How to Retain Employees

Learning from others... How are other healthcare settings navigating employee retention?

Retention among direct care workers (DCWs) has been a major challenge in healthcare for years and worsened only with the COVID-19 pandemic. DCWs (entry-level caregivers including nursing aides and patient care aides) provide vital support to patients in hospitals and long-term care settings. Because of the stressful nature of the job, inadequate compensation, and few opportunities to advance in one's career, a large number of DCWs leave their positions within the first year of employment. This churn puts a strain on health systems and increases costs because of the need to continually hire and train new DCWs; moreover, the quality of patient care is compromised as a result of staffing shortages.

Prior research has recognized challenges related to retention in the direct care workforce, including low wages and benefits, few opportunities for career growth, devaluation of this workforce, and a lack of integration with the broader care team in the patient's care and decision-making.

Consequently, several studies have evaluated the impact of different interventions to improve retention among entry-level DCWs. These interventions have included curriculum- or skills-based programs, mentoring or coaching, incremental increases in hourly wage rates or retention bonuses, or some combination of these components. The findings of these studies, however, have shown no difference or only modest improvements in retention in addition to being costly.

Although the program we evaluated focused on individual-level factors that may affect retention, the principal findings revealed other broader, contextual challenges faced by DCWs that they said would have an impact on their willingness to stay in their positions. These challenges included (1) job-related factors including limited compensation potential, aspects of the job itself (job experience compared to responsibilities), and the inability to advance in one's position; (2) health system challenges including the mission, policies, staffing, and organizational culture; and (3) external factors including federal policies and the ongoing COVID-19 pandemic.

Bandini, Julia I. PhD; Rollison, Julia PhD; Etchegaray, Jason PhD. Understanding Multilevel Factors Related to Retention Among the Direct Care Workforce: Incorporating Lessons Learned in Considering Innovative Interventions. Journal of Healthcare Management. 2024:69(1), 59-73. DOI: 10.1097/JHM-D-22-00235

Shelby 7/2024