Empowering Care Through Connection
How Peer Mentoring Transformed a Sought Carolina Nursing Homes’s Staff Retention
Since the peak of COVID-19 in 2020, the recruitment and retention of certified nurse assistants (CNAs) have been a significant challenge for many nursing homes.
High turnover rates have hurt the quality of care and have forced the cost of recruitment, training, and on boarding to rise. A recent pilot study in South Carolina, however, shows this problem can be sharply reduced using mentoring programs for new hires. Using the “Growing Strong Roots” peer-mentoring program designed by the Foundation for Long-Term Care (FLTC) as a research model (Health Prog 2005;86[6]:25–30), the Heritage at Lowman (HAL), a non-profit continuing care retirement community located in Chapin, created a mentor program of their own to assist with new hire retention. A three-month pilot program was conducted with positive results. CNA turnover, which had been averaging at 31% in 2022, fell to 15%, and the CNA retention rate rose from 69% to 88% during the study.
The Five Step Program
The peer-mentoring program at HAL consisted of five steps:
1. Preimplementation: Gathering data on clinical turnover and retention rates to establish a baseline.
2. Mentor selection: With input from the director of nursing and the HAL administrator, a list of mentors was created, with at least two in each unit.
3. Mentee–mentor matching: Based on individual qualities, each mentor was selected. A list of new hires was matched with mentors, accounting for units and shifts. When a new hire joined the staff, they were informed by human resources that their mentor would be reaching out to them.
4. Mentor meeting: The director of nursing and a graduate assistant leading the pilot functioned as facilitators in the initial mentor meeting, allowing the mentors to help create their own expectations and skills checklist. The graduate assistant informed the mentors who their mentee would be and provided their contact information and next shift staffing. The mentors were encouraged to make their initial contact as soon as possible.
5. Post-mentor meeting: The skills checklist was formally documented and set out at each unit for pickup. Weekly check-ins were conducted to assess the progress of the program and identify changes needed for future improvements. At the end of four weeks, the mentees were given a survey to determine how well they understood their responsibilities and to analyze the program to guide future improvements.
Results
Before the program’s implementation, the CNA turnover rate started at 19% in the first quarter of 2023, After implementation of the program, the CNA turnover rate was 15% in the fourth quarter of 2023.
Mentee Survey Results
The results in the first quarter were quite positive, with an average score of 80% to 90% satisfaction among the participants. The participants were asked, “Do you feel that participation in mentorship programs plays a positive role in the new nurses’ intention to stay with the organization?” The responses showed a 90% agreement, and 100% of the mentees agreed they would recommend that new nurses and direct care staff join the program.
Phase 3 Plans
The pilot project was part of the South Carolina Action Collaborative for Excellence (ACE) Leadership Academy Phase 2 (January–September 2023). During Phase 3 (January–May 2024) ACE plans to offer participating facilities a CNA Preceptor Turnover Management Pilot to train and mentor CNAs in the orientation and onboarding process. This opportunity is in collaboration with the National Association of Health Care Assistants (NAHCA).
By fostering a supportive environment through mentorship, the initiative aims to establish a more stable workforce. The ultimate goal is to enhance the continuity of staffing and promote resident-focused preferences and care. By addressing turnover issues and ensuring a consistent and skilled CNA workforce, the project elevates the quality of care provided to residents to enhance their well-being in long-term care facilities.
This study has been conducted by Constellation Quality Health of Raleigh, NC on contract with the SC Department of Health and Environmental Control. Beth Hercher, CPHQ is the program manager and is supported by Alyssa Pischel, NHA, DHA the director of Post Acute Quality Improvement. Special recognition is provided to David Farrell, a well-known author and industry leader on nursing home quality, who remains an active subject matter expert facilitating the learning sessions through the phases.
