdays are paid regular pay, but never have to work weekends.The nurses who work weekends only are paid an adjusted hourly wage that amounts to the same salary as a full-time nurse.

The payoff for the facility is tremendous. The facility saves money within a short time because it reduces your turnover immediately. Retention improves because it is hard to walk away from a job where you work your dream hours (whether weekends only as full-time, or every weekend off). You will have nurses lining up at your door,, especially to work the weekend positions, trust me. You could then even hire them into a weekday position to get on the weekend list.

Seniority and Self-Governance

Another perk is to reward seniority. If a nurse stays with you for x amount of time (say, one year), you provide him or her with four hours of a housekeeping service twice a month. It's non-taxable for the nurse, but a tax deduction for you. You can increase the reward as seniority increases.

Implement a unit-based council based on a self-governance model. This empowers nurses to make nursing practice changes, and engages employees.

Another strategy to consider is to identify an experienced and influential nurse in the community who is talented but perhaps has not yet been promoted. Target this nurse, and start recruiting him/her for a leadership position. This person has nursing connections that can benefit you. One or two friends may even join them in their new job.

I hope some of these ideas helped, or got your creative juices flowing. Keep us posted!

Best,

Nurse Beth

[BSN-to-MSN, ADN, BSN, RN]

This is great advice! They need to take care of current employees first.

What makes this SNF excellent, though? wonder if the person asking provided a description.

In my experience, no excellent SNF is short on nurses, and if they are short - then this SNF is far from excellent. Just a thought.

[RSanchez]

I am a brand new grad. I was one of the top of my class, always had top evals in clinicals, it was a no-brainer I was going to a top hospital, and I did interview and get offers with some. However, I just accepted a job at a rehab and long-term-care facility. It's a great facility, it's paying significantly MORE than the hospitals around here, and...they're allowing me to work school hours. I have kids, that's paramount to me. So if you can't compete with pay (are you sure? That's pretty important) compete with premium work schedules.

[kbrn2002, ADN, RN]

My biggest question is are you an independent facility or part of a larger company? If the latter is the case your hands may be somewhat tied as corporate has to agree to whatever monetary incentives for new hires you are offering. Even if you are a privately owned facility the people that really hold the power to make effective offers are the ones paying the bills. Unless your non monetary incentives are inventive and marketed as being highly desirable, for those seeking employment when there are multiple options on the table the option that provides the bigger paycheck usually wins.

Also don't forget your current employees. If you make the mistake of offering large sign on bonuses and a competitive starting wage without compensating your current employees there will probably be some backlash. I can't see your more loyal employees being happy when a new hire walks in making what they do after they've put in years of service. The same holds for the non monetary incentives like self-scheduling and Baylor options. Make sure to offer these perks to current employees before you offer them to a new hire.

[~Shrek~]

I am a nurse with about a year of experience working in community health and psych. I am happy with my job, but if I wanted something part-time , moved to a new city, or wanted a new job, I would gladly work in a SNF if it meant: getting my day of worship off, working day or evening shifts (not nights), and having a supportive environment where I can re-learn any skills I may have forgotten from school (I am confident I can learn them, as I have learned many skills at my current/ past jobs). For me, a supportive environment, working days or evenings and getting my day of worship off are okay to trade off for lower pay.

[Not_A_Hat_Person, RN]

How good (or bad) are the other SNFs in your area? I've worked in enough awful SNFs that I will only go back if my family is facing immediate (and I do mean immediate) homelessness. The revolving-door SNFs are the reason other SNFs have big problems finding nurses. If your SNF is excellent, you will have to show prospective nurses exactly what that means.

[Maevish, ASN, RN]

I applied to an extended care facility a couple years back and the interview went great. The lady even went so far as to say they'd be offering me the job officially the next day. Only problem was that I'd had a DUI in my remote history (which was disclosed on the application I filled out) and they had a process that would take upwards of 3 months to go through for me to be able to get the job. I couldn't wait that long because I needed a job immediately, which is why I went back to travel nursing.

I don't know if your facility does that, but I missed out on a great job opportunity (and they would have to keep hiring temp/agency nurses till they found someone else, which they still haven't done as of a couple weeks ago) because they were so stringent about something that had happened years ago and didn't effect my work whatsoever.

As far as making your facility appetizing to nurses, it seems like it may not be (unless the pay is just so abysmal that nothing would make up for it) in the broad scope of things. If the pay were only $10-$15 less an hour than a hospital job and you gave benefits, flexible scheduling, possibility of promotions and/or recognition for hard work, etc I'd think that most nurses, including myself, would be beating the door down.

I wish you luck on finding your nurses!

xo

[Nursebarebari]

I have been an RN for 13 yrs, recently took a per-diem job in a SNF at a much lower rate than my full time hospital job rate. I had to leave because of patient to nurse ratio-45 residents to a nurse. Medicating 45 residents multiple times in 8hrs, doing wound care, peg feedings, paper work, dealing with family issues, and more was just too overwhelming for me that I quit within 7 weeks. I worked straight 8 hrs without even a bathroom break most of the time. I thought it would be ok if giving it some time but it just did not work. Some of the nurses that started with me had the same experience and left. So look into your nurse patient ratio as its not all about the money.

[Angelito]

I just wonder how someone can expect this patient to nurse ratio would work out in real life... Unbelievable!

[feelix, RN]

Get a specialized wound care nurse. Wound care is the biggest time drag on a nurse's day. Your nurses will be happier.

[Nurse Beth, MSN]

Get a specialized wound care nurse. Wound care is the biggest time drag on a nurse's day. Your nurses will be happier.

What a great idea!! Makes my happy just thinking about it.

[NurseGirl525, ASN, RN]

I would have to say the issues for any nurse in a SNF facility is patient ratios. Its horrifying to me as a new grad. I could never handle upwards of 30 patients as a new grad. Even though they are not necessarily that acute, it's terrifying none-the-less. There is no time to practice and hone your skills, which is what every new grad wants. They want to become excellent nurses. You can't do that passing meds to 45 people all day.

I love our elderly population. During my rotation in a nursing home I was told by several people that I should work in that specialty. But, I would never want to be responsible for all of that as a new grad. Instead, I'm going into critical care where I have 2 patients and the support I need to become a good nurse. SNFs give very little orientation. I will have many months of orientation. That makes me feel that at some point I can practice safely.

Your problem is not pay. The problem is dangerous nurse to patient ratios and the inability of the SNF industry to recognize that. You should not be trying to hire new grads. Look for experienced nurses who are getting out of the acute care setting and have the ability to be fast. And you guys will have to offer more money to attract them. SNFs have to stop looking at the bottom line all of the time. To me, it's q greedy industry. I understand they are in business to make money, but compromising patient safety should not come at that cost.

Off Soapbox.