MMHA 6501 Week 6 Staff Retention Analysis Example

Why New CNAs Leave Maple Terrace in Their First Months: A Retention Analysis Using Herzberg's Two Factors

Student Name

Walden University

MMHA 6501: Leadership Within the Healthcare Sector

Instructor Name

Month Day, Year

Why New CNAs Leave Maple Terrace in Their First Months: A Retention Analysis Using Herzberg's Two Factors

The Problem in Operating Terms

Certified nursing assistants are leaving Maple Terrace, the fictional skilled nursing facility used throughout this course, faster than they can be replaced, and the departures cluster early. In the last twelve months, the facility hired an illustrative 34 CNAs and lost 29, and 18 of those who left had worked there less than six months. Each early departure means another round of recruiting, orientation and agency coverage, and residents who meet a new caregiver every few weeks. Nursing home staff turnover is associated with lower quality of care (Castle & Engberg, 2005), and high turnover among nursing staff has been shown to carry information about facility quality (Gandhi et al., 2021). The question for leadership is not only how to hire faster but why new CNAs leave.

Reasons for Leaving

The director of nursing and the human resources coordinator held exit conversations with most departing CNAs over the past six months. The themes, summarized here from those composite conversations, fall into three groups.

Unpredictable schedules. New CNAs reported receiving schedules one week ahead and being asked frequently to change shifts, which made child care and second jobs hard to arrange. Several said they took jobs at facilities that posted schedules a month in advance.

Assignments that fall hardest on new hires. On both units, the charge nurse assigns halls, and new CNAs consistently receive the heaviest halls, those with the most residents needing two-person transfers. Veteran CNAs described this as a rite of passage; new CNAs described it as being set up to fail.

Not knowing why care changes. New CNAs said that residents' care plans changed without explanation, such as a new transfer method or a diet change, and that they learned of changes when a nurse corrected them. They felt excluded from decisions about residents they cared for every day.

Pay was mentioned in several conversations but was rarely the first reason given. Compensation is addressed in a separate analysis.

Two cautions apply to these themes. Exit conversations capture what departing employees are willing to say to managers, which may understate complaints about specific supervisors. And CNAs who left without notice, roughly a third of early departures, gave no reasons at all. The themes are therefore a starting point, not a complete account. To check them, the director of nursing will also ask current CNAs hired in the last year, in small group conversations without managers present, whether the same issues affect them and what nearly made them leave. If those conversations surface reasons not listed here, the decisions below will be revised.

Sorting the Reasons With Herzberg

Herzberg et al. (1959) distinguished two kinds of factors at work. Hygiene factors, such as working conditions, policies and supervision, cause dissatisfaction when they are poor but do not create commitment when they are good. Motivators, such as recognition, responsibility and the work itself, build commitment when present. The distinction matters because fixing hygiene factors stops people from leaving out of frustration, while motivators give them a reason to stay.

Unpredictable schedules are a hygiene factor: no CNA is motivated by a schedule posted four weeks ahead, but many will leave because of one posted a week ahead. The assignment practice is also mainly a hygiene issue, a matter of fairness in working conditions, though it shades into recognition, since being given the hardest hall signals low status. Exclusion from care-plan changes is a motivator issue: being informed and consulted about residents is a form of responsibility and recognition, and its absence tells new CNAs their knowledge does not count. Maple Terrace's early departures, in other words, combine dissatisfiers that push people out with missing motivators that might otherwise hold them.

Three Leadership Decisions

Post schedules four weeks ahead. The staffing coordinator will publish schedules four weeks in advance, with changes after posting limited to voluntary swaps and true emergencies. Owner: director of nursing. This addresses the most frequently cited dissatisfier and costs little beyond planning effort.

Assign a peer mentor to each new hire. For their first eight weeks, new CNAs will work alongside a designated veteran CNA on the same hall, and the charge nurse will not assign them a hall alone until the mentor and unit manager agree they are ready. Mentors will be volunteers recognized for the role. Owner: unit managers. This changes the assignment practice, replacing a test with support, and gives veteran CNAs a form of recognition.

Each of these decisions also has a cost to someone. Posting schedules further ahead reduces the staffing coordinator's flexibility to fill gaps late, and the facility may need slightly more agency coverage at first. Mentoring takes veteran CNAs' time and could slow their own work. Set against another year of 18 early departures, each needing recruitment, orientation and agency cover, these costs are modest.

Hold a monthly care-plan huddle that includes CNAs. On each unit, the nurse manager will hold a 20-minute huddle each month in which care-plan changes for the coming weeks are explained and CNAs are asked what they have observed. Owner: unit managers. This addresses the missing motivator by making CNAs participants in care decisions.

What This Analysis Does Not Cover

Compensation is excluded deliberately. Pay matters, and Maple Terrace's wage rates should be compared with those of nearby facilities and other employers competing for the same workers. But that comparison involves budget decisions beyond the director of nursing's authority and would take months. The three decisions above can begin next month and address the reasons departing CNAs gave first. Herzberg's framework also suggests that pay, a hygiene factor, could reduce dissatisfaction without building commitment; a raise without changes in schedules, assignments and inclusion might slow departures but would not by itself make Maple Terrace a place new CNAs want to stay.

How Progress Will Be Judged

Progress will be judged by the share of CNAs hired in each quarter who are still employed six months later, reported quarterly by human resources. The director of nursing will also repeat the exit conversations and compare their themes with those above. If schedules and mentoring improve but early departures continue, leadership should turn next to supervision on each unit, since unit-level turnover in health care settings is associated with worse outcomes and often reflects local leadership (Bae et al., 2010).

References

Bae, S.-H., Mark, B., & Fried, B. (2010). Impact of nursing unit turnover on patient outcomes in hospitals. Journal of Nursing Scholarship, 42(1), 40-49. https://doi.org/10.1111/j.1547-5069.2009.01319.x

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

Gandhi, A., Yu, H., & Grabowski, D. C. (2021). High nursing staff turnover in nursing homes offers important quality information. Health Affairs, 40(3), 384-391. https://doi.org/10.1377/hlthaff.2020.00957

Herzberg, F., Mausner, B., & Snyderman, B. B. (1959). The motivation to work. Wiley.