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Reducing Turnover: The VNCC Approach
by Laurel A. Ditson
Many human services organizations struggle with hiring and retaining direct support workers. Certified Nurse Aides (CNAs), in particular, are in high demand. CNAs in home health care settings are quite autonomous, have only limited contact with peers, and receive minimal compensation for their efforts. Nationally, turnover rates for full-time CNAs averaged 21.46% (Hospital and Healthcare Compensation Service, 1997). Similar national numbers for part-time CNAs are not available.
In 1992, the Visiting Nurse Corporation of Colorado, Inc. (VNCC), a non-profit home health care agency in Denver, had turnover rates of 95.3% for part-time workers, and 20% for full-time workers. In addition, as many as 60% of the newly hired CNAs never performed a home visit after completing training because they quit. Other problems included customer complaints due to ever- changing caregivers, and lost productivity of office staff because they were required to constantly train new workers.
In 1992, VNCC established a team of employees to investigate the reasons for the high turnover rates experienced by the agency. This team surveyed current employees and agency schedulers. Current employees responded enthusiastically. It became obvious that participating in the survey itself fulfilled a need to be recognized and appreciated. Issues identified by employees included: housework expectations were greater than anticipated, paperwork was excessive, explanation of the paperwork was inadequate, the system for returning paperwork did not work well, and communication with the workers was inadequate. It became clear that employees’ expectations did not match reality.
To address the issues uncovered by the survey, the agency restructured the job interview process to include both positive and negative features of the job. Job descriptions were rewritten to detail job tasks, physical demands, and expectations. This description is now provided during the interview and at orientation. We also modified recruitment strategies to focus on word-of-mouth recruitment from current employees. We learned that good employees will not knowingly refer friends who do not share their work ethics and values. Furthermore, we set consistent expectations regarding acceptable previous employment history and routinely conducted reference checks on all applicants.
Another intervention was to streamline the orientation process and improve communication with workers. New employees receive a schedule detailing the time, place, and purpose for each phase of orientation. Checklists were developed to insure that each new employee received the same information. In addition, training was provided to assist workers in completing paperwork. As possible, paperwork was streamlined.
In 1994, a mentor system was introduced for new workers, giving them an opportunity to watch experienced aides provide care. It also gave them opportunities to demonstrate their skills to someone on the job. Mentors check off new employees on basic competencies and act as role models to new staff. Mentors are selected based on having been employed for more than a year, and having met all their job requirements. Efforts are made to find mentors who do not mind performing the housework parts of their jobs.
A final intervention was to form an advisory group to discuss issues, make suggestions, and offer peer recognition. We provided recognition in the form of t-shirts, discount coupons, and recognition certificates for longevity. Monthly newsletters and weekly updates on a designated voice mail message line provide inexpensive current information.
These efforts have resulted in a reduction in turnover for part-time workers from 95% in 1990 to 66% in 1996, and have reduced the number of new hires who quit before making a single home visit from 60% to 25%. These were significant successes, but we quickly learned that these successes could be reversed when we lost sight of our goals.
In 1996, a demonstration grant from a foundation enabled us to refocus on staffing issues. We established cognitive skills training as part of CNA orientation. This training, now peer-led, teaches both life skills of dealing with stress and anger as well as home health scenarios. We now use a career ladder that recognizes increased skills, and rewards CNAs financially on a skill-based-pay model. Employees have clear steps with related compensation levels. We provide training to all staff that enables them to move up the ladder and increase their earning potential.
We implemented a productivity bonus for full-time CNAs in April, 1997, to encourage responsible increases in personal productivity while increasing income. This is a management challenge, as it requires scrutiny to insure high quality care. The system encourages CNAs to maximize their schedules, within a 40 hour per week framework, instead of a previous system that rewarded inefficiency.
We have learned that a stable staff is built upon proper hiring and appropriate recognition. While no single formula exists for success, tending to basic principles of communication, support, and recognition can cut turnover rates significantly.
Reference:
Hospital and Healthcare Compensation Service (1997). Home care salary and benefits report, 1997-1998. Oakland, NJ: Author.
Laurel A. Ditson is Vice President of Human Resources for the Visiting Nurse Corporation of Colorado, Inc., Denver. She may be reached at 303/744-6363.
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Resources: Web Sites Related to Direct Support Workforce Development
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Citation: Gaylord, V., Hewitt, A., & Larson, S. (1998). Impact: Feature Issue on Direct Support Workforce Development, 10(4) [online]. Minneapolis: University of Minnesota, Institute on Community Integration. Available from http://ici.umn.edu/products/impact/104/. __________ Hard copies of Impact are available from the Publications Office of the Institute on Community Integration. The first copy of this issue is free; additional copies are $4 each. You can request copies by phone at 612-624-4512 or E-mail at icipub@umn.edu, or you can fax or mail us an order form. See our listing of other issues of Impact for more information. The print design version (PDF, 448K, 28 pp.) of this issue of Impact is also available for free, complete with the color layout and photographs. This version looks the most like the newsletter as it was printed. The University of Minnesota is an equal opportunity employer and educator.
