Researchers found that scheduling CNAs regularly with the same group of teammates reduced turnover by nearly 25%. 

If nursing homes capitalize on the results of the study, it could go a long way toward cheaply and effectively addressing the nursing home staffing crisis, according to lead author Kevin Mayo, PhD, assistant professor of finance and management science at Washington State University. 

“These findings suggest that managers may be able to leverage part-time CNA scheduling to reduce turnover,” the study asserts, “improving both the quality and cost of care.”

The study also found that giving part-time CNAs one additional hour of work per week could reduce turnover by about 2%. Turnover was increased both by too few hours worked and too many, however, so facilities need to be more cautious in this regard. 

Building cohesive, consistent teams is the most important factor to consider, Mayo said, but nursing homes should consider all aspects of the study to achieve the best results. 

“By both balancing working hours and maintaining consistent teams, healthcare facilities can greatly reduce staff turnover,” Mayo told Newswise. 

Between greater scheduling consistency and tweaking hours worked, the authors estimate that facilities can save 7% of their operating costs with greater employee retention. 

Nursing homes have already felt the pressure to employ more flexible, worker-focused scheduling in response to the staffing crisis. The results of this study suggest that there are large benefits to be gained from this approach, and at very low cost.

Greater retention should also lead to higher quality of care for residents. After analysis of their data, the researchers concluded that CNA turnover had measurable negative effects on care quality that could be eliminated by increased retention. 

The study, published in the journal Manufacturing & Services Operations Management, analyzed data for more than 6,000 part-time CNAs from 157 facilities. 

Other authors included University of Cincinnati Assistant Professor Eric Webb, PhD, as well as Indiana University’s George Ball, PhD, and Kurt Bretthauer, PhD.

It’s a question being considered before anything new takes flight, and heaven forbid you want to sink money into reengineering something old-school.

But the bigger issue to me, and I’d say, our healthcare system, is that very few people still value the things our society has traditionally valued.

Reading those words as I typed them out, I felt myself age by a good two decades. But hear me out. I’m not talking about religion or politics or even family values, a phrase I couldn’t seem to escape as a teenager growing up in the 1990s.

No, I’m talking about the way we value (or don’t) many of our nation’s long-respected professional roles.

Just as workers have turned to the gig economy in their quest for more flexibility and a better balance between their personal and professional lives, many college students and younger adults are rejecting the caring professions America relies upon.

Entrepreneurship rules the day, and for many, that career pathway doesn’t include a stop in any service industry, in a nursing home or elsewhere.

As interest in healthcare, teaching, law enforcement and similar careers shrinks, we’re experiencing major gaps in service delivery — for the very services that were once considered the crux of our communities, with the most dependable and often most-emulated workers around.

Think about the nursing programs you used to depend on, now shuttered or a ghost of their former selves because they’ve lost too many faculty members or proctors.

That same thing is happening across university campuses as interest in many service careers shifts toward higher paying and sometimes more creative and self-led jobs. Earlier this week, a parents group for pre-college students that I follow featured a post from a history professor begging for parents to encourage their kids to reconsider careers in history and teaching. His department, drawing far fewer majors year after year, is being decimated and faculty are hard-pressed to find new jobs.

Teachers now battle school boards and parents unwilling to let educators be educators. Why would a teen growing up in the middle of that want to stay involved in it?

Likewise, we have EMT, 911 dispatch and law enforcement shortages because those fields lost much of their glory-day grandeur amid a series of ugly events that degraded public respect for such roles. Who among us would want to risk their life on a regular basis in that climate and with so little thanks, even when you’re the one doing things right?

Nursing, in that vein, is no different.

Yes, respondents still tell Gallup they trust their nurses more than any other professional. But when it comes down to it, nurses just don’t feel valued the way they did in the past, either by their employers or by the public. That leaves far fewer of them willing to instill both the caregiving fundamentals and the passion for the job that previous generations got from experienced nurse faculty.

The rhetoric from the White House and the Centers for Medicare & Medicaid Services (and their bedfellows at several national unions) haven’t helped sell the public on the wonderful possibilities of a career in long-term care.

And this is where Garry Pezzano, president and CEO of LeadingAge PA, says CMS may be most blind in its quest to impose staffing mandates on nursing homes. Not only are workers not available today, the nation’s shifting values means they likely won’t be there for years to come.

“What we’re finding is that they want flexibility in their lives, and we need academia to kind of really catch up to that,” Pezzano told me as we discussed major staffing shortages in his state. “We’re talking to our academic partners about, can you consider things like waving registration fees? Can you think more in terms of a hybrid model for delivering the education and just attracting folks to the field? … We’ve got such burnout in healthcare. We don’t have enough people seeing it as a viable career.”

As Pezzano reminds us, not only do jobs need to become more enticing, but so do the training programs that turn employees from workers into career-oriented team members. Nursing homes must be once again seen by the outside world as offering safe, supportive and fulfilling careers.

Let’s hope CMS works some magic to turn its $75 million budget for building a long-term care nursing pipeline into some kind of mega value-add that delivers way beyond its funding level.

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.

The research was conducted by TollFreeForwarding.com. The team looked at 16 healthcare professions, including doctors and dentists. The data came from the US Bureau of Labor Statistics (BLS), and predicted what each profession would make now and in 10 years from now. The researchers also adjusted data for inflation to come up with the figures.  

Registered nurses will see growth of $12.82 per hour by 2033. On the other hand, dentists will see an decrease of $13.72 per hour in the next decade. Through 2033, the US will need 193,100 registered nurses per year, the BLS reports.

The recent 26th annual CCRC Salary & Benefits Report from the Hospital & Healthcare Compensation Service showed that nursing titles received the highest annual pay increases. In all nursing categories, nurses netted increases exceeding 4.1%, the report stated. That report showed registered nurses, specifically, had a 4% increase from the year before.

According to the BLS, the median salary for a registered nurse is $81,220. That data includes all types of nurses, and the wages can vary depending on the type of nurse. The national hourly pay rate for RNs in 2023 was $37.86, according to other recent data. The income travel nurses in long-term care facilities earn continues to increase as demand does.

A recent survey found there’s been 1,400% percent growth in the number of nurses transitioning using the gig models, the article said. An on-demand nurse is similar to a travel nurse but has more flexibility; they don’t necessarily travel for an assignment.

CareRev, Clipboard Health, IntelyCare, Kare, Nursa and ShiftKey are just a few platforms that try to match demand for nurses with supply of nurses, the article started. The platforms let nurses take temporary positions and move on to new opportunities. The nurses often work as contractors, so they don’t get traditional employee benefits. Depending on how they’re classified as workers, the nurses lose some worker protections like minimum wage guarantees and overtime pay. The nurses also may face inequalities, as women and people of color make up a large portion of nurses.

The platforms also can create imbalances when it comes to staffing nurses. That’s because some of the on-demand nurses may opt for the higher-paying shifts, leaving lesser-paying shifts uncovered. Also, having a different rotation of nurses could affect clinical care consistency. Nurses may care more about the money than providing quality care, according to the article. 

Businesses need to be careful about how they classify workers to prevent legal issues, rising costs, and to protect their reputations, the article reported. Healthcare facilities and the nursing staffing platforms have to be watched closely. Misclassifying nurses can create a host of issues. Plus, healthcare laws differ from state to state, which could impact issues for nurses, facilities and the platforms. 

“Travel nurses already have access to the benefits provided by these apps, including the potential for union membership,” the article stated. “Yet, not all health care facilities extend these benefits universally, often requiring full-time employees to sign non-compete agreements to deter them from seeking better-paying opportunities elsewhere.”

These platforms are different from those in other industries due to the high level of regulations affecting the healthcare field. That means there are more opportunities for legal disputes between the parties that use them. 

“The amalgamation of technology, gig economy and healthcare via on-demand nursing platforms presents opportunities such as enhanced flexibility and reduced burnout potential,” the article said. “Despite these advantages, concerns around worker status, legal implications, and job equity arise, demanding careful consideration.”

The news comes as nursing homes face a proposed federal staffing mandate, which also could affect assisted living providers.

The 2023 National Nursing Engagement Report incorporated responses from 1,923 registered nurses at 37 hospitals across the country. The nurses answered questions on topics including care quality, teamwork, leadership access, professional development and more. 

Engaged nurses are those defined as being “emotionally and intellectually connected to their hospitals” and committed to the success of the organization, according to PRC, the company that conducted the survey. Engaged nurses don’t miss work as much as those who aren’t engaged. Nurses engaged in their work also mentor their colleagues more compared with those who aren’t engaged.

More night shift nurses tended to be more unengaged than nurses who worked during the day. In fact, 18.4% of nurses working at night were unengaged compared with 12.8% who worked days.

Emergency departments at hospitals had the highest rate of unengaged nurses, as 18% of nurses there were unengaged. Inpatient settings had 14.7% of nurses who were unengaged — this includes long-term care communities. And 14.3% of nurses in other settings were unengaged, according to the survey. 

The survey found that 82% of nurses plan to remain at their current workplace for the next two years, and the majority of those who were fully engaged don’t have plans to leave. 

As for unengaged nurses, 50% said they’ll stay put for the next two years. But 41% said they felt burned out. Overall, 15.6% of the nurses surveyed had experienced burnout.

There wasn’t a big difference in the level of engagement between nurses with associate degrees and those with bachelor’s degrees, the report found. 

Employment for registered nurses is expected to grow by 9% through 2030, the US Bureau of Labor Statistics expects.

The report was published in the Journal of the American Geriatrics Society.

Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls.

“Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study,” authors said. NH PRIDE stands for Nursing Home PRevention of Injury in DEmentia program.

The study included healthcare staff members and residents at five long-term care communities. Researchers identified which residents were at a high risk for falls that could cause injuries. In total, there were 46 people enrolled in the program (out of an initial 274 who were eligible). Of the residents studied, 73.9% were female, and 63% had dementia. 

A remote team looked at electronic health records and gave recommendations for injury prevention plans, or IPPs. Staff completed IPPs for 45 residents. On-site, a research nurse coordinated care and engaged residents as well as educating them to facilitate shared decision-making. The team measured outcomes with surveys, medical records and interviews with staff members.  

Upon examining the data, the nurse suggested 93 medications be prescribed in 36 of the residents. (A total of 80% of the residents had one or more deprescribing recommendation.) Of the 45 participants, the nurse recommended osteoporosis treatment for 20 of them. 

Four months after the study started, most people adhered to the medication changes that were recommended, and adverse side effects were rare.

The deprescribing intervention was unique in that it was led by a nurse with interprofessional support. Medication reviews in a nursing home are usually led by pharmacists with shared decision-making left to busy providers; but in the NH PRIDE model, the nurse communicated with staff before making recommendations on medication, letting the staff participate in the decisions. 

During the study, staff members found several ways to improve the program including communicating with psychiatrists and aligning suggestions into the  provider workflow.

Though they want to see more research to see if this can reduce falls throughout nursing home chains, they say the program can help people with dementia avoid injuries.

The Health Resources and Services Administration grants are intended to address increasing demand for registered nurses, nurse practitioners, certified nurse midwives and nurse faculty.

“Nurses are an essential part of our nation’s health care system,” said HHS Secretary Xavier Becerra in a press release announcing the awards. “Now more than ever, we need to double down on our investments in nurses who care for communities across the country.”

But the awards did not provide specific support for entry-level nursing positions, such as the certified nurse aides that are the backbone of the skilled nursing sector. Nursing homes lost more than 200,000 frontline workers during COVID, and the sector remains behind all others when it comes to refilling those positions, the American Health Care Association has reported. The sector could need an estimated 190,000 additional workers to help meet an expected federal staffing minimum.

Earlier this summer, HHS also announced a new, $15 million to entice nurses, clinicians and other staff to frontline roles in pediatrics. But no such funding has been offered to the skillled nursing sector.

“Nurses are the frontline in delivering life-saving care and in keeping all of us healthy and well,” said HRSA Administrator Carole Johnson. “Today’s investments from the Health Resources and Services Administration demonstrate our ongoing commitment to supporting the nursing workforce, training and growing the next generation of nurses, creating career ladders for nurses, and recognizing the critical role nurses play in primary care, mental healthcare, and maternal healthcare.”

The announcement outlined the following awards:

• $8.7 million to help Licensed Practical Nurses become Registered Nurses:  through the Nurse Education, Practice, Quality and Retention-Pathway to Registered Nurse Program. It trains licensed practical nurses and licensed vocational nurses to become registered nurses.  RNs are needed in every nursing homes, but they have become harder to hire in a strapped labor market where acute care and other providers often offer higher salaries and more flexible schedules.
• $26.5 million for addressing bottlenecks in nurse training through the Nurse Faculty Loan Program for award recipient schools to provide low-interest loans and loan cancellation to incentivize careers as nursing school faculty.

$64.8 million for the Advanced Nursing Education Workforce Program and the Advanced Nursing Education-Nurse Practitioner Residency and Fellowship Program, which will increase the number of primary care nurse practitioners, clinical nurse specialists, and certified nurse midwives trained and prepared to provide primary care services, mental health and substance use disorder care, and/or maternal health care.

Researchers looked at blood pressure readings in 195 adults who lived in a community in 2021. Participants went through four sets of measurements. The first three sets used a cuff size that was too small or too large. The fourth reading was done with the correct-sized cuff.

The mean age of people was 54 years old. Among those who needed a small cuff, using the regular stuff gave a lower reading. In fact it was off by a mean less than 3.6 mm Hg (that’s the unit doctors use to measure blood pressure). People who needed a large or extra-large cuff but used a regular cuff had higher readings. Their readings were higher by a mean of 4.8 mm Hg.

“We were shocked at how big of a difference there was,” Tammy Brady, MD, PhD, a study author and an associate professor of pediatrics at Johns Hopkins University, told CNN. “I didn’t expect the magnitude that we found.”

It’s vital to get the right sized cuff because a reading can influence a diagnosis.

“It can have really significant clinical implications,” Brady added.

Healthcare professionals should have easy access to multiple sizes of blood pressure cuffs. And people should steer clear of general cuffs in grocery and drug stores.

“Most people take for granted the blood pressure,” Brady said. “They assume that the machine is very smart and it’s just going to give you the right value, but there’s a lot that depends on the operator doing things properly.”
Brady presented research last year saying that blood pressure cuffs that were too large missed hypertension in 22% of people. Overestimating blood pressure by using a cuff that was too small indicated that 39% of participants were hypertensive when they weren’t.

Johanah Napoleon, 47, former president of the Palm Beach School of Nursing, was given one year and nine months in prison for her role in the scam that took millions of dollars from people looking to earn nursing degrees. Three schools in Florida gave aspiring RNs, LPNs and vocational nurses a “shortcut” to avoid having to go through two-year programs that require clinicals, exams and certifications.

Five more defendants were scheduled to be sentenced today (July 27) in federal District Court in Fort Lauderdale. Each could face up to 20 years in prison but are expected to receive much less after pleading guilty in May to wire fraud conspiracy counts.

A joint investigation led by the FBI and the Department of Health and Human Services found that approximately 7,600 students paid $114 million for fake degrees between 2016 and 2021. Approximately 2,400 students passed licensing exams, with many of them sitting for the New York test, which allows people to retake it multiple times if they fail. 

Stephen B. Hanse, president and CEO of the New York State Health Facilities Association, told McKnights Long-Term Care News in March that two facilities in the state were contacted by authorities asking about employees. 

“Nursing homes in New York are highly regulated,” Hanse said at the time. “We feel very confident that the hiring policies and procedures that are in place are working.”

The federal investigation was dubbed “Operation Nightingale, and authorities brought charges against 25 nursing school recruiters, owners, and managers in the scheme in which students paid $6,000 to $15,000 each for fraudulent documents.

Napoleon was sentenced July 18 and has paid approximately $2.6 million of her fines through the sale of three real estate properties, according to court documents. Her attorney said that she has been cooperating with the government and is expected to testify for the government in at least one pending trial.

When it came to their colleagues, 62% of nursing home and home health workers surveyed by NORC for the Robert Wood Johnson Foundation said they’d seen or been subject to racism or discrimination based on race or ethnicity.

The staggering results published Wednesday show another reason skilled nursing providers may have an uphill battle selling frontline nursing jobs to prospective employees. 

“If we are to truly provide just and equitable care to our patients, we as nurses must hold ourselves accountable for our own behavior and work to change the systems that perpetuate racism and other forms of discrimination,” Beth Toner, RN, director of program communications at the foundation said in announcing the survey results.

The survey included nearly 1,000 registered nurses, nurse practitioners and licensed vocational nurses nationwide. Overall, 79% reported facing racism from patients, with 59% reporting similar behavior among colleagues. In private practices, doctor’s offices and outpatient clinics, those numbers dropped slightly to 74% and 54%, respectively.

While nine out of 10 nurses said diversity, equity and inclusion are stated priorities at their workplace, survey respondents said more education and training is needed.

Although 40% of nurses across all settings represented in the study reported observing or experiencing discrimination from their supervisors, only 23% formally reported or documented such incidents. Just 16% of nurses said they have discussed discrimination or racism they’ve experienced with a human resources leader. Instead most nurses, 57%, talked about those kinds of events with their fellow nurses.

Just four in 10 nurses said they were satisfied with their reporting response; five out of 10 said their relationship with supervisors, senior leaders or fellow nurses was “negatively impacted” by reporting.

There was some good news, however. About 85% of respondents said hiring ethnically and racially diverse nurses is a priority for their organization, and 82% agreed that the nursing workforce hired over the past two years is more diverse than before.

As for solutions, 96% of those polled said they wanted to see more transparent hiring practices, while 92% thought hiring more racially and ethnically diverse nurses in executive leadership and managerial positions would improve the ability to recruit and retain.