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How to create an environment which reduces turnover – Dr. El
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How to create an environment which reduces turnover – Dr. El

How to create an environment that reduces turnover - The World According to Dr. El
Dr. El

As I mentioned in my last column staff turnover can be reduced by improving the facility’s emotional tenor. Ill provide additional suggestions to help you achieve that goal.

Most companies have a psychologist who is able to lead or contribute to the following recommendations. Psychologists can do much more than provide direct services to residents. 

Psychologists are unique because of their deep understanding of research and extensive training in individual behavior and group behavior. They also spend most of their time on the units talking to residents, staff, and their families. 

They can see patterns in the units and observe interactions that are often hidden from leaders. Their expertise can improve the environment and function of the nursing home.

Support for staff

Even in situations where there is sufficient staff and reasonable wages, the nursing home can be a stressful place. As you can see in this STAT first opinion piece We all need support in dealing with grief and hardshipStaff members may be trying to help others while dealing with their own losses. COVID-19’s impact on long term care facilities means that almost every worker has to deal with grief and the myriad of triggers that come with it.

The authors recommend enhancing policies to provide support systems and anticipatory guidance. These system-wide strategies would benefit from psychological knowledge. Other options for helping workers deal with common stressors like team conflicts, difficult residents, and family problems are employee assistance programs, support group hours, and psychologist open offices.

There are many ways to reduce stress on the job, in addition to emotional support.

Education and restructuring

As I explained in Post-pandemic populations may require higher staffing, the number of residents in nursing homes has changed. The decrease in elective surgery and the increased avoidance of nursing home rehabilitations means that the remaining residents will be more demanding because they are unable to manage at home due to their medical acuity, behavior, and/or lack of support family. Residents with severe mental illness or other medical conditions are more common.

Staff members must manage multiple and urgent needs simultaneously, such as a resident with dementia who is about to get up from his wheelchair, a recent admission with alarming vital sign and a young woman suffering from bipolar disorder, who demands immediate attention.

The psychologist can offer expertise in behavior management, critical thinking skills and mental illness understanding as part of ongoing staff training. 


Staff conflict is another common problem in nursing homes. Psychological training can not only be used in the prevention and mitigation of disagreements but can also be used as a tool to identify and fix problems and systems. 

In the case of the diverse resident needs described above, it might be possible to train staff members to better triage care. Instead, you could create floors or neighborhoods that are geared towards specific types of residents. 

Psychological expertise can help in team building, facility-wide transitions and training teams to deal with specific populations. If a nursing home has residents with severe mental illnesses, mental health professionals should be used to educate staff.


Psychologists could lead educational and support groups for families, take part in discussions about end-of-life planning, and work with disgruntled relatives, which would reduce the time required by other professionals and probably reduce litigation costs.


Psychologists can help to review and adjust the onboarding process as well as the support provided to new workers in order to increase the likelihood of newbies becoming old-timers (directly reducing turnover).


The greatest obstacle to harnessing the expertise of psychological experts outside of direct resident care is the lack of a payor source. I hope that grants and studies to provide these services will show cost mitigation, leading more organizations or CMS to consider expanding the scope of paid services for psychologists. 

The pandemic revealed the fragility of our long-term health care system and the need for mental health services. The former must be fixed by better utilization of both the former and the former.

Eleanor Feldman Barbera (Ph.D.), author of The Savvy Resident’s GuideThe following is an example of a? Winner of the Award for Excellence In the Blog Content category of APEX Awards for Publishing Excellence. She is also a Bronze Medalist for Best Blog in The American Society of Business Publication EditorsNational competition andYou can find more information at Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. Visit her to contact her about speaking engagements. at

These opinions are the author’s. McKnights Long-Term Health Care NewsGuest submissions are the authors, and not necessarily the authors. McKnights Long-Term Health Care News oder its editors.

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