In long-term care, staff turnover is at a staggering 40%, twice the national average across industries. New staff are costly to train (in most cases, hiring and training a new staff member costs around 20% of their salary) and take time to find their “groove.” If turnover rates are high, those numbers can stack up quickly.


Countless articles have been written on this topic, listing reasons for turnover:


  • Lack of recognition that leaves employees feeling unappreciated or unsupported
  • Stress
  • Lack of resources to help reduce job-related stress and support new hires as they begin to acclimate
  • Low pay
  • A general poor work environment


“Depending on who it is, you lose that institutional memory of the particulars about the residents and what they’ve done or how they’ve been in the past, or how they’ve responded to different interventions,” says Dr. Randy Beckett, PMHNP-BC. “Things that aren’t written down go with them.”


Turnover is not only costly, it disrupts continuity of care.


Reduce Stress


Frequently, to address stress and reduce turnover, skilled nursing facilities focus on building support structures to help staff cope with stress. Other solutions (such as hiring more staff to reduce individual workloads) seem unviable due to cost. It’s not often that the source of the stress is addressed itself.


One stressor in skilled nursing facilities is resident behavioral episodes. Staff may not know how to address resident episodes, and seeing another person in distress is extremely stressful—not just on an emotional but also on a physical level.


Rather than letting staff become overwhelmed, an alternative is preparing for those episodes to help reduce them directly.


“One of the things that we can help with is the pressure they have with residents who have behaviors… which have not been addressed appropriately in the past,” says Beckett. “It takes a lot of stress off [the staff.]”


Calling the provider is the last intervention skilled nursing facility staff are trained to take, but knowing that they have an Encounter provider to back them up reduces a lot of stress.


“It gives them a real sense of safety or a sense of comfort, that they can reach out to somebody after they’ve tried everything they know how to do,” Beckett says.


Reduce Friction with Families


Telehealth also offers the opportunity to include residents’ families directly in their care. Families have the option to call in to the video conference if they can’t be physically present. This streamlines care and further reduces stress, since the family is involved and aware of what’s going on with their family member.


“I have people who are 1,500 miles away who participate in the meetings via VSee,” says Beckett. “They can participate in their loved one’s care without being physically present. And the software’s free, so no reason not to.”


Train for Success


Another way to reduce stress associated with resident behaviors is to train staff to be prepared to address them when they do occur. These trainings alone can help improve job satisfaction before even seeing any results. Indeed, training on how to work with difficult residents was a major element of job satisfaction.


Encounter Telehealth offers specialized training for staff to help them work with family members, educate them on dementia, dementia behaviors and mental illness, and basics of cognitive behavioral therapy to help staff regulate their feelings by reviewing and controlling their thought patterns, thereby reducing stress and workplace friction.


“The training helps the staff learn not only about mental health, but also how to take care of themselves when under pressure,” says Beckett, who has held many of these trainings. “We talk about boundaries with coworkers, with residents, with family members, and we teach people about how their thoughts determine their feelings.”


Encounter’s staff trainings are held in groups, often through teleconferencing, and usually include follow-up trainings to ensure that staff remember key points.


When a behavioral health provider works closely with a nursing home, resident episodes can be reduced greatly. Cooperation between behavioral provider and staff can extend further with trainings on why episodes occur and how to address them. This reduces behavioral episodes on both fronts, from provider and from nursing staff.


Peer Mentorship and Cooperation


Another way to reduce staff churn is to offer a mentorship program. Vague job expectations lead to a lack of clarity, causing disconnection for staff, and most of the time it’s the staff who have been with the facility for less than a year who are most likely to leave. Peer mentoring programs help by providing a support system for new staff members, immediate responses to questions, and a clear path forward. Christian Living Communities improved its retention rate of certified nursing assistants from 49% to 90% by implementing a mentorship program and offering incentives for mentors whose mentee stayed.


To read more on implementing a peer mentoring program, click here.


A similar solution for nurses is a nurse leadership program. This helps reduce the feeling that staff aren’t being heard.


“If people don’t feel like they have some ownership in what goes on in the facility, or that their suggestions or things that they would like to try or change aren’t listened to, eventually they stop trying… and they leave,” Beckett says.


Environment and Culture: Examples from Encounter Partner Nursing Facilities


St. Francis Manor (Grinnell, Iowa)

Building a culture of support and fun is key to improving job satisfaction. The most important factors for Morgan Beck, director of nursing at St. Francis Manor in Grinnell, Iowa, are the system of support between her and her coworkers and her relationships with residents.


“I’ve had a lot of growth here, and I just like the elderly population,” says Beck, who has worked at St. Francis Manor for three years. “We just try to have a really relaxed environment whenever we can. We try to work around people’s schedules and be accommodating to them so they’ll be accommodating to us.”


Teamwork is important at St. Francis Manor.


“[Those of us] working in the office try not to be above going out to work on the floor, or if extra staff is needed, we come in and help,” says Beck. “We try to have a teamwork approach… Nobody is above doing any work.”


St. Francis Manor also uses a job-shadowing program, pays for testing for certified nursing assistants (CNAs), and offers pay incentives for picking up shifts outside normal scheduled hours. About half of CNAs who complete the job-shadowing program stay on at St. Francis.


To learn more about St. Francis Manor, visit


Morys Haven (Columbus, Nebraska)

At Morys Haven in Columbus, Nebraska, size and community are the main drivers of job satisfaction for telehealth coordinator Julie Shaecher. Shaecher says that of all the areas of nursing she’s worked in, long-term care is her favorite, and relationships with her coworkers offer her the support she needs.


Morys Haven is a smaller facility, which is important to CNAs’ job satisfaction.


“It’s not like they have 20 people per CNA; they have about eight,” Shaecher says.


This is also true of other facilities; staff at smaller, more family-like facilities tend to have more job satisfaction.


“I think we’re a more family-oriented facility than some of the other, bigger ones that kind of get lost in the shuffle, and that’s not how it is here,” Shaecher says.


To encourage CNAs to stay with the facility, 5-Star Senior Living, Morys Haven’s parent corporation, offers tuition reimbursement and scholarships for CNAs, and flexible scheduling allows staff to find a good work-life balance.


To learn more about Morys Haven, visit


Community Pride Care Center (Battle Creek, Nebraska)

Lyn Klug, telehealth coordinator at Community Pride Care Center in Battle Creek, Nebraska, also finds inspiration in the residents and “seeing their love for the staff and their love for each other.”


“It’s more than just a facility; it’s a family,” Klug says.


Community Pride found success in reducing stress on staff by eliminating unnecessary alarms to reduce alarm fatigue.


“We’ve tried to have a much more relaxed atmosphere, decreasing noises, turning off extra sounds,” says Klug. “We’re finding that noises seem to heighten staff stress level, and residents’ [stress].”


Another innovation at Community Pride Care Center was the implementation of the Uninterrupted Sleep and Natural Awakening Program, a sleep program that allows residents more control over when they go to bed and get up. When residents are sleeping, they aren’t awakened at set times; instead, staff check every thirty minutes to see if a resident needs assistance, which makes things easier on both staff and residents. Residents can set their own schedule for going to bed, waking up and eating breakfast.


“One of the coolest things I remember was one of the first nights… was the sound of silence,” says Klug. “I had never heard that in this building in 28 years… it was a beautiful sound to hear everyone snoring.”


The Uninterrupted Sleep and Natural Awakening Program was originally supposed to reduce falls. However, residents with dementia showed great improvement. All these benefits led to less stress on staff as well as residents.


“Within the first week, we were totally amazed,” Klug says. “The one thing we did not expect was one of our residents, who I’d known since I was a child, had end-stage Alzheimer’s… Within the first two months, he was able to call us staff members by name. He hadn’t done that in five years.”


To learn more about Community Pride Care Center, visit




Innovation and collaboration are the key drivers of staff retention. By partnering with a telehealth behavioral health provider, resident behavioral episodes can be reduced, reducing staff stress. Other innovations such as flexible and self-scheduling and limiting unnecessary alarms can further reduce stress, leading to increased job satisfaction and staff retention.


Katherine Hartner is Encounter Telehealth’s Social Media and Marketing Intern. She is studying journalism, with a concentration in PR and advertising, at UNO. She has written multiple articles for the Gateway, UNO’s student-run newspaper, and is active with MavRadio, UNO’s college radio station. In her free time, she enjoys writing fiction, gardening, and volunteering.