Everywhere you look, “Now Hiring” signs abound. We are in a nationwide workforce crisis that affects nearly every industry, but health care has been especially impacted. Employees in our industry experienced first-hand the very worst of the pandemic. It has left our workforce frustrated, disillusioned, and exhausted. Many have given up and left health care. Many more have found paths that keep them away from direct patient care. As we emerge from the devastation, we find our industry in real crisis with few options. For many providers, agency and contract staff members offer the only way out as we work to rebuild our laborforce.
When we think of these temporary workers, though, most of us do not get all warm and fuzzy. We know that our permanent staff is alienated by those who choose to work only when and where they want to—and earn more doing it. These temporary staff members carry an image of doing less work, caring less about the residents, and having questionable competence and little loyalty. Depending on these people to care for our most vulnerable creates real fear for our providers, as they also face low levels of confidence from hospitals, families, and residents, as well as increasing demands from regulations.
So, how do we survive this “perfect storm” and maintain our clinical and customer service standards of excellence while utilizing agency staff? Read on to uncover a system you can use to ensure you consistently provide quality care and excellent customer service to the residents of your community.
Be Sure You Are Staffing to Census and Acuity
This is no time to schedule extra employees that exceed your Per Patient Day budgeting standards. By using block schedules, you will be able to replace whole or partial openings for blocks of time instead of trying to fill your schedule hour by hour or day by day. This assures consistent staff members who will come to know and care for your residents.
Choose an Agency You Can Build a Relationship with
You need the agency to have some loyalty and commitment to you, and you must return the favor. Clearly state your expectations and require that the agency be committed to meeting those expectations: to find consistent, competent, and dedicated contractors who will truly fill in until your own team can take over. Try to negotiate buy-out agreements that will allow those who want to accept a permanent position the option to do so.
Set a Standard of Demonstrated Competency
Every agency should ensure that the staff members it sends are competent to do the job. Ask your agency about its quality control measures and what it is doing to guarantee that its contractors meet your community’s competencies. And, ask the agency to provide documentation of those competencies for each person they send. The standards you choose should be equal to what you expect from your own team.
- CMS has an excellent set of competencies for both licensed and unlicensed team members.
- If your contractors have met CMS’s competencies, you should have confidence that they can provide the same level of care you expect from your own staff.
Decide What Policies Are Unique to Your Community
Provide a copy of the unique policies to all agency workers when they arrive for their first shift. These policies should include:
- your grievance policy
- who your abuse coordinator is
- how you expect any irregularities to be reported
- the codes you use for all emergencies, such as fire safety and elopement
- rules about lifts and safety
- how you handle falls
- smoking safety rules
- other policies that might give you pause when you think about agency staff delivering care
Have all contractors sign for a copy of the unique policies and keep the record on file.
Be Sure Your Agency Team Members Know Where They Are, Who They Are Caring for, and Where to Find What They Are Looking for
Agency employees should be met by a permanent staff member on arrival, given a brief tour, and should complete walking rounds to meet the residents they will care for. Create a staff information board that all agency staffers are shown. Make sure it has basic rules, names, and phone numbers—numbers for the DON, Administrator, doctors, pharmacies, and under what conditions to call each of them. Having contractors sign for the unique policies makes them accountable to follow your rules, and the board allows them to reference information quickly when they need it.
Put Your Own Team Members on a Set Schedule
Position them to deliver primary care to your residents and to assure that someone from your team is always present and accountable when a contractor is providing care. A goal should be to give your team members first choice of schedules and use agency staff to fill in what is left. Too often, the opposite happens, which furthers the exodus of permanent employees to agency ranks. Try to give your team a work-life balance to begin to relieve the frustration and exhaustion.
Include Agency Contractors in all Your Education and Promotions
They are your staff too, and the more you can draw them in and engage them, the better they will serve you. If they like you and you like them, they may become part of your long-term solution.
Have Your Own Staff Help Make up Resident Information Cards or Update Care Cards You Already Use
These cards can be hole-punched and dealt out at the beginning of the shift to whoever is providing care, or they can be kept in a notebook at the nurse’s station. They should include each resident’s photo, name, age, family information, social history, personal stories, and preferences that will enhance the resident’s care. In addition, the cards should contain crucial medical diagnoses and special treatment needs of each resident, such as the resident’s safety and behavioral interventions, how the resident transfers, how the resident eats, and how the resident takes medications. Keep the descriptions brief but don’t forget the personal touch. By having some basic understanding of the person they are caring for, the contractors are more likely to deliver the care you would expect.
Reward Both Your Staff and the Contractors When Things Go Well
Reinforce working together in care teams and having good outcomes. If you hand out rewards for successes, include agency staff members. Make them feel truly welcome and valued. Doing so builds a culture of caring that everyone, your staff as well as the contractors, will remember.
Create Supervisors for all Off Shifts
This is an excellent opportunity to demonstrate your appreciation to staff members who have stayed with you. Reward that dedication by using them to assure that your agency staff knows what it is doing, is comfortable asking for help, and can maintain the quality of care the residents are accustomed to receiving.
During This Challenging Time
We often find ourselves just trying to keep up. We are chasing the tasks instead of mastering them. This is the perfect time to stop for a minute and really put your agency plan together and then take that plan to QAPI. If you take the steps outlined, you will have a team that performs for you while you rebuild. You will have confidence that your residents are in good hands, even if they are agency hands. Your own staff will begin to relax into the calm, the organization, and the sense of working as a team to deliver great care. This is the culture that will rebuild your team as well as keep your residents safe and comfortable while you do it.
How Can HDG Help?
HDG has dozens of years of combined experience in the analysis of operations, workforce development and staff, financial and strategic planning, and effectively managing industry changes. Let our team partner with yours to get through this difficult point in time.