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Retention: “If she would only just listen…”

Retention: “If she would only just listen…” May 15, 2022

Marketing, research and business development consultant in healthcare, human services and senior living.


“Listen…” In our language and in our society this phrase, often as an injunction, is extraordinarily powerful.

We say this to young children or adolescents to emphasize an important point. We also often say this when talking to a friend who has sought out our advice on a sensitive matter. As important as the injunction, “Listen” is, it’s amazing how, upon introspection, we realize that we don’t. This is certainly the case in long-term care and the front-line workforce.

The quote,

“If she would only just listen…”

is taken from a long term care employee survey, referring in this case to the nursing home administrator.

pointing fingers - blameWith 60 – 75% of every operation’s budget devoted to labor, workforce is critical. You can’t provide care without staff; they are your “means of production.” Without the correctly credentialed staff, deployed on the right days and shifts, your operation is at risk of punitive action by state and Federal oversight agencies. And according to the White House Fact Sheet , and President Biden’s State of the Union Address show that more punitive actions are looming.  The current staffing shortages have many contributing factors and a few root causes. Staff resources are declining and because there’s competition for employees in most marketplaces, job candidates can be more discriminating.

What did you say?

In a resource crisis, like a drought, the first step is to conserve and protect the existing supply of the precious resource. Whatever you have, you want to hold onto it. The same is true regarding the current staffing crisis. So many LTC managers rush to fill vacant positions (to be covered in the next article) without first understanding why the remaining staff stay.

What is desperately needed in the sector is scrupulous monitoring of current employees’ perceptions of, and attitudes toward other staff, their supervisors and working at your operation. This can be done at a systems and an interpersonal levels. The sector leadership needs to borrow heavily from other service-based industries. Performance appraisals, surveys, training supervisors in active listening, conflict management training, informal interviews, formal interviews, group discussions, focus groups and exit interviews; the list is almost endless. All of these listening techniques provide important information and data for keeping the employees you want and interesting others in working for you.

Ask them… then listen

One of the most widely used, and comprehensively misused methodologies for collecting mission-critical employee feedback is the “performance appraisal system.” The performance appraisal (PA) is too often a perfunctory, tense, yearly interview between supervisor and subordinate, which is more dreaded than appreciated.[i] One definition of the process:

…the performance review process includes setting clear and specific performance expectations for each employee and providing periodic informal and/or formal feedback about employee performance relative to those stated goals. Recent trends, however, include a less formalized process focusing on more feedback and coaching, rather than a time-consuming paper trail. [ii]

The typical arrangement, often associated with a possible pay rate increase, is a 20 to 30-minute scheduled meeting between a supervisor and his / her direct report. In this short meeting, the supervisor runs through the required and predetermined checklist, rates the performance of the CNA on a  scale from 1 – 3 or 1- 5, asking intermittently, “Do you agree?”

This arrangement does not help the supervisor, or the subordinate. In a setting like a nursing home, these individuals probably spend to 15 – 25 hours per week interacting with each other, giving and receiving instructions and sharing key clinical information, with many opportunities to provide feedback and to listen. Moreover, because the most performance appraisal interviews are often conducted so infrequently, misunderstandings or resentments have a way of building up and getting distorted out of proportion.

Over the past two years, using the pandemic-related staffing shortages as a rationale, many supervisors and subordinates have postponed or glossed over the performance appraisal process. It may be that both are relieved by avoiding what is very often seen as a judgmental, conflict-laden requirement.[iii] In one system studied before the pandemic, 51% of CNA, MedTech and Dietary Department resignations occurred within 30 days of a scheduled PA interview.

What’s a better way?

  • First, you may want to start over!  Creating a better system offers you, your supervisors and your employees the opportunity to participate in drafting a better method for legitimate, two-way communications. And it has the potential to interrupt a pattern within your operation that may be causing premature staff departures.
  • Conduct a review of what you’ve done up till now; can you streamline and increase the frequency?
  • Train for success. Every supervisor, every manager should learn how to conduct frequent, opportunistic observations of, and interactions with their teams and their peers. This training includes tact & language, active listening skills, use of concrete examples, body language & eye contact, and cultural sensitivity. Recording the observations and comments should be easy.
  • Is your human resources information (HRIS) system up to the task?
  • Coach supervisors and staff that the methods are not to find fault or to judge, but to improve team collaboration and patient care.
  • At least 4 times per year, the staff rate themselves and supervisors rate their direct reports on standard job-related dimensions such as skills, collaboration, adherence with policies & procedures and interpersonal skills. This is followed by a conversation with supervisor(s) who share the ratings on the same scales.
  • Anticipate conflict and train for it. Conflict management training is crucial to success.


Remember the adage, “What gets measured gets done”?  Within your operation, could appraisal interactions happen regularly, even daily? An “appraisal” could be as simple as a supervisor asking how a procedure could be done more efficiently, (appreciatively) listening to the response and then making observations about the staff person’s knowledge and engagement.


Who stays, and why?

It is natural, when vacancies occur as they have recently, to turn our attention to recruitment. Perhaps more important, is to first figure out how to keep the staff you already have. Another valuable system tool, which has historically been glossed over by long-term care providers, are employee surveys.

Asking employees to answer simple, direct questions using a standardized measurement method is extremely important and too often neglected. Details about frequency and the types of surveys are less important than actually conducting the surveys (confidential and, if possible, anonymous) and then talking among staff about the results.

If you conduct the surveys, collect the responses, convert the information to some tables that are distributed and reviewed by management, does this communicate to your employees that you’re listening? Be sure to reinforce participation by sharing the results of the surveys with your team, several different ways over time and this includes both good and less-than-flattering results.

Good surveys ask about employees’ willingness to refer other, prospective employees to work with your operation.  For example:

If someone working for you isn’t willing to encourage others to do the same… Are you listening?

And another good survey question relates to how willing respondents are to leave or to stay. For example:

On the Way Out the Door: Exit interviews

Another systems-based procedure which can be invaluable in “listening” to staff are exit interviews. These are generally brief in-person interview scripts that ask a few important questions. The reasons for the person’s departure may be very well understood and may be unavoidable (relocation, retirement or career change, for example). What’s most important is the departing employee’s attitude toward employment at your operation. Is the departing person willing to refer potential employees to your organization?

Regardless of whether or not the person will be in a position to do so, the question should be asked, with a brief follow-up such as, “Why do you say that?” Exit interviews are extraordinarily valuable to highlight the management and interpersonal skills of certain supervisors, to identify systems that need to be corrected or to reward and reinforce other behaviors.

Exit interviews are often avoided because of hesitancy toward confronting difficult conversations. In this case, refer back to the urgency of Conflict Management training!

These are general outlines about systems; more details and examples are available on line (see the Society of Human Resources Management[iiii] (SHRM) and the Resources tab at

Don’t you ever just want to… talk?

At a more person-to-person level, there are many steps that some providers are taking to improve the relationships between and among staff in long-term care operations. In the past, turnover of the frontline workforce in long-term care has in 50 to 90% or more, making it difficult for leadership to keep track. If the faces are continually changing, how can you remember which one has the aunt recovering from cancer in the Caribbean, or the one whose sister just had twins?

As you pass her in the hall, you can’t remember, so you don’t say anything, and you have lost the opportunity to listen. Many employers have adopted small group interview sessions for leadership, supervisors and staff. With different names like town-hall meetings and chat sessions, these are opportunities to recover from errors and to empathetically listen to staff and to observe interactions.

Surveys, active listening, informal interviews, formal interviews, group discussions, etc. – even focus groups. All of these systems-based listening techniques provide important information and data for keeping the employees you want and attracting others to work for you.  Interpersonal skills training, such as conflict management, active listening and body language training are essential ingredients to shifting the balance of relationships between and among staff, supervisors and management.


Irving Stackpole is President of Stackpole & Associates, a marketing, market research and training firm at He can be reached for direct consultations at: or at +1-617-719-9530.


[i] DeNisi, A. S., & Murphy, K. R. (2017). Performance appraisal and performance management: 100 years of progress? Journal of Applied Psychology, 102(3), 421–433.

[ii] Society of Human Resource Management (SHRM). See:

[iii] Yager, E. (1981). A critique of performance appraisal systems. Personnel Journal, 60(2), 129–133.

[iiii] Ibid. SHRM

Marketing, research and business development consultant in healthcare, human services and senior living.

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