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Thursday, June 13, 2024

Hiring to Retention: A Model of Community Integration



Hiring to Retention: A Model of Community Integration


Sylvia K. Abbeyquaye, Ph.D. MPA RN

Behavioral Objectives:

Upon completion of this program participants will be able to:

  • Understand the scope and severity of the nurse turnover problem in long-term care facilities and its impact on healthcare quality and access.
  • Explain factors contributing to nurse turnover in long-term care facilities.
  • Explore the proposed community integration model as a facilitator of nurse retention.
  • Discuss practical strategies for implementing elements of the community integration model in long-term care facilities.


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

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