HCM 700 Module 4 Workforce Strategy Paper Example

Making Willow Creek Worth Staying For: A Nursing Workforce Retention Strategy

[Student Name]

Southern New Hampshire University

HCM 700: Healthcare Administration Capstone

Module Four Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Making Willow Creek Worth Staying For: A Nursing Workforce Retention Strategy

Milestone One concluded that workforce stability is the lever on which Willow Creek Care Center's quality and finances depend. This paper translates that conclusion into a strategy. It profiles the nursing workforce, estimates what turnover costs, compares pay with competing employers and proposes seven strategies that address the reasons staff leave, especially in their first three months. It closes with a plan to phase down agency use and measures to track workforce health.

The Nursing Workforce Today

Willow Creek budgets 64 full-time-equivalent certified nursing assistant positions, 18 licensed practical nurse positions and 9 registered nurse positions. Currently 42 aide, 14 practical nurse and 7 registered nurse positions are filled. Last year 58 aides left, 27 of them within 90 days of hire. Practical nurse turnover was lower but still high at 61%. The median aide has worked at Willow Creek for 14 months, and five aides have worked there more than ten years; families mention those five by name in satisfaction surveys.

What One Departure Costs

Each aide who leaves costs Willow Creek an estimated $5,200. Recruiting and background checks cost about $1,200. Paid orientation and two weeks of precepting consume roughly $1,900 in wages for the new aide and the preceptor. Until a replacement is productive, vacant shifts are covered by agency staff at about $23 an hour more than an employed aide, adding roughly $2,100 over a typical six-week gap. With 58 aide departures last year, turnover cost roughly $300,000 before counting any effect on quality, inspections or admissions.

Table 1. Estimated Cost per Aide Departure

Note. Estimates by the author with human resources and finance.

How Pay Compares

Willow Creek starts aides at $17.25 an hour. The regional hospital starts nursing assistants at $19.50, two for-profit nursing homes nearby start at $18.00 and $18.75 and a distribution warehouse ten minutes away starts at $20.00 with no weekend work. Several exit interviews named the warehouse. Pay alone does not explain turnover, but Willow Creek is asking aides to do hard, emotionally demanding work for less than they could earn lifting boxes.

Strategy 1: A Competitive Wage Scale

The plan sets a starting wage of $19.50 with steps at six months, one year, two years and three years, reaching $22.00. Steps reward staying rather than only attracting new hires. Raising all current aides to their step on the new scale costs about $360,000 a year including benefits once positions are filled, a figure that must be weighed against agency and turnover savings in the financial analysis.

Strategy 2: A Structured First 90 Days

Because nearly half of departing aides leave within 90 days, onboarding receives special attention. New aides will spend two weeks paired with one trained peer mentor, who earns a $1.50 hourly differential while mentoring. The director of nursing or a unit manager will sit down briefly with each new aide at the end of the first, second and third months, asking what is going well and what might make the new aide leave. Mentors will be chosen from long-serving aides and trained in teaching and in welcoming new colleagues.

Strategy 3: Consistent Assignment

Under consistent assignment, each aide cares for the same group of about ten to twelve residents on most shifts. Castle (2013) found this practice associated with lower aide turnover and absenteeism. It also builds relationships that families value and that help aides notice when a resident seems unwell. Willow Creek will reorganize each unit into two or three resident groups, schedule aides to their groups and track the percentage of shifts in which residents receive care from their usual aide.

Strategy 4: Predictable Scheduling and a Float Pool

Schedules will be posted four weeks ahead, and aides will be able to request and trade shifts through a scheduling app. A 12-hour shift option will be offered on units where staff prefer it. Weekend work will be shared fairly, with a $2 hourly weekend differential. Most importantly, Willow Creek will build an internal float pool of six aides who earn an extra $1.50 an hour to cover call-outs across units, replacing much of the agency coverage that now fills last-minute gaps with strangers.

Strategy 5: A Career Ladder

Aides who stay should be able to grow. The ladder has four rungs: aide, senior aide with dementia care and restorative care training, certified medication aide and licensed practical nurse through tuition assistance in exchange for a two-year commitment. The national aide survey profiled by Squillace et al. (2009) gathered evidence on training, working conditions and intentions to stay, and practice reports suggest that advancement opportunities matter to aides deciding whether to remain. Each rung carries a pay increase and a new title.

Strategy 6: Supervisors Who Coach

Castle et al. (2007) found that nurse aides' job satisfaction, including satisfaction with supervision, predicted both intent to leave and actual turnover. At Willow Creek, charge nurses are often newly licensed and receive no leadership training. The plan provides a 12-hour coaching and recognition course for all charge nurses and unit managers, covering feedback, conflict and simple recognition practices such as thanking aides by name at shift huddles.

Strategy 7: Safer Workloads

Exit interviews described shifts so short-staffed that aides felt unsafe. The plan sets a staffing floor below which the float pool or, as a last resort, agency staff must be called, so no unit runs below a defined aide-to-resident ratio. It adds two ceiling lifts on the long-term care unit, where most transfers occur, and tracks staff injuries monthly.

How the Strategies Fit Together

The strategies work as a system. Wages and schedules help recruit and retain, onboarding and mentors carry new aides through the riskiest period, consistent assignment and coaching make the work more satisfying, the career ladder gives a reason to stay for years and the float pool and staffing floor protect workload. Table 2 links each to the reasons staff give for leaving.

Table 2. Strategies, Causes Addressed and Evidence

Note. Compiled by the author.

Phasing Down Agency Staff

Agency hours currently make up 18% of nursing time. As vacancies fill and the float pool starts, the plan targets 10% by the end of year one and 5% by the end of year two, keeping agency only for true emergencies. Castle (2009) found better quality where agency use was lower, and Castle and Engberg (2005) linked lower turnover with better care, so the phase-down should improve care as well as finances.

Measuring Workforce Health

Progress will be tracked monthly through overall and aide turnover, 90-day retention of new hires, vacancy rate, agency share of nursing hours, overtime hours, absenteeism, consistent assignment percentage and staff injuries. Quarterly stay interviews with a sample of aides will reveal new problems before they appear in turnover figures.

Conclusion

Willow Creek loses about $300,000 a year to aide turnover alone and much more in agency premiums and lost admissions. A system of seven strategies addressing pay, the first 90 days, consistent assignment, schedules, careers, supervision and safety offers a credible path to stability. The next steps are to test the policy environment in Module Five and to build the full solution and implementation plan in Milestone Two.

References

Castle, N. G. (2009). Use of agency staff in nursing homes. Research in Gerontological Nursing, 2(3), 192-201. https://doi.org/10.3928/19404921-20090428-01

Castle, N. G. (2013). Consistent assignment of nurse aides: Association with turnover and absenteeism. Journal of Aging & Social Policy, 25(1), 48-64. https://doi.org/10.1080/08959420.2012.705647

Castle, N. G., & Engberg, J. (2005). Staff turnover and quality of care in nursing homes. Medical Care, 43(6), 616-626. https://doi.org/10.1097/01.mlr.0000163661.67170.b9

Castle, N. G., Engberg, J., Anderson, R., & Men, A. (2007). Job satisfaction of nurse aides in nursing homes: Intent to leave and turnover. The Gerontologist, 47(2), 193-204. https://doi.org/10.1093/geront/47.2.193

Squillace, M. R., Remsburg, R. E., Harris-Kojetin, L. D., Bercovitz, A., Rosenoff, E., & Han, B. (2009). The National Nursing Assistant Survey: Improving the evidence base for policy initiatives to strengthen the certified nursing assistant workforce. The Gerontologist, 49(2), 185-197. https://doi.org/10.1093/geront/gnp024