The State of Employee Retention in U.S. Health Care

In December 2016, approximately 531,000 positions went unfilled in U.S. health care and social assistance, reports the U.S. Bureau of Labor Statistics (BLS). This includes nurses, direct support professionals (DSPs), certified nursing assistants (CNAs), home health aides, administrative staff and educational instructors for the health care industry.

From senior care to managing the well-being of children, youth and families, health care organizations need to think about the severity of the problem, its driving forces, and how it will impact at-risk individuals.

Employee Retention in the U.S. Health Care System

Health care professionals, including nurses, face multiple challenges every day. These challenges may reflect mental, emotional or physical issues. A person may experience severe emotional disturbances, or he or she may engage in self-injurious behaviors (SIB). However, caring for a person with such health problems drains the mental strength of caregivers, alluding to a possible reason behind burnout in the industry. But, exactly how bad is the problem?

Among nurses providing bedside care across different health care settings, the turnover rate remains high, reports the University of New Mexico. In 2015, the turnover rate among this group of nurses was 17.2 percent. Meanwhile, other areas, including behavioral health, emergency medicine and surgery or post-surgical centers, also deal with high turnover rates. Yet, frontline staff, such as CNAs and DSPs, have the highest turnover rates of all professionals at 23.8 percent.

What’s Driving High Turnover Rates Among Health Care Providers?

High turnover rates among health care professionals reflect three pain points in the industry, explains Becker’s Hospital Review, which include the following:

  • Employees have a high workload, which varies between specific positions. When workloads are not fairly distributed among similar positions, the likelihood of resignation increases. Furthermore, workload includes fair pay for a certain position, such as appropriate raises and bonuses per company policy. However, these factors can breed hostility or violence in the workplace, so managing workloads appropriately is essential to keeping the workplace safe and reducing high turnover rates.
  • A lack of leadership leaves employees without a sense of backing. Management and administrative officials should have a strong leadership role in your company. Health care professionals need to see the bigger picture beyond their respective assignments to be successful, which translates into better treatment outcomes and service offerings in your organization. Furthermore, your company needs to lead your team toward better care standards. More than 50 percent of surveyed health care professionals in a 2015 Gallup Poll cited a previous “bad boss” as reason for resignation. Although this goes back to the need for strong leadership, it indicates a possible miscommunication or disruption along the chain of command.
  • Employees may not have the ability to grow and expand their careers in a company. Regardless of their current designation and skillset, every employee needs opportunity for growth. Implementing wage or hiring freezes, or stopping employees with appropriate credentials and experience from being promoted in your organization, will increase turnover rates.

How Does Employee Benefits or Salary Impact Employee Retention?

Employee benefits and salary impact employee turnover rates as well. According to the BLS, wages and salaries among health care professionals rose 0.3 percent in 2016. However, health care workers in state and local government-based organizations that provide services to populations in need experienced a 0.1-percent decrease in annual compensation. This slow growth in wages may result in fewer people staying in the industry.

Regarding benefits, including health insurance, paid time off (PTO), vacation time and retirement packages, trends since 2006 reveal another possible cause of high employee turnover. Over the last decade, the hourly percent of wages devoted to benefits has increased from 1.87 percent to 2.79 percent.

In other words, approximately $2.79 of every $10 earned hourly goes into premiums or payment for other benefits. Thus, the total net paycheck per pay period reflects a smaller percentage of take-home pay than people received 10 years prior. Of course, this does not consider increased wages over the same amount of time. So, raises over the past few years may appear smaller to employees than they actually are after subtracting the cost of benefits.

What Does It Mean For At-Risk Individuals?

In behavioral health, high employee turnover can be detrimental to treatment quality and deadly. Yet, a study, published by the U.S. National Library of Medicine, found that there was “no significant association between staff turnover and [overall] quality of treatment.” However, the chances of successful treatment during periods of high staff turnover among those served were dramatically lowered.

This association exists as daily activities and operations continue with current employees trying to manage training new professionals, handle responsibilities and assess current physical and mental states of people receiving care. Unfortunately, this creates problems with staff density.

Depending on the budget of your organization, additional personnel being trained may result in the removal of one or more people from the evening or weekend shift roster. While this may not be an issue at first, an increase in services rendered may cause staff density to drop even further. Consequently, risk in the facility increases.

For example, a person experiencing a behavioral health crisis may engage in behaviors that threaten his or her security and safety or the well-being of others currently receiving treatment. This may lead to suicidal or homicidal attempts, which can undermine the integrity and effectiveness of your facility.

A Quick Recap

High employee turnover leads to worse treatment outcomes and distrust among those you serve, and it is a major problem in U.S. health care delivery across centers that provide behavioral health services, senior care services, services for the health of children, youth and families and other people in need. To help your organization grow and continue to serve others in the coming years, you need to understand the causes and effects of high employee turnover rates. Ultimately, you can change the tone by acting to stop the causes now.

Jason Vanover

Working in health care since 2005, Jason's body of experience encompasses dozens of care settings, including Senior care, psychiatric facilities, nonprofit health service centers, group homes for those with developmental disabilities and beyond. Jason understands the need to tailor his skills to each setting to encourage the best treatment outcomes and promote an inclusive, healing environment.

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