In a tight labor market, nurses are looking for transparent leadership and strong performance on quality when choosing an employer.

Hospices that see success in the “ebb and flow” of recruitment and retention are often those that seek to gain insight into the priorities of the current and future workforce, according to Sarah DeFalco, chief human resources officer at the New Hampshire-based home health and hospice provider Granite VNA.

An open line of communication between staff and executive leaders is among the most successful strategies, DeFalco stated.

“There isn’t a specific list of priorities. What’s more important than focusing on XYZ is continuing to have the finger on the pulse of the work nurses do,” DeFalco told Hospice News. “How can your leaders best support you? Most importantly, hearing the ‘why’ behind what gets them to the bedside everyday, because that intrinsic motivation is such a critical part of this incredibly meaningful work.”

Leveraging quality

Staffing challenges have been top of mind among operators for several years running.

The nation’s pool of hospice nurses has grown shallow, a trend that was exacerbated by the pandemic. This has also contributed to intensified competition in the labor market, as well as higher rates of both retirements and clinician burnout in recent years.

This came in tandem with rising wages, inflation and other economic factors. In some cases, these pressures and labor challenges have pushed hospices to temporarily or permanently shutter their programs. 

Providing quality care is a large part of why hospice nurses enter and remain in the workforce, making clinical outcomes an organization’s best asset, DeFalco stated.

“We are all fighting for talent, that is the reality of the landscape,” DeFalco said. “The drive in clinical excellence and opportunities for future growth really are important, because hospice clinicians want to deliver the best care that they can. Clinical excellence is a large part of their existence.”

The ability to improve care for terminally ill patients can be both a rewarding and challenging career, DeFalco added. Hospices that keep this notion in mind and provide support and resources to clinicians can see higher levels of retention compared to others, she explained.

Recent research backs this theory. Having career growth and doing impactful work were among the most significant priorities reported by the next generation of clinicians in a recent study published in the Journal of the American Medical Association (JAMA) Network.

Workforce priorities are evolving alongside generational shifts in clinical teams, particularly management and supervisor roles, said Alivia Care CEO and President Susan Ponder-Stansel. The Florida-based nonprofit provides hospice, palliative and supportive care.

Clinical leaders are retiring at higher rates without a sufficient supply of new nursing graduates to keep pace, Ponder-Stansel said. Executives need a clear window around retention and an evolving recruitment strategy that understands multi-generational workforce priorities, she stated at the National Association for Home Care & Hospice’s (NAHC) Financial Management Conference in Las Vegas.

“I see a generational change coming with people recognizing we need to take a patient-centered approach to hiring,” Ponder-Stansel told Hospice News at the conference. “Hospices of the future need leaders that recognize you have to deliver a good product in the manner that the patient wants and needs. We laid a good foundation and I look forward to what the new generations will bring.”

Transparency is a retention priority

Executives need a double-pronged retention strategy that focuses on quality improvement and transparent communication, according to DeFalco. Staffing engagement is a large part of sustainable clinical retention, she stated.

Hospice nurses face myriad challenges at the bedside and need an organizational culture that supports open communication, she added. This involves having feedback channels that go beyond their clinical management to executives and decision makers, DeFalco explained.

“Focus on clinical excellence and the opportunity to have transparent and collaborative discussions about the needs of our workforces is where the learning is at,” she told Hospice News. “That’s where we understand where the educational opportunities are, whether we need additional tools and resources to support the work in a different way. That relationship, that transparency and commitment to collaboration and insight is absolutely critical.”

Program integrity issues in the hospice industry have made apparent the tie between transparent leadership styles and clinical outcomes, according to Kristen Yntema, president and CEO of AuthoraCare Collective. The North Carolina-based nonprofit provides hospice and palliative care, among other services.

The small portion of negligent and poor quality providers in the hospice space have heightened misunderstandings and fears about these services, Yntema said. The current negative light shining on hospice may be giving new nurses pause about entering the field, she added.

“This minority of bad apples in the space is being highlighted when most are providing value-based hospice services,” Yntema told Hospice News at the conference. “It’s [about] accountability and quality. Hospices have historically run a very high excellence of care. We have clear standards that we need to abide by and communicate with staff.”