The high turnover rate among nurses in long-term care facilities significantly challenges healthcare quality and access. This issue has been exacerbated by the COVID-19 pandemic, making it essential to address the problem of nurse retention in these settings. This course will explore the critical issue of nurse turnover in long-term care and present a proposed community integration model based on a comprehensive literature review and field study. This model outlines a pathway to cultivate a sense of belonging, improve staff retention, and ultimately enhance the quality of care in long-term care facilities. The seminar provides a comprehensive approach and strategies to reduce nurse turnover and foster a stronger workplace community using various supports, including comprehensive onboarding and orientation, mentoring, and peer support.

1. Introduction

• Overview of the high nurse turnover rates in long-term care facilities
  • High nursing staff turnover in nursing homes is associated with higher mortality.
  • Increased number of deficiency citations.
  • Increased likelihood of infection control citation.
  • CNA turnover is associated with higher odds of pressure ulcers, pain, and urinary tract infections in nursing homes.
  • nurse turnover in NHs relates to the use of antipsychotic medications.
  • NH's licensed nurse retention rate is significantly associated with the 30-day rehospitalization rate (est. = -.02, p = .04)
  • High nurse turnover in NHs leads to substantial costs, such as recruitment and training for new nursing staff.
• Exploration of contributing factors to nurse turnover
  • Affective Sentiments
  • Individual factors
  • Organizational factors
• Importance of community integration in the workplace
  • To foster a sense of belonging
  • Enhance organizational citizenship.
  • To foster the development of job satisfaction
  • To improve nurse retention

1. Theoretical Framework- Community Integration Model

• Definition of Community Integration in the workplace
  • Involves vulnerable populations.
  • Movement or transitioning due to illness, situation, migration, or as part of a rehabilitation or recovery process.
  • Dynamic, continuous, and reciprocal process of integration that occurs over time.
  • Influenced by a number of factors- supports, individual perceptions, participation in and with community.
  • Associated with productivity, independence, job satisfaction, recovery, health, role mastery, well-being, and empowerment.
  • Ultimately developing an affective sentiment of oneness with self and community.
• Introduction to the model and its components
  • Transition Phase
    • Fear
    • Anxiety
    • Anticipation
    • Excitement
    • Vulnerability
    •  “Transition shock”
  • Adjustment Phase (0-3months)
    • Orienting to the new environment
    • Building trust
    • Becoming self-aware
    • “Transition shock”
    • Forming perceptions
    • Beginning new relationships
  • Adjustment supports.
    • Welcoming and inclusive Environment
    • Effective onboarding and comprehensive Orientation
    • Mentorship and Preceptorship
    • Effective communication
    • Team collaboration and camaraderie
    • Emotionally intelligent leadership (Compassion and empathy)
    • Supportive Supervision
    • Opportunities for emotional support for stressful situations
    • Adequate resources
    • Fair financial remuneration
  • Social Integration Phase (3-6months)
    • Strengthening relationships
    • Increasing participation in the workplace
    • Improved job competence
    • Increasing productivity
  • Social Integration supports.
    • Maintain an Inclusive and safe work environment.
    • Shared governance- e.g. Participation in QAPI
    • Social events (e.g., staff retreat with stress-relieving activities, etc.)
    • Effective leadership
    • Effective Communication
    • Support for Work-Life Balance
    • Recognition and Feedback
    • Maintain efficient systems
    • Maintain adequate resources
    • Cultural competence and diversity training
    • Workload management
    • Staff development (Continuous education and competencies)

• • Community Integration Phase (6-12 months)
    • Independence
    • Role mastery
    • Increased productivity

• • Community integration supports.
    • Career development
    • Recognition and appreciation
    • Celebration of Milestones
    • Continuing education and competency training
    • Foster professional autonomy
    • Maintain a flexible work schedule.
    • Employee perceptions
    • Healthy work environment
    • Access to employee assistance programs
    • Continuing education
    • Review Compensation

• • Barriers to Integration
    • Lack of supports and resources.
    • Poor leadership
    • Workload
    • Financial barriers (Low wages)
    • Environmental barriers (organizational barriers)
    • Marginalization
    • Bullying
    • Incivility
    • Racism

• • A Practical Application of CI Model to a structured orientation program for Long-term care nurses
    •  General onboarding
    • Didactic (7-days)
    • Clinical emersion (5-days)- Patient and Task Layered Approach
      • Day 1 – Preceptor led
      •  10 residents- Assessment and documentation – level 1
      • Day 2- Preceptor led
      • 10 residents – Level 1 task + medication and treatment administration- level 2
      • Day 3- Preceptor led
      • 15 residents- level 1 and 2 tasks + communication and family engagement- level 3
      • Day 4- Preceptor assist
      • 20 residents- level 1,2,3 tasks + safety & quality – level 4
      • Day 5 – new hire led/preceptor assist
      • Full load assignment- level 1,2,3,4 tasks + continuum of care (acute transfer, discharges, admissions)
    • Trained preceptorship
      • Recruit preceptors (offer an incentive to precept)*
      • Role training and expectation
      • Communication and feedback
      • Methods of evaluation (Use of standard evaluation tool)
      • Documentation
      • Provide supportive supervision.
    • Continual Mentorship
      • Weekly one-on-one check-in sessions
      • Weekly goal setting and review
      • Self-care
      • Relationship building
      • Supportive leadership
    • Continual education (Monthly)
      • Include team-building activities.
      • Opportunities for socialization
    • Monthly staff meeting
      • Foster relationship building (Social Integration)
      • Self-care activities
      • Interactive discussions
      • Problem-solving (Team approach)
    •  Maintain a healthy work environment.
      • Continual education
      • (Team building- creating opportunities for engagement and socialization)
      • Cultural/ diversity training
      • Workload management
      • Time management training
      • Effective communication
      • Managing workplace incivility, bullying, and violence
      • Enhance general regulatory compliance.
      • Shared governance
      • Flexible work schedule
      • Communication/suggestion box
    • End of program evaluation
      • Weekly preceptor evaluation
      • Skills competency checklist
      • Comprehensive medication test
      • 3-months new hire survey
      • 3-month end of probation evaluation and feedback
      • 6- months’ recognition and celebration of milestone
      • 12-months employee survey (job satisfaction/retention focus)
      • Annual evaluation and survey