Models for Practice


A few years back, WAHSA's Health Issues Committee developed the Task Force on Long Term Care Employment. The purpose of this task force was to examine current concerns, consider future trends, and recommend positive strategies to issues such as labor shortages, recruitment and retention, work ethic, attendance concerns, and general labor trends. The first project of the task force was the booklet Enhancing Employment in Long Term Care, which originally was published two years ago. The book was adopted and enhanced by WAHSA's sister association, the Indiana Association of Homes and Services for the Aging (IAHSA). Earlier this year WAHSA incorporated many of the additions incorporated by IAHSA, and republished this book of ideas to enhance job satisfaction and retention in long term care. WAHSA's quest to enhance recruitment and retention in long term care has continued to spark new ideas and new products. Most recently, IAHSA surveyed long term care facilities for ideas for a new publication, Models for Practice During the First Ninety Days of Employment . The Indiana association has graciously shared this publication with WAHSA as we continue to work together to nurture a more positive environment for people to live and work in this arena we call long term care. Like IAHSA, WAHSA believes the first ninety days of employment is a critical time for retention. As such, we hope you find these low cost ideas easy to implement and helpful to utilize. WAHSA wishes to acknowledge and commend the efforts of the long term care employees in Indiana, and the staff of IAHSA for sharing these ideas with us. Sincerely, John Sauer, Executive Director

Attracting Employees 

What do you do to attract applicants?

    • First impression of facility is important; friendliness of receptionist is very important
    • Professional advertisement in local newspaper
    • Ads in church bulletins, laundromats, colleges, high schools
    • Word of mouth
    • Good benefits that are fully explained; medical insurance a plus
    • Flex hours; advertise that moms can leave after the school bus and be home when it arrives
    • Tuition reimbursement
    • Offer competitive pay rates, especially for positions with greatest turnover
    • Offer attractive benefit package to those scheduled to work 20 hours or more per week
    • Assign a "preceptor" to new employees for the first 90 days
    • Child care in facility
    • Post available jobs in house
    • Participate in career days in the area high schools
    • Good community public relations; attend job fairs, health fairs
    • Appearance of facility
    • Discuss fact we are accredited
    • Employee referrals; bonus paid to current employee
    • Quick response by department heads for interviews and follow-ups
    • Use response post cards on receipt of application to let candidate know when they will be contacted
    • Open house for interviewing; on the spot interviews
    • Sign-on bonuses
    • Recruitment bonus for current employees who refer new employees
    • Serve as a clinical site for nursing students
    • In ads, stress mission, benefit program and shift flexibility
    • Offer and provide orientation with above average co-worker
    • Shift differentials
    • Free uniform after one year of employment
    • Medical doctor in building also sees employees
    • Cross training of different departments
    • Encourage "pool" employees to become permanent; present a 30-minute orientation to first time personnel; help them have a pleasant experience
    • Offer tour of facility at time of application
    • High school/work programs; high school seniors attend class five days per week for two hours per day; program explores different health occupations while getting CNA license
    • Job shadowing through technical programs
    • Nurses work every third weekend instead of every two
    • Benefits offered to employees working 20 hours or more per week

Successful Techniques for Screening Applicants

  • Give clear, concise job description
  • Require resume to pre-screen for interview
  • On-site application and interview
  • Complete drug screen and criminal check
  • Check references
  • Second interview
  • Work with local agency "Welfare to Work"; they do the screening
  • Look for job stability
  • Ask a series of questions (same questions) to all candidates to learn about individuals likes and dislikes.
  • Make applicant feel important and comfortable
  • Make eye contact with the applicant
  • Have applicant observe area where she will be working
  • Have other staff members interview applicant to get feedback
  • Screening committees
  • Two step interview process; first Human Resource Department, then Department head
  • Interview by department heads including many open-ended questions to determine suitability
  • Conduct joint interview by management team
  • Department heads screen applicants as a group for other department head positions; trying to implement this with other front line departments
  • Facility tour and introduction to staff and residents to observe comfort level and interaction
  • Make sure transportation to work is not an issue
  • Ask what kind of residents she has cared for in the past, how she responds to aggressive residents, co-worker issues
  • Questions: what do you like best about the job? What is the worst part of the job? What can I expect to hear from past employers? How did you solve problems at your past job?

Orientation Process 

Common Orientation Components

    • Review policy and procedure manuals thoroughly
    • Review safety policies and procedures
    • Review job descriptions and expectations on a weekly basis, then bi-weekly, then monthly as necessary as evidenced by satisfactory performance
    • Provide constructive feedback
    • Three hours of orientation to facility and policies and at least one week working with another employee
    • One time weekly for four hours -- Review resident rights, HIV/Aids, OSHA, needs of the elderly, paperwork, employee handbook
    • One day to review policy book, insurance, safety; at least two days on each unit that they will be working on
    • 40 hours of orientation
    • Three hours of policy and procedure history and mission of organization presented by the CEO
    • CNA Training Assistants act like a mentor for new employees
    • Review mission of organization
    • Review two weeks after person begins to determine their favorite part of job, least favorite aspect of the job

Sample Orientation Programs

    • Before employee begins, an appointment is made for her to meet with human resources for completion of new hire paperwork and review of employee handbook; she then goes with the department head for orientation and training in areas such as general safety, evacuation, fire/electrical safety security, blood-borne pathogens, MDS; there is ongoing department orientation for the first 90 days related to job duties.
    • Orientation program addresses needs of aged, organizational chart, personnel policies, appearance and grooming, first aid, fire prevention and evacuation, tornado, resident rights, ethical considerations and confidentiality universal precautions and a specific review of residents the employee will be caring for
    • Orientation day lasts eight hours and includes policies, procedures, videos, tours; there also is training with someone for 4-5 days on the specific job
    • Physical exam and then a general orientation to facility by Human Resources for the morning; lunch is provided and then the new employee receives a specific orientation to the job; she then spends three days with a peer
    • Total orientation time is five days and includes tour and introductions to all department heads plus completion of mandatory inservice requirements
    • Two hour orientation with Human Resources before reporting to the respective department for work; included here is a tour, time clock procedures, payroll paperwork, required films; one month after hire a four-hour orientation is given in order to meet all department heads and have an extensive review of the handbook
    • A welcome sign is posted and refreshments are served on arrival; we plan our day together, we review paperwork and create a schedule together; we do not use many videos. Administrator has lunch with the new employee
    • Four-hour classroom orientation session that covers personnel policies, dress code, customer service, benefits and facility tour; after one week we visit with new employee to see how things are going
    • Day one is four hours; staff development coordinator goes over all policies, tours the building; introduces to co-workers; day 2-10 -- work with another employee who holds the same position; Staff Development Coordinator observes performance and assists where needed
    • Two orientations for each employee -- facility orientation which covers basics of OSHA, resident rights, employee manual, safety, time clock, blood borne pathogens; and department orientation which covers actual training for the position. Each department has its own process for orientation which ranges from 3-14 days.
    • Part I -- 1/2 day corporate orientation covering mission, values, history, human resource policies, benefits interviewing residents and staff, experiential learning. Part II -- facility specific information such as parking, resident rights, lockers, safety. Part III -- position/department specific orientation
    • After completing general orientation, new employees are guests for lunch in the Main Dining Room and a member of the management team will dine with them
    • Try to keep new employee on same schedule with a buddy
    • Nursing department orientation on the first day -- logistics, OSHA, OBRA guidelines plus specific nursing policies and procedures; used a scavenger hunt game to acquaint staff to the facility

Hospital Based Units

    • RN/LPN orientation is a six-week minimum; assign 1-2 preceptors, give overview the first week, one day shadow, 1st week assign 1-2 residents, 2nd week assign 2-3 residents, 3rd week assign 3-4 residents and one admit and one discharge, 4th week with unit secretary, MDS coordinator, admissions coordinator as well as 3-5 residents care, nurse manager meets with new nurse weekly; CNA orientation -- meet with them initially to establish their needs, strengths and weaknesses, two weeks full-time orientation with 1-2 preceptors rotate all three shifts
    • One full day of hospital orientation is given by Human Resources department that covers hospital policies and includes all mandatory in-services. Then they orient with department for 3-5 days
    • Full day orientation includes personnel manual, guest relations, lunch with CEO, tour; then at least three days of orientation on the unit and shift
    • Hospital orientation begins during application/interviewing/recruiting/even advertising process. Orienting people to our culture requires that Human Resources provide golden rule treatment of candidates. Hospital orientation is scheduled once a month from 9-4. It may or may not be the employee's first day. It is designed to be warm, welcoming and informative; includes music, balloons, slides
    • After a general orientation, the new employee is paired with a preceptor for up to six weeks of orientation
    • First three days are with Human Resources to discuss benefits, tax forms, required in-services; the rest of the first week is spent with supervisor doing a departmental orientation; second week the new employee shadows someone with same job class and becomes aware of facility policies and procedures
    • All new hires attend a four-hour hospital orientation before beginning on the unit. Orientation on the unit is with an experienced employee, usually on at least two shifts
    • All licensed personnel have five days with clinical educator; unlicensed personnel have two days with the clinical educator. Each person then has a clinical orientation on the unit generally 10-14 days for LPN, three weeks for RN and 5-8 days for CNA
    • A needs list is given to all new associates so they can identify areas in which they need assistance; resources are then provided to help them; all new associates receive a packet of competencies which they must complete within 90 days
    • Day 1 -- orientation to department including how and where to find supplies, policies and procedures; documentation using our computer system, goals and expectations of new staff member; Day 2 -- work with assigned staff member, gradually increasing responsibility for care, no assigned patient; Day 3 -- 1-2 patients, during this time progress toward goals is reviewed.
    • Human Resources provides a two-day orientation of non-nursing issues, including blood-borne pathogens, TB, safety, resident rights

Training Period

What do you do to encourage employees to remain?Assignments

    • Assigned to another CNA for three days
    • Assign someone to work with new employee until she reaches her comfort zone
    • Department heads have employee working with them until they are sure of their position
    • Do not reassign to different units within the first six months, if possible
    • Employees are assigned a trainer for 3-5 day training period
    • Have 3-5 orientation days on the same unit, so new employees can get into a routine
    • Send employee to another unit to broaden her knowledge base
    • Assign a preceptor
    • Buddy system -- one good experienced person to work with new person
    • Provide resources such as reading material, videos
    • Gradual case load for nurse aides; place on unit which best suits their level of competency


    • Informal three and nine month evaluation by supervisor; keep in touch on a regular basis
    • IWelcome forms distributed to all departments heads introducing new employees so they can welcome them also
    • IGive new employee a notebook to carry around so they can jot down questions or concerns
    • IFollow-up with department director at least once a week for the first month
    • IHave been discussing a 21, 30 or 90 days touch-base orientation group
    • IKeep detailed achievement list
    • IOne-to-one sessions with supervisor
    • ITwo week evaluation; 90 day evaluation with pay increase; insurance after two months
    • IMission follow-up; are we doing what we say in our mission?
    • IPost welcome signs with a little bio about new employees
    • IReinforce the orientation by asking questions and encouraging employees
    • IHR director checks in with employee during first week
    • IProvide a lot of contact with their immediate supervisor and department director; remind current staff to be supportive and friendly
    • IAsk their opinions as to how unit functions; make effort daily to greet employees and ask if they have questions or concerns
    • IThank employee for going a good job
    • IPost new employees' picture in the break room, welcoming them to the facility
    • IFollow-up with new employees, listen to concerns
    • IFriendly, patience, praise new employees' work, use diplomacy when correcting errors
    • IPeriodically review training to date and praise employees' progress
    • IExecutive Director meets with new employees to see how they are adjusting
    • IStaff development director follow-up with new employee


    • IHave new employees pitch in during lunch
    • IFree meal ticket for three days of training
    • IProvide a five-day meal ticket to welcome them to the facility
    • ILunch/break with co-worker
    • IProvide a free meal ticket during the first week of employment
    • IEmployees are assigned to a trainer for 3-5 days, employees and trainer receive free meal ticket during training


    • IAward company logo polo shirts at the end of the 90-day training period
    • IProvide information about committees that they can participate in that include family members, staff and residents -- for example, social committee, quality of life committee

Mentoring Programs

    • For new nurses, a 12-week program with one main mentor who is designated as a resource buddy for the first year of employment. Perks such as stethoscope, drug book; bonus for three years of maintaining same FTE status and additional bonus for five years
    • Develop a CNA trainer program -- long time CNAs are asked to work as mentors to new CNA students. Hopefully, the long term commitment will rub off.
    • Implement a "senior aide" program
    • Assign new employees to work with a well-seasoned employee. New employees must complete a skills check sheet as duties are preformed. Preceptor also initials this check sheet.
    • Each new employee is assigned a mentor/preceptor for the orientation period (3-5 days) and follow-up into the first three months or employment. No more than three employees are assigned to one preceptor. Preceptors must meet certain qualifications
    • Experienced CNAs work with new employees for a two week period; selected CNAs are paid an additional $.50 per hour. There are certain requirements to become a preceptor, not just longevity

Recognition of Employees

Food Events

    • Monthly employee appreciation receptions -- 45 minute staff party; grab bag, entertainment, songs, awards
    • Banana split days
    • Bring in food -- pizza, sandwiches, etc.
    • Each month have an employee appreciation day -- ice cream social, caramel apples, donuts
    • Recognition dinner; annual banquet, entertainment, prizes and gift for each employee Staff that work extra hours get free meals, DQ treats or coupons
    • Recognition party each quarter for employees
    • Special meal after completion of good survey
    • Catered all-employee dinner

Award Programs

    • 90-day pins, employee of the month
    • Pins for certain years

Attendance Recognition

    • Perfect attendance sheet
    • Perfect attendance receives day off with pay; employee of the month receives $50 gift certificate, plaque and parking spot; employee of the year gets $150 gift certificate
    • Attendance gift certificate
    • Bonus days for perfect attendance
    • Perfect attendance for two consecutive months receives $25 cash or $25 savings bond

Established Recognition Programs

    • Would like to start a staff recognition box and have family, staff, residents input information about good employees
    • "Good Samaritan" program
    • "Pat on the Back" program for special efforts
    • If your team does not have any accidents for a three-month period, each team member gets a $25 bonus
    • "Service Star" program -- resident, co-worker, family, can write a letter (star); when you receive so many stars the employee earns a paid day off
    • Employee of the month -- certificate, picture in newsletter, savings bond, eligible for employee of the year; employee of the year -- plaque, pin, reserved parking fore a year, cash, trip
    • Applause sheets -- fellow co-workers and residents voluntarily fill out sheets to recognize other employees; the information is then published in facility newsletter and posted
    • Weekly "Caught Caring Award"
    • "Ambassador Program" -- nominated by peers, residents, families if they go above and beyond job duties; if selected, we have a breakfast in their honor, picture and name on display in local newspaper, plaque and jacket
    • "Angel Program" -- angel cards submitted for above and beyond; each employee who receives a card also receives an angel button; angel of the month gets angel pin, picture taken. Angel of the Year receives a rhinestone pin and a gift certificate
    • "Associate of the Month" receives a gold star on badge
    • "Catch in the Act" Program -- manager gives a certificate and candy bar
    • Birthday Gifts -- For employees with at least one year of service, they can pick a gift with a $25 value from a catalog; those with less than one year receive an umbrella or water bottle

Printed Forms of Recognition

    • Bi-weekly newsletter features "Roses to"; Attitude slips that go to HR file
    • Frequent thank you notes to the department
    • Publish thank you notes from families
    • Care grams or cards
    • Thank you board -- employees are recognized by other employees for small and large efforts
    • All family and resident thank you letters are posted
    • Appreciation certificates
    • Use talent cards, bravo pads that display an "I Can" attitude
    • Letters of appreciation when we see acts of kindness
    • Anniversary cards every year on anniversary of employment

Other Forms of Recognition

    • Tokens given that can be used for purchases at our general store
    • Birthday cards
    • Verbal recognition
    • Promote from within for example restorative care, unit carrier CNA
    • Be flexible (schedule) when they have special needs
    • In July, hold a free car wash where department managers and supervisors wash employees' cards
    • Send to state association conventions and educational training seminars
    • After 20 years of service, receive a savings bond
    • Ongoing appreciation on a daily basis by Executive Director and department heads
    • Recognize privately and publicly
    • Flexible scheduling
    • Preferred parking space for employee of the month
    • Special dress down days with refreshments; turkeys and hams given on Thanksgiving to every employee
    • Involve in problem solving process of department
    • Offer training and staff development opportunities
    • Monthly service excellent award recipient

Incentive Programs

Describe the Incentive Programs that Encourage and Reward EmployeesOther than Monetary Incentives

    • Free immunizations and screenings, sick child care at discount price
    • Flexible scheduling
    • Tuition assistance
    • Staff chooses uniforms
    • Staff and family picnics, pot lucks and back sales
    • Fridays are dress down days
    • Education seminars outside the facility
    • Project Pride -- staff turns in ideas that cost $250 or less; if the project is selected, the staff member helps plan the project and purchase any materials; winner receives a prize
    • Publish thank you notes from residents and families
    • Free meal ticket for working extra shift
    • "Catch'm in the Act" Program -- when an employee goes above and beyond regular duties, any manager can give a certificate to the employee which can be redeemed for candy, soda or other treats
    • Paid days off to use for vacation if they are not used for sick days
    • Bonus days for attendance and for recruiting new employees
    • Holiday and sick pay accrual after 30 days
    • Individual's birthday is considered a holiday
    • All nursing personnel may attend workshop of their choice yearly; hospital has goal sharing program -- for an 18-month period the following has to be met:
        • Hospital financial goals
        • Unit goals as directed by administration
      • Personal individual goals, i.e., current CPR
      After 18 months if goals are met, each individual receives a check for 1-3% of annual salary
      based on goal accomplishments
    • Encourager Group -- Anyone can belong and we charge $1.00 per month. If someone is ill or has a hardship, we give cards, money. Once a month we have an "encouraging event" pitch in etc.
    • Flowers sent by facility to sick employees or if there is a death in the family
    • Safety-fund money is paid out for no work injuries

Paid Incentives

      • Six months perfect attendance receives $100
      • Perfect attendance for two months, the employee receives $25 cash or $25 savings bond
      • Perfect attendance savings bond
      • Upon successful completion of six months employees receive a 2% increase in pay
      • 90 day review with merit increase
      • Nursing assistants receive $.60 increase once they pass the state test; other departments receive 10-20 cent raise after six months of service
      • Retention bonus of $200
      • Nurse attendance get 4.5% increase after completing training program and state exam
      • $.25 increase for non-nursing staff after 60 days
      • Monetary bonus given to employees that work 510 hours; then 1020 hours, then 1530 hours
      • 90 days and annual increase based on performance
      • Referral bonus -- if new employee stays 120 days, current employee receives $250
      • Begin earning time off benefits immediately, but they are not paid until employed for at least 90 days