Like hospitals, post-acute care facilities face a staffing crisis and are trying to enhance nurse recruitment and retention. Even before the pandemic, it was challenging to maintain adequate staffing levels for long-term care, home health, rehabilitation and other post-acute services.
At an event held by the Massachusetts Health and Hospital Association (MHA) and the regional Organization of Nurse Leaders (ONL) on October 19, 2021, nurse leaders talked about strategies they use to attract and support nurses and other staff who provide direct care in the current hiring environment.
The discussion illustrated a tension between finding ways to partner with their acute care colleagues and at the same time compete for staffing and other resources. Maureen Banks, R.N., D.N.P., Chief Operating Officer and Chief Nursing Officer at the Spaulding Rehabilitation Network in Boston, noted that health care has become more a “team sport” among different levels of care than at any earlier time in her career, saying, “We recognize how dependent we are on each other for the system to work and for the patients to have good outcomes.” At the same time, speakers noted that lower levels of reimbursement for post-acute, long-term and home care put them at a disadvantage in the competition for qualified staff.
Tammy B. Retalic, R.N., D.N.P.(c), Chief Nursing Officer at Hebrew SeniorLife and Vice President of Patient Care Services at Hebrew Rehabilitation Center in Boston, advocated for a new approach to clinician education without the current barriers between acute and post-acute care. In her vision, students would move through the continuum, including hospital care, self-care and care delivered at home, in long-term facilities and hospice. “Students would learn how care interrelates,” said Retalic, “and we could create employment opportunities across the continuum.”
In today’s reality, Retalic said that Hebrew SeniorLife offers tuition and other support to licensed practical nurses working toward a bachelor’s degree in nursing and asks all employees to act as recruiters, with incentives to encourage people to reach out to friends and family. Hebrew SeniorLife also schedules time for their emerging nurse leaders to pursue other aspects of nursing, such as quality improvement, education or research, to help them develop their careers while staying engaged in direct patient care.
Spaulding also supports professional development for nurses. Banks said she offers to help nurses explore opportunities and asks them, “What kind of clinical ladder can we structure so you can continue to grow?” She pointed out that, historically, many nurses would work in post-acute care after graduation and then move into acute care. With the current shortage, hospitals are hiring newly graduated nurses, and post-acute care is finding that “the pipeline is completely dry,” according to Banks.
Retalic and Banks both observed that without further attention to the problem, post-acute care settings, especially skilled nursing facilities, can become a ‘bottleneck’ in transitioning patients from acute care to long-term or home care. They reported that, on top of staffing shortages, COVID restrictions have limited the number of patients served in facilities that often feature shared rooms and limited space. COVID testing and quarantine protocols can also impact their ability to help patients progress to the most appropriate care setting. This can, in turn, impact hospitals’ ability schedule surgeries and admit patients from the emergency department.
Like Retalic, Banks wishes the U.S. health care system were more broadly supportive of collaborative efforts to improve health. At the end of the MHA/ONL program, she asked, “How do we come to terms with the issue of how much time and money it would take to shift to a health focus that could really make a difference over generations? I think we can do it, but you’ve got to be incredibly passionate and believe that it’s worth the fight.”